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You’ve found a telehealth service, you’re ready to book, and then that familiar hesitation kicks in right before you enter your card details: is this actually going to be covered, or am I about to find out the hard way that Medicare doesn’t work the way I assumed? It’s a fair question, and an oddly hard one to get a straight answer to, because the honest answer involves a few moving parts rather than a single yes or no. Whether an online doctor is covered by Medicare in Australia depends on things like which doctor you’re seeing, what kind of consultation it is, and whether you’ve built up what Medicare now calls an “eligible telehealth” relationship with that practice. None of that is obvious from the outside, so let’s actually walk through it properly.
Are Online Doctors Covered by Medicare in Australia?
Sometimes, and the honest answer really does hinge on the specifics rather than a blanket rule either way. Medicare rebate telehealth in Australia arrangements exist and are genuinely used every day, but eligibility depends on your relationship with the practice, the type of consultation, and occasionally your personal circumstances. It’s less a locked gate and more a set of conditions worth understanding before you assume either outcome.
The Medicare “12-Month Rule” Telehealth Explained
This is the rule that trips up more people than almost anything else in telehealth billing. Historically known as the “established clinical relationship” requirement and was renamed the “eligible telehealth practitioner” requirement from 1 November 2025. It is intended to support ongoing care, but the precise eligibility rules depend on the relevant Medicare Benefits Schedule (MBS) item and the patient’s circumstances.
For many GP telehealth services, the practitioner or practice must generally meet Medicare’s eligible telehealth practitioner requirements. This may include a face-to-face MBS service billed to Medicare with the doctor or practice within the previous 12 months, unless an applicable exemption or MyMedicare arrangement applies. The rule exists to encourage continuity of care with a doctor who actually knows your history, rather than a rebate applying to any random consultation with any random provider.
There’s a genuinely useful update worth knowing here too. As of 1 November 2025, patients registered with MyMedicare at a particular practice became exempt from this 12-month face-to-face requirement for telehealth with that practice, which has made ongoing telehealth access considerably simpler for a lot of people. The service and practice must still meet the applicable MBS requirements.
Read: Telehealth 12-Month Rule Explained
Why Many Telehealth Services Charge a Private Fee
If a telehealth consultation does not meet the relevant MBS requirements and no exemption or alternative pathway applies, the provider may charge a private fee and a Medicare benefit may not be available.
This isn’t telehealth services being sneaky about cost, it’s simply how the underlying Medicare rules work regardless of which provider you’re using. Bulk-billed online doctor appointments are not available from every provider in Australia, even where a rebate does apply, since bulk billing is a choice each practice makes, not an automatic entitlement tied to every eligible service. Understanding this distinction genuinely helps explain why one telehealth service might be free and another isn’t, even for what looks like the same type of appointment.
Also read: Your Guide To Online GP Consultation Costs In Australia
Exceptions: When Telehealth Is Eligible for Medicare Rebates
Medicare provides specific exemptions and alternative eligibility pathways for some patients and services. These do not necessarily apply to every telehealth consultation or MBS item. Depending on the relevant MBS item and the patient’s circumstances, examples may include patients under 12 months of age, people experiencing homelessness, people in a natural-disaster-affected area, patients receiving care through an Aboriginal Medical Service or Aboriginal Community Controlled Health Service, and people subject to COVID-19 isolation or quarantine requirements under a state or territory public health order.
Certain mental-health, eating-disorder, chronic-condition-management and obstetric services may have separate MBS item requirements or exemptions. These rules can differ between video and telephone services, so confirm the relevant item with the practice or check the current MBS guidance.
Can I Claim Online Prescriptions or Referrals on Medicare?
This is where a lot of confusion creeps in, because people tend to lump the consultation and everything that comes out of it into one cost.
The Difference Between the Consult Fee and the Medication or Test Cost
Medicare does not generally pay for the medicine itself through the consultation rebate. Eligible medicines may receive a separate PBS subsidy, while eligible pathology or imaging services may attract their own Medicare benefit if the relevant requirements are met. A prescription or referral issued after a telehealth consultation does not automatically guarantee that a medicine, test or scan will be subsidised.
So a rebated telehealth consult can still be followed by out-of-pocket costs elsewhere in the process, and that’s not a hidden catch, it’s just how the system is structured across the board.
Private health insurance online GP cover is a separate question again, and it’s genuinely worth checking your own policy rather than assuming either way, since extras cover for GP-style services varies considerably between insurers and isn’t something Medicare rules determine.
What This Actually Means for Your Telehealth Out of Pocket Cost
Put simply, your telehealth out of pocket cost comes down to three questions: does a Medicare rebate apply to your situation, does the practice bulk bill or charge a gap, and are there any follow-on costs for medication or testing. None of these are things a good telehealth provider should leave you guessing about. Under the Medical Board of Australia’s Good Medical Practice code, doctors are expected to ensure patients understand fees before treatment is provided, which in plain terms means you should be told what something costs, and what Medicare will or won’t cover, before you’re asked to pay for it.
Telehealth is not suitable for every symptom or clinical situation. A doctor may recommend an in-person assessment if a physical examination, testing or urgent treatment is required.
Doctor Help Pricing and Consultation Fees
Cost shouldn’t be a mystery you only solve after the appointment’s already booked. We keep our pricing simple and upfront, so you know exactly what you’re paying before you book, not after. Whether a Medicare rebate applies to your consultation depends on the eligibility factors covered above, but our fees themselves are clear and consistent. You’re welcome to check current pricing or go ahead and book a standard telehealth consultation if you’re ready to get started.
Disclaimer: This article is general information only and does not replace individual medical or financial advice. Medicare rules can change, and eligibility depends on your individual circumstances, so it’s worth confirming current details with Services Australia or your provider directly.
References
- AskMBS Advisory: MBS Telehealth Eligible telehealth practitioner requirement, Clarification of exemptions. (2025). In Department of Health, Disability and Ageing.
https://www.health.gov.au/sites/default/files/2025-11/askmbs-advisory-mbs-telehealth-eligible-telehealth-practitioner-previously-known-as-established-clinical-relationship-requirements-clarification.pdf - Who can claim telehealth services. (2026, July 7). Services Australia.
https://www.servicesaustralia.gov.au/who-can-claim-telehealth-services-under-mbs-or-dva?context=20 - Authority approval for PBS medicines by condition. (2026, August 1). Services Australia.
https://www.servicesaustralia.gov.au/drug-program-or-condition-for-pbs-medicines?context=20 - Good medical practice: a code of conduct for doctors in Australia. (2024, November 20). Medical Board Ahpra.
https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct
Reviewed By: Dr. Momal Ahmad.
