In bulk billing, patients do not need to spend anything, and Medicare bears the cost. But in mixed billing, some patients, like children, can have bulk billing, but other patients need to pay some fees above the Medicare rebate. Bulk billing eligibility is determined by Medicare rules and individual medical practices.
You need to know the differences because you do not want to find any surprise invoice. For example, an adult with no concession card expects a free visit and gets a $53 bill. This can be due to mixed billing.
Today we’ll cover what each billing type means and how the gap fee works. We’ll also look at the November 2025 changes, who gets bulk billed, if billing affects quality of care, and how to check a clinic’s policy before you book.
What Is Bulk Billing?
Bulk billing in Australia: the GP does not charge any as the clinic accepts the Medicare rebate as full payment. If you get bulk billing, you won’t need to spend anything from your pocket. The doctor claims the money from Medicare.
- How it works: The GP accepts the Medicare rebate as the total payment for the doctor visits or treatment.
- Payment process: You can show your Medicare card. The clinic itself processes the claim with the government.
- Access: Any patient with a Medicare card can be bulk billed. But each clinic or doctor chooses whether to offer it.
- Eligibility: You need a valid Medicare card. Australian citizens, permanent residents, and some visa holders can get the card.
- Pathology and imaging: These providers bill separately. In such tests, a bulk-billing GP can’t control what they charge.
What Is Mixed Billing?
A clinic can have both bulk billing and mixed billing. In mixed billing, some patients need to pay a private fee with a gap. But there is bulk billing available, and doctors can choose to have bulk billing or charge a gap. There are fixed rules, but the Australian government and individual doctors or clinics decide it. Two mixed clinics on the same street can treat the same patient differently.
- How it works: The practice uses a split-tier policy. Children under 16, pensioners, and Department of Veterans Affairs (DVA) or concession card holders are bulk billed. Standard adult patients pay a private fee.
- The gap fee: For a privately billed visit, you pay the clinic’s full fee upfront (say $95). Medicare refunds a portion of the total bill. After deducting the portion Medicare pays, the rest is the gap fee, and the patient needs to pay it.
Mixed Billing vs Bulk Billing: Key Differences
The difference between bulk billing and mixed billing is who pays and when. As we already said, Medicare pays the doctor directly in bulk billing. At a mixed clinic, private patients pay the full fee first. After Medicare provides the rebate, it is returned to the patient. Most other differences, from paperwork to appointment length, grow out of that split.
Under bulk billing, a practice earns only the Medicare benefit. Mixed billing adds private fees. Both models can claim the standard bulk billing incentive. Only fully bulk billing practices qualify for the extra 12.5% BBPIP payment covered below.
Here is a different table.
Factor | Bulk billing | Mixed billing |
Who pays? | Medicare pays the doctor directly | Medicare pays for bulk-billed patients, and private patients pay the clinic |
Out-of-pocket cost | Usually $0 | $0 for select groups, a gap fee for others (often $20 to $60 or more) |
Medicare rebate | Accepted as full payment | A partial refund for private patients, who cover the difference |
Payment and claim | No upfront payment, and the practice claims | Private visits often need upfront payment, and you may claim the rebate yourself |
Appointment length | Can be shorter at high-volume clinics | Often more flexible |
Who it suits | People who want a predictable $0 cost | People who want longer visits or one regular GP and can absorb a gap |
What Is Private Billing?
Private billing means you pay the full cost of the medical consultation upfront. There is still a Medicare rebate in most cases. The service is listed on the Medicare Benefits Schedule (MBS). If you have a Medicare card, you can claim the rebate.
In private billing, because the doctor’s fee is higher than the government subsidy, you will need to pay the gap fee, the same as we described for mixed billing. The gap fee is the difference between what the doctor charges and what Medicare pays back.
At a mixed clinic, standard adult patients without cards are billed this way for regular visits and longer consultations. At a fully private clinic, you need to pay the full fee first and receive the rebate afterward.
How Do You Get Your Money Back?
You do not have to wait weeks to get your rebate. Most private clinics use electronic systems to process it immediately, like Instant Refund (EFTPOS), or the clinic submits the claim to Medicare electronically on your behalf. The rebate is deposited into your nominated bank account within 24 to 48 hours.
What Changed for Bulk Billing in November 2025?
From 1 November 2025, bulk billing incentives expanded from children under 16 and concession card holders to all Medicare-eligible patients. The government also launched the Bulk Billing Practice Incentive Program (BBPIP) for clinics that bulk bill every eligible patient and service mbsonline.gov. Before that, GPs mainly earned the incentive for children and concession card holders, which left working adults most exposed to gap fees mbsonline.gov.
Clinics responded quickly: Cleanbill’s 2026 Blue Report found 40.2% now fully bulk bill a standard adult weekday consult, up from 20.7% in early 2025. The reform doesn’t force any clinic to bulk bill everyone, though health.gov.
- BBPIP payment: Participating practices receive an extra 12.5% on MBS benefits from eligible bulk-billed GP services, split 50/50 between practice and GP, and paid quarterly from January 2026 health.gov.
- BBPIP conditions: Practices must bulk bill all eligible patients and services, register through MyMedicare (with an exemption for those not yet registered), and display Medicare Bulk Billing Practice signage nwmphn.org health.gov.
- Mixed clinics still benefit: They can claim the standard incentive without joining BBPIP, but the extra 12.5% needs full bulk billing at racgp.org.
- What didn’t change: Pathology and imaging incentives stayed as they were, and a bulk-billed visit still can’t carry an extra fee on mbsonline.gov.
- What it means for you: Adults without concession cards may find more GPs willing to bulk bill them, but a clinic that stays mixed can still charge a gap racgp.org.
Why Do Some GP Clinics Use Mixed Billing?
Some clinics use mixed billing to cover some financial costs like rent, staff wages, or medical supplies. This is because everything is becoming costly, and to stay financially stable, clinics go for mixed billing.
Clinics use mixed billing because Medicare rebates haven’t kept pace with running costs, and private fees fill the shortfall. Longer or complex consultations are a common example. The rebate often doesn’t cover the true cost of that time. Mixed billing also lets a clinic keep bulk billing children, pensioners, and others who’d struggle with a gap. The RACGP’s 2025 Health of the Nation report found financial pressure and rebate adequacy remain a top concern for practice owners.
Curious what a visit costs? [Check our fees.]
Who Is Usually Bulk Billed at a Mixed Billing Clinic?
Most mixed billing clinics bulk bill children, pensioners, concession card holders, and some add specific visit types. The exact list is set by each GP. It is better to ask before you book for any health issues like men’s health checks, women’s health checks, or other specific health concerns.
Commonly bulk-billed groups:
- Children and youth under 16. But some clinics set the cutoff at 15.
- Age Pension card holders.
- Concession card holders. DVA Gold or White Card, Health Care Card or Commonwealth Seniors Health Card holders.
- Specific visit types like government-funded health assessments, chronic disease plans, or mental health treatment plans at some clinics.
- Patients in financial hardship, at the individual GP’s discretion.
Does Billing Type Affect Quality of Care?
No, billing type doesn’t change the medical quality of your care. Every Australian GP has the same training, registration, and AHPRA standards. Their qualifications do not depend on billing types.
Here are some ways the billing types can affect your visit runs.
Consultation Length and Time Pressure
Bulk billing clinics can run shorter appointments. They can push low rebates for higher costs, but this is not a strong statement. Whereas mixed and private clinics offer more benefits for complex or multi-issue visits. You can just ask if longer consultations are bulk billed too.
Waiting Times and Scheduling
Busy bulk billing clinics can mean longer waits. Fees naturally limit demand at mixed clinics. So they often run closer to the schedule.
Continuity of Care
Seeing the same GP is easier at mixed and private clinics. High-volume centers can have higher staff turnover. This makes it harder of care harder. Some fully bulk-billing practices still build long relationships with patients.
How to Check How a Clinic Bills Before You Book
Checking takes a few minutes and starts online. If the answer is still unclear after that, you can directly phone the clinic.
- Scan the clinic’s website: Look for tabs called Fees, Billing Policy, Patient Information, or Pricing. Check the fees for a Level B consultation (a standard visit under 20 minutes) and a Level C consultation (20 to 40 minutes), and see if the clinic says who it bulk bills. You can start with the [Franklin GP contact page link to add].
- Check the online booking platform: Booking engines such as HotDoc, Healthengine, or MediRecords often show a notice like “This is a private billing practice.” A gap fee applies” before you confirm.
- Look for signage: Clinics that bulk bill every eligible patient can display Medicare Bulk Billing Practice signage, which makes them easy to spot.
- Ask reception-specific questions: A clinic that says “yes, we bulk bill” may only mean some patients. Try these instead:
- “Are you a fully bulk billing, private, or mixed billing practice?”
- “Do you bulk bill all Medicare-eligible adults at every appointment?”
- “What’s the gap fee for an adult without a concession card?”
- “Do I pay in full today, or do you process the rebate on the spot?”
Ask for the full fee, the Medicare rebate, and the gap before you book. If your GP refers you for tests or scans, ask those providers separately too.
Billing at Franklin General Practice, Gungahlin
Franklin General Practice in Gungahlin offers mixed billing. Your consultation may be bulk billed or privately billed depending on your eligibility and the applicable fees. If a private fee applies, you may be eligible for a Medicare rebate.
Our consultation fees include Level B and Level C appointments and applicable Medicare rebates. If you’re unsure about your billing arrangements or expected costs, contact our team before booking. We’ll be happy to explain the fees that apply to your visit.
Frequently Asked Questions
Is mixed billing the same as private billing?
Not quite. Private billing means every patient pays the clinic’s full fee, whereas mixed billing means some patients are bulk billed, and others are billed privately. Privately billed patients in both models pay the full fee and get the Medicare rebate back afterward.
How much is a gap fee at a GP?
It depends on the clinic and the service, and gaps often run from $20 to $60 or more. In the earlier example, a $95 visit with a roughly $42 rebate leaves a $53 gap. Ask for the full fee, the rebate, and the gap before you book.
Do I get money back from Medicare if I pay a gap fee?
Yes, for eligible services. Medicare refunds the rebate portion, but the gap itself stays with you. Some clinics process the rebate at the desk, and others expect you to claim it, so ask which applies.
Can a bulk billing clinic charge me a fee?
Not for a bulk-billed consultation, because the doctor accepts the Medicare benefit as full payment. Services Medicare doesn’t cover can still carry a cost, and pathology or imaging providers bill separately. Check the clinic’s fee page if you’re unsure.
Are telehealth appointments bulk billed?
It depends on the clinic or provider, as it does with in-person visits. Some bulk bill telehealth for eligible patients, and others charge a fee. Confirm the policy before you book, and check the current Medicare telehealth rules on the Services Australia site.
