Mixed billing
In Australia, a “mixed billing” medical clinic charges some patients a private, out-of-pocket fee while choosing to “bulk bill” others (such as children under 16, pensioners, and concession card holders). This means not all appointments are fully covered by Medicare.
If you have ever been surprised by a bill after visiting a GP clinic you believed was bulk-billing, there’s a good chance you attended a mixed-billing practice. Understanding mixed billing can help you avoid unexpected costs and make more informed healthcare choices.
What is the difference between mixed billing, bulk billing, and private billing?
Australia’s Medicare system allows doctors to choose how they charge for their services. The three main billing options are:
| Billing type | Who pays? | Out-of-pocket cost |
| Bulk billing | Medicare pays the full MBS fee; the doctor accepts it as full payment | None |
| Mixed billing | Medicare pays the MBS rebate; patients may pay a gap fee depending on their eligibility. | Possible, depends on your concession status |
| Private billing | Medicare pays its standard rebate; you pay the remainder | Yes, you pay the gap between the doctor’s fee and the Medicare rebate |
Bulk billing means the doctor accepts the Medicare Benefits Schedule rebate as full payment, so the patient does not need to pay anything. Medicare covers 100% of the MBS fee for GP visits.
Private billing means the doctor charges their own set fee, which is often higher than the Medicare Benefits Schedule fee. Medicare covers part of the cost, and you pay the gap fee.
Mixed billing is a combination of both. The clinic bulk bills certain eligible patients, such as children under 16, concession card holders, and pension card holders, while charging private fees to other patients. Whether you pay or not depends on your individual eligibility.
It is important to note that mixed-billing clinics may charge different rates depending on the appointment type. For example, a standard consultation might be bulk-billed, but after-hours or extended appointments may incur an extra fee. Always check the billing details before your appointment.
Why are so many Australian clinics moving to mixed billing?
Two main factors have contributed to this shift. First, the federal government’s freeze on the Medicare Benefits Schedule indexation from 2014 to 2017 meant rebates did not keep pace with rising clinic costs. Second, overheads such as wages, rent, and medical equipment have continued to rise.
Mixed billing helps clinics remain financially sustainable while continuing to support vulnerable patients in accessing care at out-of-pocket cost. The federal government’s Bulk Billing Practice Incentive Program, launched on 1 November 2025, offers a 12.5% incentive to practices that bulk-bill all patients, though many clinics remain uncertain about its financial viability.
Will I have an out-of-pocket cost at a mixed billing clinic?
It actually depends on who you are and what the clinic’s policy is. Here is how it works:
- If you hold a Commonwealth Concession Card, a Health Care Card, or a Pensioner Concession Card, most mixed billing practices will bulk bill you, meaning you don’t have to pay anything.
- If you are under 16, many mixed-billing practices will also bulk-bill you at no charge.
- If you do not belong to any of the above groups, you will likely be charged a private fee and will need to pay a gap fee, the difference between the doctor’s fee and the Medicare rebate.
Medical Disclaimer: The content on this page is for informational purposes only.
