Pulse ·

Bulk billing is up. So are out-of-pocket costs. Both are true.

By Dr HB Lo, FACRRM 4 min read
Verdict Yes — worth knowing about

Cleanbill's June 2026 data found that for the first time since 2023, every Australian electorate has at least one universal bulk billing clinic — a genuine Medicare reform gain.

The same data shows out-of-pocket costs rose in 147 of 150 electorates since November 2025, with a 340% increase in clinics charging over $50 per consultation. Ten electorates now average above $100.

Both reflect the same structural reality: the reforms rewarded universal bulk billing but did not cap what non-bulk-billing practices charge. The result is a clearer two-tier system — one free at point of care, the other costlier than a year ago.

What just happened

New data from Cleanbill, published 21 June 2026 and reported in Medical Republic on 23 June, has produced a headline that looks like a contradiction: bulk billing is up, and so are out-of-pocket costs — in the same Medicare reform cycle.

For the first time since 2023, every one of Australia’s 150 federal electorates has at least one universal bulk billing clinic. 143 of 150 electorates showed an increased proportion of bulk billing general practices. Thirteen electorates recorded increases exceeding 45%. By the headline measure, the November 2025 Medicare reforms are working as designed.

At the same time: out-of-pocket costs rose in 147 of 150 electorates over the same period. There has been a 340% increase in clinics charging more than $50 for a standard consultation (MBS Item 23). Ten electorates now have average consultation costs exceeding $100. Tasmania recorded an average out-of-pocket cost of $71.01 per consultation — up from $61.18 the year before. In Bourke-Cobar-Coonamble in the Northern Territory, the average sits at $87.48.

A Cleanbill spokesperson put it plainly: “While reflective of the economic realities currently faced by individual GP clinics, it does mean that patients not accessing universal bulk billed care are, on average, paying more to see a GP than at this time last year.”

The both-and

The reform is doing what it was designed to do

The November 2025 Medicare reforms substantially increased rebates for general practices that commit to bulk billing the majority of their patients — particularly those bulk billing complex patients: people managing multiple chronic conditions, people on concession cards, people in clinically vulnerable groups. The intent was to make it financially sustainable to operate without a gap fee for those cohorts. That intent has been partially realised.

Every electorate having at least one universal bulk billing clinic is a concrete, meaningful win for patients who previously had no local option. A person in a regional electorate or a lower-income urban area who had no bulk billing GP nearby now, at least in principle, has one. This matters in the access-to-care conversation and should be named clearly as progress.

The Northern Territory reports the highest bulk billing rate in the country at approximately 90%, reflecting both the concentration of government-funded health services and the demographic and geographic profile of the region. The ACT has the lowest rate at 54.1% — reflecting a health market skewed toward privately billing specialists and well-resourced, privately billing general practices.

What the headline doesn’t capture

Access and proximity are not the same thing. Having at least one universal bulk billing clinic per electorate does not mean that clinic is near you, has appointments available, or has clinical capacity to take new patients. The Cleanbill data measures clinics offering to bulk bill a standard consultation (MBS Item 23) based on self-reported data. It measures an offer; it does not measure whether a patient can realistically use it.

The 340% increase in clinics charging more than $50 tells the story of a system sorting itself. The November 2025 reforms created incentives for practices that wanted to go universal — but did not regulate the ceiling for practices that didn’t. Those practices, many of which had absorbed rising costs through modest gap fees for years, recalibrated. Commercial rent, GP wages, and consumable costs are not going backwards. The gap between what Medicare rebates cover and what delivering general practice care actually costs remains real, regardless of how an individual practice chooses to position itself in the market.

The result is a system that is now more explicitly two-tier than it was before November 2025. One tier is fully accessible and free at point of care. The other is more expensive than it was twelve months ago. Both are operating with internal logic. What is missing is a clear, navigable bridge for patients who live geographically closer to the expensive tier but cannot afford it.

The ACT’s average out-of-pocket of over $100 in some electorates, and Tasmania’s $71 average, represent a significant barrier for anyone on a fixed income, anyone without sick leave, or anyone already managing the cost pressure of a chronic illness. The data is worth sitting with rather than averaging away.

My two cents

If out-of-pocket costs are becoming a barrier to seeing your GP, it is worth asking your clinic directly: “Are there circumstances in which I would be bulk billed?” Many practices that are not universally bulk billing still bulk bill for specific patient groups — people holding a Healthcare Card or Pensioner Concession Card, children under 16, or patients with a chronic disease management plan under MBS items 721, 723, or 732. The answer depends on your situation and the clinic’s capacity, but the question is worth asking before assuming the gap fee is fixed.

Healthdirect’s service finder lets you search by postcode and filter for bulk billing availability. It is not always real-time — clinics update billing status on their own schedule — but it is a practical starting point for finding alternatives.

The bigger picture here is not individual navigation. It is that the Medicare reform conversation needs to track both sets of numbers at once. A rising bulk billing headline alongside a rising out-of-pocket headline is not a contradiction — it is accurate. A reform that improves access for some while raising costs for others is doing something, but it is not doing the same thing as universal improvement. That distinction deserves honest language in policy discussions, in general practice advocacy, and in the conversations patients are having at the front desk right now.

Verdict: yes — worth knowing about.

Sources cited

  1. “Bulk billing up, out-of-pockets also up” — Medical Republic, 23 June 2026. https://www.medicalrepublic.com.au/bulk-billing-up-out-of-pockets-also-up/126688
  2. Cleanbill 2026 Blue Report — electorate breakdown. https://www.cleanbill.com.au
  3. Healthdirect — Find a health service (GP finder). https://www.healthdirect.gov.au/australian-health-services

Frequently asked questions

  • Why are bulk billing rates and out-of-pocket costs both rising at the same time?

    The November 2025 Medicare reforms increased rebates substantially for practices that commit to bulk billing most of their patients, making universal bulk billing financially viable for more clinics. But the reforms did not cap what non-bulk-billing practices charge. Practices outside the universal bulk billing model passed rising costs — staffing, rent, consumables — through higher gap fees. The reforms sorted the system into clearer tiers without eliminating the gap between them.

  • How do I find a bulk billing GP near me?

    Healthdirect's 'Find a health service' tool lets you search by postcode and filter for bulk billing. Some practices that are not universally bulk billing will still bulk bill for certain groups — children under 16, concession card holders, or patients with chronic conditions under MBS care plan items (721/723/732). It is worth asking your local clinic what applies to your situation, even if a standard gap fee applies in general.