General practice in Australia has long been the front line of healthcare access for millions. However, with rising operational costs, workforce shortages, and changing patient expectations, the traditional model (i.e., bulk billing) has been under pressure.
In response, the Australian Government has periodically initiated changes to the bulk billing incentive structure. These updates, including a significant increase in incentives effective from November 2023, aim to reinforce the viability of bulk billing for targeted patient groups and ensure practices can sustainably deliver care where certain services are needed most.
Through this guide, we discuss the key changes in bulk billing, the rationale behind them, and what medical practices need to do to adapt and make the most of the upcoming new incentive framework.
What’s Coming This November 2025
The Federal Government has announced further Medicare Benefits Schedule (MBS) reforms effective this November 2025, to simplify the billing process and improve equity in primary care.
Planned adjustments include:
- Revising eligibility checks: Integrating Services Australia systems more tightly with patient Medicare and concession data to auto-verify eligibility in real time.
- Possible expansion of incentive-eligible services: Consultations for mental health and chronic disease management may be included.
- New billing codes for team-based care: Practices offering care through nurse practitioners or practice nurses may see new incentive structures for integrated care models.
Key Changes This November 2025
Starting November 1, 2025, the Australian government will introduce two major changes to bulk billing incentives under Medicare:
- Increase in Bulk Billing Incentive (BBI) Eligibility: Bulk billing incentives, which currently apply mainly to children under the age of 16 and concession cardholders, will be expanded. The implication of this change is that all Australians with a valid Medicare card become eligible for bulk billing incentives. This move to expand BBI eligibility means many more patients can access GP services without the need to spend out-of-pocket, thus improving the affordability and accessibility of healthcare services across the population. Bulk billing incentives will be scaled according to remoteness (Modified Monash Model). Higher incentives will be provided in regional, rural, and remote areas to support those communities.
- Introduction of the Bulk Billing Practice Incentive Program (BBPIP): Practices that enrol in the BBPIP and commit to bulk billing all eligible patients for all eligible services will receive an additional 12.5% loading payment on top of the MBS benefit paid for those services. This 12.5% loading is an incentive payment based on the dollar value of eligible bulk billed MBS services, paid quarterly in arrears. The payment is split evenly (50/50) between the practice and the GPs providing the services, to recognise both clinical and operational contributions in the delivery of bulk-billed care.
Practices must be registered through MyMedicare to participate but will have accreditation requirements waived if they are not already accredited. This allows for more flexibility when it comes to participation. Participating practices need to promote their participation as Medicare Bulk Billing Practices, signalling to patients that bulk billing is available to all eligible patients.
Services not on the eligible list or those that are procedural can have a gap charged and are exempt from the bulk billing requirement under BBPIP.
Overall Impact of These Changes
These changes are meant to encourage more practices to fully bulk bill. Doing so will increase patient access to free GP care, essentially reducing financial barriers and supporting the government’s goal of providing universal healthcare.
The new BBPIP incentive explicitly rewards practices for committing to consistently bulk bill every eligible patient rather than selectively doing so.
The expanded eligibility combined with the additional 12.5% incentive makes bulk billing financially more attractive and sustainable for practices, especially in regional and rural areas where the bulk billing incentive is scaled up.
This reform represents a significant government investment of $7.9 billion, making it the largest Medicare investment in decades to increase bulk billing rates, uplift primary care access, and reduce patient out-of-pocket expenses.
To qualify for BBI, practices must bulk bill every eligible service for all patients. However, participation is voluntary as practices can opt in or out at any time.
How Practices Can Prepare for the Changes
To be ready for the changes to be introduced through the Bulk Billing Practice Incentive Program (BBPIP) starting November 1, 2025, we recommend that general practices take the following steps:
- Register for MyMedicare as early as possible. As pointed out earlier, practices must be registered with MyMedicare to participate in the BBPIP. Accredited practices are encouraged to register in advance to facilitate their smooth enrolment when the program launches. Practices can begin registering for BBPIP on 1 November 2025. Quarterly incentive payments will begin in the first quarter of 2026.
- Commit to bulk billing all eligible services for all patients. To qualify for the incentive, practices must bulk bill every eligible service provided to every eligible patient consistently, not selectively.
- Promote your participation as a Medicare bulk billing practice. Practices will need to clearly advertise their participation in BBPIP to inform patients that all eligible services will be bulk billed. Doing this will help a lot in attracting and reassuring patients.
- Know about eligible services and locations. Practices should familiarize themselves with the list of eligible services subject to the incentive and how the scaling of incentives varies by practice location using the Modified Monash Model.
- Review and possibly adjust practice billing and financial models. Practices may need to reassess their current billing practices and financial planning. They have to consider the new 12.5% quarterly incentive payment and the elimination of gap fees for bulk billed services.
- Train practice staff and providers. All GPs and administrative staff must be familiar with and understand the requirements, billing changes, registration process, and patient communication strategies to implement the program smoothly.
- Prepare for an increase in patient demand. The broader eligibility for bulk billing and improved affordability offered through the program should compel practices to plan operationally, as these favourable factors can potentially lead to more patient visits.
- Be on the lookout for further guidance from government or health authorities. Always be ready for further detailed instructions and FAQ updates from the Department of Health and Services Australia regarding BBPIP registration, compliance, and payment processes.
By proactively addressing these areas, practices can remain sustainable and better position themselves to benefit financially from the BBPIP while also ensuring patient access to universally bulk billed care.
Why the Incentive Is Split 50/50 Between GPs and Practices
The incentive in the BBPIP is split evenly (50/50) between GPs and practices to recognise the contributions of both parties in delivering bulk-billed services.
It’s undeniable that practices and GPs both play essential roles in providing bulk billed care. Therefore, the 50/50 split acknowledges and rewards the efforts of both the clinical providers (GPs) and operational support (practices). Moreover, the government aims to balance incentives to encourage both individual doctors and practice owners to participate fully in bulk billing every eligible patient consistently.
While individual doctors need to be rewarded for choosing to bulk bill all patients, practices themselves also need to benefit financially to support the sustainability of bulk billing services. This approach is intended to drive widespread bulk billing uptake by making it attractive and financially viable for both GPs and practices.
Despite some opposition from the Royal Australian College of General Practitioners (RACGP) and some GPs, the government believes the 50/50 split is a fair arrangement that will boost bulk billing rates nationally. In fact, government analyses show that over 4,800 practices stand to benefit financially from the program by switching to bulk billing under the new BBPIP structure.
The new bulk billing model with BBPIP does represent the largest Medicare investment for the government and is designed to improve financial support for practices to bulk bill. However, its impact on practice sustainability will vary. While it is expected to help many practices remain viable under a full bulk billing model (especially ones located outside major metros), ongoing cost pressures can mean that some practices may continue mixed billing approaches to balance quality care with financial health.
The History and Rationale Behind Bulk Billing Incentives
The bulk billing incentive program was introduced to encourage general practitioners (GPs) to provide free services to patients who might otherwise face financial barriers to care. Over time, however, the value of these incentives lagged behind inflation and did not keep pace with rising operational demands, namely rent, insurance, wages, digital infrastructure, and administrative burdens, whose costs have all gone up.
Note that the bulk billing incentive program wasn’t always as generous (or as complicated) as it is now. Over the years, the government has tinkered with it: adjusting eligibility, boosting rural incentives, and tying payments to patient groups like children and concession cardholders. The program structure is reviewed regularly to reflect cost-of-living pressures, regional disparities, and GP shortages.
According to the Australian Institute for Health and Welfare (AIHW), data shows that bulk billing rates declined somewhat during the latter part of the global pandemic and picked up again in 2024. However, it should also be noted that there are deep regional disparities, with rates in some rural and remote areas. Practices in these areas often struggled to attract and retain GPs, let alone offer bulk-billed services consistently.
The rationale for boosting bulk billing incentives is both economic and health-focused. Economically, encouraging early access to primary care is cheaper than treating complications in emergency departments. From a health equity standpoint, providing no-cost GP services to children, pensioners, and concession cardholders ensures these populations aren’t forced to defer care due to financial concerns.
With patient demand rebounding post-COVID and the cost of providing care escalating, many practices began charging private fees even for concession patients. The government responded by nearly tripling the bulk billing incentive for certain patients in November 2023.
The 2023 changes included 13 new Medicare Benefits Schedule (MBS) bulk billing items. This was the largest increase since the incentive’s introduction and signalled a strong policy push to protect universal access for the most vulnerable.
Current Uptake and Regional Differences
Initial uptake data from Medicare and analysis by the Royal Australian College of General Practitioners (RACGP) indicate that bulk billing rates for children and concession cardholders rose slightly in Q1 2024 following the incentive increase.
However, the broader picture remains mixed. While many practices in urban fringe areas reintroduced bulk billing for select groups, others (especially in high-demand suburbs or affluent zones) opted to continue private billing for all patients.
In regional and remote areas, where bulk billing was already more common, the higher incentive made a more noticeable difference. According to an April/May 2024 RACGP survey:
- 58% of rural practices said the increased incentive improved their financial sustainability.
- 31% said they were now more likely to bulk bill children and pensioners.
- Only 12% of metro practices in high-income postcodes changed their billing model.
Smaller practices (solo or 2-GP clinics) reported the most benefit from the changes, particularly those in MMM3–5 zones where the highest incentives apply.
Despite the increases, full bulk billing is still financially challenging for many practices, especially when Medicare indexation fails to keep pace with inflation. The updated incentives help, but they don’t fix broader structural issues.
Are the Incentives Working?
The short answer: yes, but unevenly. In capital cities, where patient demand is high and overheads are manageable, the current incentives provide a modest bump. However, the impact is more pronounced in the regions.
That said, challenges remain in general. Some urban GPs still opt out of bulk billing entirely, citing stagnant MBS rebates and high overheads. Others use a mixed billing model—bulk billing concession cardholders while privately billing everyone else.
State-by-State Comparisons
The impact of bulk billing incentives isn’t uniform across Australia:
- New South Wales and Victoria: Urban practices in Sydney and Melbourne often bulk bill at lower rates, with many moving to mixed billing. Still, incentives help clinics in Western Sydney or rural Victoria stay viable.
- Queensland: Regional centres like Townsville and Cairns benefit from mid-tier incentives. Some practices qualify for special rural support grants.
- Western Australia: Vast distances and GP shortages mean clinics in the Kimberley or Pilbara regions rely heavily on incentive payments.
- Northern Territory: Bulk billing incentives are essential in remote Indigenous communities where patient volumes are low and private billing is unfeasible.
- South Australia and Tasmania: Smaller states with ageing populations see steady demand for concession-based bulk billing, which means incentives can make a real difference.
Frequently Asked Questions
What is the bulk billing incentive program?
It is a federal initiative that provides extra payments to practices that bulk bill eligible patients. Currently, eligibility includes pensioners, concession card holders, and children under 16. From 1 November 2025, the program will be expanded so that all Medicare cardholders will qualify for the bulk billing incentive payment, greatly broadening eligibility.
Who qualifies for bulk billing incentives?
Patients must hold a current healthcare or concession card or be under the age of 16. Only specific MBS items attract the incentive payment. But starting 1 November 2025, this will change to include all Medicare-eligible patients regardless of age or concession status.
Will incentives increase this 2025?
After November 2025, the bulk billing incentive payments will increase significantly, with a new additional practice incentive of 12.5% of MBS benefits for practices that bulk bill every eligible service for every patient. This 12.5% incentive is in addition to the standard bulk billing incentive payments.
Is the incentive automatically paid?
Yes, if claims are submitted correctly with valid patient and provider information. Errors in data entry or expired cards can lead to missed payments.
How are regional classifications changing?
Some suburbs and towns are being reclassified into higher MMM categories, increasing the payments practices in those areas will receive.
Can I still bulk bill privately insured patients?
Yes, but bulk billing incentives only apply if the patient meets eligibility criteria (currently those with concession cards, children under 16, and from November 2025, all Medicare cardholders). Patients with private insurance but without an appropriate Medicare card status do not generate incentive payments for bulk billing.
What are the key requirements for practices to qualify for BBPIP incentives?
The key requirements for practices that wish to qualify for BBPIP incentives include:
- Medicare Billing Compliance: The practice must bulk bill all eligible services for every eligible patient (not selective bulk billing).
- Registration: Practices must register for BBPIP participation via the Organisation Reister using the MyMedicare portal. New practices registering for the BBPIP are exempted from the accreditation requirements of MyMedicare.
- Advertising/Promotion: Practices must promote their participation as a Medicare Bulk Billing Practice.
- Ongoing Compliance: Practices need to maintain their eligibility requirements continuously to continue receiving incentives every quarter.
A Welcome Development
The boost to bulk billing incentives is a meaningful step toward supporting the need for widespread affordable care in Australia, but it’s not a cure-all.
For many practices, especially outside metro hubs, it’s a welcome relief that lets them serve their communities better. But for others, especially those facing skyrocketing overheads, the incentive (although quite improved) may not be enough to reinstate bulk billing across the board.
The challenge for GPs is to assess their circumstances, including their patient mix, location, and business model. For practices that serve a high number of eligible patients, these new payments can represent tens of thousands of dollars a year. For others, especially private billing clinics, the trade-offs might not make sense.
Regardless of where a clinic falls, one thing is clear: billing rules are becoming more complex, and staying compliant is no longer optional. Practices must invest time into understanding item numbers, upgrading systems, and training their staff, not just to claim correctly, but also to serve patients fairly and sustainably.
The November 2023 changes were just the beginning.
With more reforms coming this November 2025, proactive practices will be best positioned to benefit from any changes in the Medicare landscape.