Medicare, Private Health and the PBS for Weight Loss Treatment
Medicare pays benefits for services such as eligible doctor consultations, tests and some weight loss surgery, while medicines are subsidised separately through the Pharmaceutical Benefits Scheme (PBS). As at 1 October 2026, no weight loss medication was listed on the general PBS for weight management (Schedule of Pharmaceutical Benefits, October 2026), so a treatment that is not PBS-listed for your condition costs the full price.
This is general information, not medical, financial or insurance advice. Cover rules and fees change, your own cover depends on your circumstances and your policy, and outcomes vary between individuals.
On this page
- Key Points
- Weight Loss Cover at a Glance
- What Medicare Covers for Weight Loss
- Allied Health Support Through a GP Plan
- Is Weight Loss Medication on the PBS?
- What Private Health Insurance Covers
- How to Check Your Own Cover
- Where Diet and Physical Activity Fit
- Telehealth With Burst Health
- Frequently Asked Questions
Key Points
Medicare pays a benefit for eligible consultations with doctors and for many tests. A doctor can charge more than the schedule fee, and you pay the gap.
Most GP telehealth consultations attract a Medicare benefit only if you have had a recent face-to-face visit with that doctor or practice, with some exemptions.
A PBS listing needs a committee recommendation and an agreed price. In November 2025, the committee recommended one listing for people with established cardiovascular disease and obesity, and a price had not been agreed by August 2026.
Private health insurance does not cover GP visits. Extras cover may help with a dietitian, an exercise physiologist or some medicines that are not on the PBS, depending on your policy.
A healthy diet and regular physical activity are part of every weight management plan, whatever your cover.
Weight Loss Cover at a Glance
The table shows which system can help with each part of weight loss care. Your own cover depends on your eligibility and your policy.
| Part of care | Medicare or PBS | Private health |
|---|---|---|
| GP consultation | Medicare benefit if eligible | Not covered |
| GP telehealth consultation | Benefit if telehealth rules are met | Not covered |
| Specialist in their rooms | Medicare benefit if eligible | Not covered |
| Tests outside hospital | Medicare benefit if eligible | Not listed as covered |
| Dietitian or exercise physiologist | Benefit for 5 visits a year in total, with a GP plan | Extras cover may help |
| Treatment PBS-listed for you | PBS co-payment applies | Not listed as covered |
| Treatment not PBS-listed for you | No subsidy: full price | Some policies cover part |
| Weight loss surgery in hospital | Medicare benefit if eligible | Gold hospital cover; others vary |
The sections below explain each row and name its source.
What Medicare Covers for Weight Loss
Medicare benefits are based on a schedule fee set by the Australian Government. For a service outside hospital, Medicare pays the full schedule fee for GP services and 85% of the schedule fee for a specialist. Your doctor can choose to charge more than the schedule fee, and the difference is your gap, or out-of-pocket cost. If a doctor bulk bills, they accept the Medicare benefit as full payment and you pay nothing for that service (healthdirect).
Medicare also pays benefits for tests a doctor needs to treat an illness, such as pathology tests (privatehealth.gov.au). If you spend over a set amount in a year on certain services, Medicare pays a higher benefit for those services for the rest of the calendar year. Medicines are separate: they are subsidised through the PBS, which you use by showing your Medicare card at the pharmacy.
Telehealth consultations
For most general practice telehealth items, video or phone, Medicare pays a benefit only if the doctor has given you a face-to-face service in the last 12 months, or a face-to-face service in that time was arranged by the same practice. If you are registered with a practice through MyMedicare, telehealth with that practice also qualifies. A previous video or phone consultation does not count as face-to-face. Exemptions include people experiencing homelessness, people living in a declared natural disaster area, and preparing or reviewing a GP chronic condition management plan (Medicare Benefits Schedule, note AN.1.1).
Weight loss surgery
Medicare lists bariatric surgery for clinically severe obesity, which the schedule generally describes as a BMI of 40 or more, or 35 or more with other major medical conditions such as diabetes. It notes that some ethnic groups may face major health risks at a lower BMI, and that the decision to operate rests with the surgeon (Medicare Benefits Schedule, note TN.8.29).
As a public patient in a public hospital, you are treated at no charge. As a private patient, Medicare pays 75% of the schedule fee for the doctors' services, and your hospital cover may pay some or all of the remaining costs, depending on your policy. Weight loss surgery is a set category of hospital cover: Gold policies must include it, while Basic, Bronze and Silver policies may leave it out (hospital cover tiers).
Allied Health Support Through a GP Plan
A GP chronic condition management plan is available if you have at least one medical condition that has been present, or is likely to be present, for at least 6 months. There is no list of eligible conditions: your GP judges whether a plan would help you. The schedule's own notes give obesity as an example where a plan may be appropriate, when it needs managing alongside a chronic condition, such as after a heart attack (Medicare Benefits Schedule, note AN.0.47).
With a plan, your GP can refer you for up to 5 Medicare-supported allied health services each calendar year, or up to 10 for Aboriginal and Torres Strait Islander people. These can include a dietitian, an exercise physiologist or a psychologist. Unused services do not roll over, and these visits may still involve out-of-pocket fees. You get the plan through the practice where you are registered with MyMedicare, or through your usual GP. If you also live with type 2 diabetes, see weight management with type 2 diabetes.
Is Weight Loss Medication on the PBS?
Weight loss medication is not listed on the general PBS for weight management, as at 1 October 2026 (Schedule of Pharmaceutical Benefits). The Repatriation PBS for eligible veterans is a separate scheme with its own rules, so veterans can ask their pharmacist. In August 2026, the Health Minister said the Government and the companies had not yet agreed a price, and that this was the main barrier to a first listing (RACGP newsGP, 12 August 2026).
What the PBAC recommended
In November 2025, the Pharmaceutical Benefits Advisory Committee (PBAC) recommended a PBS listing of one weight loss medication for people with established cardiovascular disease and obesity, and named other groups it would prioritise for any future subsidy (PBAC minutes, November 2025).
How a PBS listing happens
A medicine must first be approved by the Therapeutic Goods Administration (TGA). Its company then gives evidence of a benefit over medicines already on the PBS, and consumers and others can give input. A committee reviews the evidence, and if it recommends a listing, the company and the government must agree on a price before the medicine can be listed (healthdirect).
The PBS medicine status website tracks each step. For the listing recommended in November 2025, it showed this as at 1 October 2026:
Completed: the submission, consumer comment, the PBAC meeting and recommendation, and the company's notice of intent and documents (lodged February 2026).
Not completed: acceptance of those documents (marked "Not Accepted"), agreement on the listing arrangements, the Government processes and the listing itself.
Listed for one condition, not another
Some medicines on the PBS are subsidised only for certain conditions (PBS fees and patient contributions), and you must meet specific criteria for some PBS scripts. A medicine that is not PBS-listed for your condition can still be supplied, but you pay the full price.
Where a treatment is PBS-listed for your condition, from 1 January 2026 a general patient can be charged a co-payment of up to $25.00 each time it is dispensed, and a concession card holder up to $7.70. Pharmacies can add some fees on top, such as a brand premium (PBS fees and patient contributions). The general amount will be indexed each year from 1 January 2027, and the concession amount stays at $7.70 until the end of 2029. If you and your family reach a yearly spending threshold on PBS medicines, you can get them at a reduced cost or free for the rest of the calendar year: ask your pharmacist.
If a treatment is not PBS-listed for you, ask your pharmacist what it will cost, check whether your private health policy covers part of it, and talk with your doctor or nurse practitioner about cost and other options.
What Private Health Insurance Covers
Private health insurance does not cover visits to your GP, or visits with specialists in their rooms (healthdirect). Those visits sit with Medicare, and any gap above the Medicare benefit is yours to pay.
Extras cover, also called general treatment cover, pays towards some services outside hospital, which can include pharmacy, a dietitian or an exercise physiologist. Nearly all of these services are covered only to a limited extent, with limits per service, per year or for life, and each insurer sets its own waiting periods.
For medicines, private health insurance can cover many medicines that are not listed on the PBS. Most insurers require a co-payment and limit how much you can claim. The Australian Government's summary of cover does not list private cover for PBS-listed medicines or for tests outside hospital (privatehealth.gov.au).
Hospital cover helps with the costs of care and accommodation as a private patient, including surgery, if your policy covers the treatment. An insurer can apply a waiting period of up to 12 months for hospital treatment of a pre-existing condition, which the law defines as one you had signs or symptoms of in the 6 months before you joined or upgraded (privatehealth.gov.au). Check this with your insurer well before any planned surgery.
How to Check Your Own Cover
Only the people below can confirm your own cover. These questions are a starting point:
Your GP. Would a GP chronic condition management plan suit me? Do you bulk bill, and will I have any out-of-pocket costs?
A telehealth service. Does this consultation attract a Medicare benefit, and what will I pay in total?
Your doctor, nurse practitioner or pharmacist. Is this treatment PBS-listed for my condition, and if not, what will it cost?
Your health insurer. Does my extras cover include medicines that are not on the PBS, and what are the co-payment and the yearly limit? Does it cover a dietitian or an exercise physiologist? Is my hospital cover Gold, or does it list weight loss surgery, and what waiting periods apply?
For the steps of a medical program, see how medical weight loss programs work.
Where Diet and Physical Activity Fit
Cover rules change, but the base of a weight management plan does not. A healthy diet is built on a wide variety of foods from the five food groups, with plenty of water (Eat for Health), alongside regular physical activity. In the trials the PBAC reviewed, everyone received some form of diet and physical activity advice or support, and the committee considered that diet and physical activity support should be encouraged alongside these treatments. It also noted that several states already provide free health coaching tailored to the individual, some in person, by phone or in groups. For everyday steps, see how to lose weight, what a calorie deficit is and how many steps a day to lose weight.
Telehealth With Burst Health
Burst Health offers telehealth consultations for weight loss over the phone with registered Australian doctors and nurse practitioners. You complete a brief online assessment, and a doctor or nurse practitioner calls you to discuss whether treatment is clinically appropriate. Any treatment is provided only where a practitioner considers it suitable for you, and outcomes vary between individuals.
Any weight loss medication sits alongside a healthy diet and regular physical activity, as covered above. Burst Health does not bulk bill.
Because Medicare and private cover leave gaps for weight management, Burst Health provides medical weight loss plans online after review by an Australian-registered doctor or nurse practitioner, and you can check whether you are eligible.
Frequently Asked Questions
Will Medicare pay for weight loss medication?
No. Medicare benefits pay towards services, not medicines. For weight management, Medicare can help with eligible GP and specialist consultations, tests, allied health visits with a GP plan, and bariatric surgery for clinically severe obesity. Medicines are subsidised through the PBS instead, and as at 1 October 2026 no weight loss medication was on the general PBS for weight management.
What weight loss procedures are covered by Medicare?
Medicare pays benefits for bariatric surgery when obesity is clinically severe. The schedule describes this by BMI and other major medical conditions, and the decision to operate rests with the surgeon. What you pay depends on whether you are treated as a public or a private patient, and on your hospital cover. The weight loss surgery section above gives the details.
When will weight loss medication be on the PBS?
The date is not yet known. The PBS medicine status website shows no listing date. After a PBAC recommendation, the company and the government must agree on a price before a medicine can be listed. In August 2026, the Health Minister said a price had not yet been agreed, and at 1 October 2026 the status website showed the listing arrangements had not started.
Does private health insurance cover weight loss medication?
It depends on your policy. Some extras policies cover part of the cost of medicines that are not listed on the PBS, usually with a co-payment and a limit on what you can claim. Private health insurance does not cover GP visits. Ask your insurer what your policy covers, and what you would pay, before you start any treatment.
Does private health insurance cover weight loss surgery?
It depends on your hospital cover. Gold is the only tier that must include weight loss surgery, so a policy on another tier may not cover it. A waiting period can also apply if you had signs or symptoms of the condition before you joined or upgraded. Ask your insurer whether your policy lists weight loss surgery before you plan any treatment.
How do I qualify for weight loss support under Medicare?
If you have a medical condition that has lasted, or is likely to last, at least 6 months, your GP may prepare a GP chronic condition management plan. The Medicare notes say a plan may suit obesity when it needs managing alongside another long-term condition, and your GP decides. With a plan, your GP can refer you for Medicare-supported visits with a dietitian or an exercise physiologist.
Medical weight loss plans, online
In three steps.
- 1Answer a quick questionnaireOnline, no appointment, no in-person visit.
- 2A practitioner reviews itAn Australian-registered doctor or nurse practitioner decides whether treatment is suitable for you.
- 3Start your planIf treatment is suitable, you start your plan with the practitioner supporting you throughout.
References
Pharmaceutical Benefits Scheme. Schedule of Pharmaceutical Benefits, 1 October 2026 (pbs.gov.au).
PBS medicine status website. November 2025 PBAC submission, established cardiovascular disease with obesity (information current as at 1 October 2026, pbs.gov.au).
Pharmaceutical Benefits Advisory Committee. Public Summary Document, November 2025 PBAC meeting (minutes, pbs.gov.au).
RACGP newsGP. News report on PBS price talks and the Health Minister's update, 12 August 2026 (racgp.org.au).
Pharmaceutical Benefits Scheme. Schedule of Pharmaceutical Benefits: fees and patient contributions.
Medicare Benefits Schedule. Note AN.1.1: eligibility criteria for MBS telehealth.
Medicare Benefits Schedule. Note AN.0.47: GP chronic condition management plans.
Medicare Benefits Schedule. Item 31575 and note TN.8.29: bariatric procedures.
Australian Government, privatehealth.gov.au. What is covered.
Australian Government, privatehealth.gov.au. Private health insurance.
Australian Government, privatehealth.gov.au. Waiting periods.
Australian Government, privatehealth.gov.au. Gold, Silver, Bronze and Basic hospital tiers.
Australian Government, privatehealth.gov.au. Clinical categories.
Eat for Health (NHMRC). Australian dietary guidelines 1 to 5.
This article is general information only and does not replace individual medical, financial or insurance advice. Please speak with a registered Australian healthcare practitioner, your health insurer or Services Australia about your own circumstances.