The concept of universal health cover in Australia is under increasing threat.  An aging population and an expansion of services have put pressure on both Federal and State Budgets to deliver effective and affordable health services.  Challenges of equity, access and affordability are significant.  The Federal government has responded to this by freezing Medicare Benefits recently and inadequate indexation for more than 20 years.  Previous attempts at Medicare reform have failed (the Relative Value Study) and new services are slow to be approved through the MSAC process.  Various budgetary attempts have been made to cut Medicare services including the introduction of GP Co-payments and more recently legislation that failed trying to limit access by patients to both out traditional Medicare Safety Net and the extended Medicare Safety Net.  In 2016 the government is embarking on a Medicare Benefits review process.  This process carries mostly threats for the profession and patients and very few benefits. This presentation will attempt to explain the pathways to Medicare reform and the potential effects on private practitioners and their patients.