She and her husband Rob have been travelling from Fern Bay to Mayfield Medical Connection (MMC) for eight years.

She visits roughly once a fortnight for epilepsy, aphasia, asthma, reflux and anxiety. Mr Clayden visits about once a month for diabetes and asbestos related disease, pleural fibrosis.

"We are so grateful to have bulk billing doctors," she said.

"We live fortnight to fortnight. By the time we pay bills, put petrol in the car, buy food, there's not much left.

"Without the bulk billing I don't know where we would be."

Related: Hunter GPs warns changes to bulk billing incentives in January 2020 will mean vulnerable people, pensioners and children may need to be charged for services

The federal government updated the classification system used to determine doctors' eligibility for rural Bulk Billing Incentives on January 1.

Newcastle, Maitland, Kurri Kurri and Raymond Terrace are classified as metropolitan areas, but up until this year had an exemption to access the rural incentive.

Doctors in these areas now receive $6.40 instead of $9.65 to bulk bill patients on a Commonwealth health care card.

Patients can't opt to pay the $3.25 difference.

MMC co-owner Kath Teagle said Newcastle's population was different to Sydney's.

She said even with the higher incentive, bulk billing doesn't cover the cost of providing care because Medicare rebates have not kept up with CPI, but doctors and practices have been absorbing losses to help those who can't afford to pay.

She said under the lower incentive her practice will be about $38,000 worse off each year.

The Hunter General Practitioners Association estimates the region will lose about $7.5 million dollars a year.

Ms Teagle said her practice will be forced to start charging most of the patients who had been bulk billed up to this year.

At MMC, private patients currently pay $83.20 for a standard appointment and pensioners pay $60.70.

All patients receive $38.20 back from Medicare almost instantaneously, leaving them with an out of pocket cost of $45 or $22.50 respectively.

She is considering introducing a new fee level as a stepping stone.

She said doctors, who are employed as independent contractors, will use their discretion to determine who to continue to bulk bill.

"But that's not what the GP is in the room for... to judge their financial capacity to pay."

She said some patients will turn to GP Access, hospitals, or not seek help until their health worsens.

"This is the cheapest level of healthcare available, but the government keeps picking away at it," she said.

"Unless they're going to look at the actual ability of the population to pay, they're going to cause suffering and cost the public more money through hospital funding and chronic disease."

Dr Bo Wong used to bulk bill about 95 per cent of patients and said he wants to continue for as many of his elderly and mentally ill patients for as long as possible.

"I don't want money to be a barrier for how I treat a person," he said.

Pensioner Georgina Poon, 83, visits once every four weeks for her osteoporosis, diabetes and macular degeneration.

She uses taxis for transport due to her eyesight.

"Bulk billing makes a lot of difference," she said.

"If I have to [pay to] see a doctor it will cost me a small fortune."

She said paying would mean going without some groceries.

"Old people won't bother going to a doctor, they'll stay home and die. If not, the outpatients of hospitals will be full up."

A Department of Health spokesperson said "all doctors who bulk bill will continue to be eligible for standard bulk billing incentives".

"This change is about ensuring incentives are correctly targeted... [and] ensuring the latest data is used in our programs."

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