Australian citizens eligibility for Medicare 011-44010000

Australian citizens enrolling for the first time in Medicare must prove their identity and residency by providing:

• a Medicare enrolment form (MS004) or Digital Medicare Enrolment (DME), and
• a valid Australian passport, Australian birth certificate, or foreign passport, and Australian citizenship certificate
• 2 residency documents dated within the last 6 months

If the Australian citizen cannot provide residency documents after 6 months they can submit a Commonwealth statutory declaration. In some cases, a statutory declaration can be made available to an Australian citizen within 6 months from their arrival date.

See Escalation process for Medicare Eligibility.

If the MS004 is incomplete or documents are missing, Service Officers must request information. See Medicare eligibility and enrolments request for information.

If the DME documents are incorrect, see Digital Medicare enrolments (DME) and the MEE Portal.

For children under 12 months of age born:

• in Australia, see Child born in Australia enrolling in Medicare
• overseas, see Child born overseas enrolling in Medicare

To verify documents for enrolments, see Identity verification for Medicare enrolments and re-enrolments in the Medicare Document Verification Service (DVS) Portal.

Note: if a customer submits a DME application, DVS is completed in the MEE Portal. See Digital Medicare enrolments (DME) and the MEE Portal.

See Table 1 in Register a customer for Medicare in the Consumer Directory Maintenance System (CDMS).

After registration of a new customer:

• Select Entitlement on the Registration Type screen
• The New Medicare Entitlement Details screen will show:
• Entitlement Type Australian citizen
• Country of Relevance (Australia or previous country of residence)
• Entitlement Start Date date of arrival
• Entitlement End Date not applicable - open Medicare card

• Select Documents tab
• Select or key the details of each of the customer’s eligibility documents:
• Eligibility Document (mandatory)
• Residency Document (if applicable)
• Reference Text (mandatory)
• Reference Date (mandatory)
• Select Add
• Repeat above to enter all eligibility documents provided

A child born in Australia, who has resided in Australia for 10 years, automatically becomes an Australian citizen on their 10th birthday regardless of the parents status.

The following documents are required to enrol or update a child’s entitlement to Australian citizen:

• completed Medicare enrolment form (MS004), and
• child’s birth certificate, and
• child’s Australian citizenship certificate

If the MS004 is incomplete or documents are missing, Service Officers must request information. See Medicare eligibility and enrolments request for information.

To verify documents for enrolments, see Identity verification for Medicare enrolments and re-enrolments in the Medicare Document Verification Service (DVS) Portal.

If the child has not previously been enrolled in Medicare see Register a customer for Medicare in the Consumer Directory Maintenance System (CDMS).

Note: a parent must be listed as the group contact on the child’s new Medicare card.

After registration of a new customer:

• Select Entitlement on the Registration Type screen
• The New Medicare Entitlement Details screen will show:
• Entitlement Type Australian citizen
• Country of Relevance Australia
• Entitlement Start Date date of citizenship grant
• Entitlement End Date not applicable - open Medicare card

If the child has previously been enrolled in Medicare:

• Select Amend Consumer Details on the CDMS home page
• Key the child's Medicare card number in ID Number field
• Select Entitlement
• The New/Additional Medicare Entitlement Details screen will show:
• Entitlement Type Australian citizen
• Country of Relevance Australia
• Entitlement Start Date date of citizenship grant
• Entitlement End Date not applicable – open Medicare card

If help is required to change the child’s entitlement type to Australian citizen see Escalation process for Medicare Eligibility.

Note: if the child’s Australian citizen entitlement is different to the parent/s’ Medicare entitlement, transfer the child to a new Medicare card. An Application to copy or transfer from one Medicare card to another form (MS011) is not required.

• Select Documents tab
• Select or key the details of each of the customer’s eligibility documents:
• Eligibility Document (mandatory)
• Reference Date (mandatory)
• Select Add
• Repeat above to enter all eligibility documents provided

Customers updating their Medicare entitlement from Permanent Resident to Australian citizen must provide a:

• Medicare enrolment form (MS004) or Digital Medicare Enrolment (DME), and
• valid Australian passport or Australian citizenship certificate

Customers must provide these documents for each person listed on the enrolment form or listed in their Digital Medicare enrolment (DME) application.

If the

• MS004 is incomplete or documents are missing, Service Officers must request information. See Medicare eligibility and enrolments request for information
• DME documents are incorrect, see Digital Medicare enrolments (DME) and the MEE Portal

To verify documents for enrolments, see Identity verification for Medicare enrolments and re-enrolments in the Medicare Document Verification Service (DVS) Portal.

Note: if a customer submits a DME application, DVS is completed in the MEE Portal. See Digital Medicare enrolments (DME) and the MEE Portal.

See Table 1 in Register a customer for Medicare in the Consumer Directory Maintenance System (CDMS).

Once eligibility is established, enter the new entitlement details.

On CDMS home page:

• Select Amend Consumer Details
• Key the customer's Medicare card number in ID Number field
• Select Entitlement
• The New/Additional Medicare Entitlement Details screen will show:
• Entitlement Type Australian citizen
• Country of Relevance (previous country of residence)
• Entitlement Start Date date of citizenship grant
• Entitlement End Date not applicable - open Medicare card

Note: if the customer is amending their entitlement after returning from residing overseas their entitlement start date is their date of arrival. Two residency documents dated within 6 months of date of lodgement are required to prove residency in Australia.

• Select Documents tab
• Select or key the details of each of the customer’s eligibility documents:
• Eligibility Document (mandatory)
• Residency Document (if applicable)
• Reference Text (mandatory)
• Reference Date (mandatory)
• Select Add
• Repeat above to enter all eligibility documents provided

Returning Australian citizens who have been absent from Australia for more than 5 years must:

• complete a Medicare enrolment form (MS004) or Digital Medicare Enrolment (DME), and
• provide their passport and 2 residency documents dated within 6 months from date of lodgement

Customers must provide these documents for each person listed on the:

• MS004, or
• DME application

If the:

• Australian citizen cannot provide residency documents after 6 months they can submit a Commonwealth statutory declaration. In some cases, a statutory declaration can be made available to an Australian citizen within 6 months from their arrival date. See Escalation process for Medicare Eligibility
• MS004 is incomplete or documents are missing, Service Officers must request information. See Medicare eligibility and enrolments request for information
• DME documents are incorrect, see Digital Medicare enrolments (DME) and the MEE Portal

Note: if the Australian citizen has not returned to reside and has been absent from Australia for more than 5 years they are not eligible for Medicare unless they are visiting from an RHCA country. See Reciprocal Health Care Agreements (RHCA) eligibility for Medicare and Pharmaceutical Benefits Scheme (PBS).

To verify documents for enrolments, see Identity verification for Medicare enrolments and re-enrolments in the Medicare Document Verification Service (DVS) Portal.

Note: if a customer submits a DME application, DVS is completed in the MEE Portal. See Digital Medicare enrolments (DME) and the MEE Portal.

Once eligibility is established, add the new entitlement details.

On CDMS home page:

• Select Amend Consumer Details
• Key the customer's Medicare card number in ID Number field
• Select Entitlement
• The New/Additional Medicare Entitlement Details will show:
• Entitlement Type Australian citizen
• Country of Relevance (previous country of residence)
• Entitlement Start Date date of arrival
• Entitlement End Date not applicable - open Medicare card

Note: the group eligibility start date for Australian citizens has not changed, this remains the citizen’s original eligibility start date.

If an Australian citizen has been absent from Australia for more than 5 years:

• the previous entitlement must be end-dated five years after the date of departure (if known)
• and the exact date of departure is not known, the end-date is 5 years from the end of the known departure year. That is, 5 years from 31 December of the advised year of departure

• Select Documents tab
• Select or key the details of each of the customer’s eligibility documents:
• Eligibility Document (mandatory)
• Residency Document (mandatory)
• Reference Text (mandatory)
• Reference Date (mandatory)
• Select Add
• Repeat above to enter all eligibility documents provided