Australian citizens eligibility for Medicare 011-44010000

Cocos (Keeling) Islands

Residents of Cocos (Keeling) Islands are eligible for Medicare for services provided in Australia if their citizenship or permanent residency status is established.

Christmas Island

Residents of Christmas Island are eligible for Medicare for services provided in Australia if their citizenship or permanent residency status is established.

Lord Howe Island

For the purposes of Medicare, Lord Howe Island is regarded as part of New South Wales.

Norfolk Island

From 1 July 2016, Medicare eligibility was extended to Norfolk Island. Eligibility applies to citizens and permanent residents of Norfolk Island.

Note: all Norfolk Island Provisional Resident Return (subclass 159) visas expired 31/12/2023

Itinerant workers are people who travel from place to place, usually for work.

Standard enrolment procedures apply. Customers must provide identification and supporting documents. See Document types for Medicare eligibility and enrolment.

If an itinerant could reasonably be expected to be in possession of, or to obtain, the required documentation, the customer should provide this documentation to enrol.

If an itinerant is unable to provide enrolment or identification documents due to extenuating circumstances, Service Officers can accept an identifying letter.

Request an identifying letter

The customer can provide a letter from a responsible representative of a welfare, religious or charitable organisation that identifies the itinerant.

Escalate enrolment request

If an itinerant, who appears to be eligible, is unable to provide the required eligibility and identification documentation, or an identifying letter, Service Officers must contact Local Peer Support (LPS) who will refer to Medicare Consumers Program Support - Medicare Consumers Section - Medicare and Veterans Health Branch for consideration.

When referring the application, Service Officers must provide detailed information as to why eligibility and identification documentation, or an identifying letter were unavailable or not provided.

People who entered Australia from Commonwealth countries prior to 1974 are considered legal residents and are entitled to Medicare. A customer presenting for enrolment on this basis should be asked to obtain a certificate of status from the Department of Home Affairs to verify their entitlement, standard enrolment procedures apply.

The customer must supply an identity document that can be verified through the Medicare Document Verification Service (DVS) portal.

Section 10 of the Health Insurance Act provides for Medicare benefits to be payable for medical expenses incurred for a medical service rendered in Australia to an eligible person.

There is no reference as to whether the seas around Australia or the airspace above Australia are to be regarded as part of Australia for the purposes of the Act.

If an eligible person is travelling between 2 Australian ports, Medicare benefits are payable for services rendered by registered medical practitioners on board the ship. Medical practitioners must be registered in Australia for benefits to be payable.

Medicare eligibility is not affected if the ship leaves Australian waters enroute.

Medicare benefits are not payable if an eligible person is travelling between

• an Australian port and a foreign port, or
• 2 foreign ports

Requests for enrolment (or an existing enrolment update) in Medicare from a customer who is homeless, must be made by the customer.

For customers 15 years of age, see Homeless child enrolments in Medicare.

Identification documents available

Where a customer requests enrolment in Medicare, standard eligibility and identification documents should be requested:

• Birth certificate, or
• Passport

Identification documents unavailable

Where identification documents are not available, the customer can provide a letter from one of the following:

• social worker
• minister of religion
• police
• member of the legal profession
• Salvation Army officer

The letter must:

• confirm the customers eligibility and identity, and
• advise why the customer is unable to meet the standard enrolment requirements

Note: eligibility refers to the customer's status as an Australian citizen or holder of permanent resident status.

The customer must provide a mailing address, this is to receive their Medicare card and correspondence.

If authorised by the customer, the mailing address can be the address of one of the above who have provided information supporting the application for enrolment.

Enrolment check

From the personal details provided, the Service Officer must search the Consumer Directory Maintenance System (CDMS) for an existing enrolment, and either update an existing enrolment or create a new Medicare enrolment.

Enrolment restrictions

Homeless customers cannot be enrolled in Medicare if the customer:

• refuses to give their correct name to enable Service Officers to locate the customer in CDMS
• cannot provide documentation to support their application to enrol in Medicare

Note: Service Officers must assure the customer that Services Australia maintains complete confidentiality and that the customer's whereabouts will not be disclosed.

Customers in witness protection programs should be aware of the correct channels to conduct business relating to the customers enrolment circumstances.

In the event a customer requests information or services relating to witness protection, the customer must be advised to contact the witness protection unit within the sponsoring agency.

Service Officers:

• should tell customers to seek legal advice, for example, through the police or an appropriate Legal Aid Office, if they:
• do not understand this advice, or
• are seeking to protect their identity independently of an official program
• must not, under any circumstances, identify or contact business areas responsible for witness protection within Services Australia

Medicare enrolments must continue to be processed in accordance with current policy. A customer must not be enrolled and issued a Medicare card without supporting documentation.

The agency has established a Witness Protection help line for Service Officer assisted enquiries only. For contact details, see Witness protection information.

Australian citizens are not eligible for Medicare if they have:

• been absent from Australia for 5 years or more (from their initial departure), and
• not returned to reside in Australia

Note: the 5 year period does not re-start on return visits to Australia if it is not to reside.

This does not include government and defence force personnel posted overseas.

Advice confirming that a customer is residing overseas can come:

• over the phone, or
• in person, or
• in writing (letter or email)

Where advice is received that the customer intends to or is residing overseas, enter the departure date (if known), in the Comments field in Personal.

Where a customer's absence from the country for 5 years or more has been confirmed but the exact date they left the country is unknown, eligibility can be end dated with the date advised or date the advice was received.

Note: an end date must not be applied to a customer’s record until they have been residing outside Australia for 5 years or more.

Australian citizens returning to reside in Australia after 5 years or more must provide:

• a completed Medicare enrolment form (MS004) or Digital Medicare enrolment (DME)
• a current passport (of all people listed on the application form), and
• 2 residency documents, or
• completed Commonwealth statutory declaration

See also: Document types for Medicare eligibility and enrolment.

For how to complete the Medicare enrolment, see Register a customer for Medicare in the Consumer Directory Maintenance System (CDMS).

If the customer was enrolled on a Medicare card with other family members, and those members have not returned to reside in Australia, then the customer needs to be transferred to a new Medicare card. The customer does not need to complete an Application to copy or transfer from one Medicare card to another (MS011) form.

Note: the entitlement start date is the date of arrival in Australia.

To enrol as an Australian citizen in Medicare, customers must prove their identity and residency.

Australian citizens that have never been enrolled in Medicare must provide a:

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

To prove the customer resides in Australia, they must also supply 2 residency documents dated within the last 6 months.

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

See Document types for Medicare eligibility and enrolment for more details.

Defence force personnel remain Australian residents for the purposes of the Health Insurance Act 1973 and are not required to satisfy the standard process for residency. This includes if they have been absent from Australia for more than 5 years.

Defence force personnel need the following to enrol or re-enrol in Medicare:

• Completed Medicare enrolment form (MS004)
• Identification, which can include:
• current Australian driver’s licence
• Australian birth certificate
• valid Australian passport
• Residential document, which can include:
• discharge papers
• evidence of employment
• a completed statutory declaration to support their application where documents cannot be provided

Entitlement details if not previously enrolled in Medicare

• Start date can be one of the following:
• date of birth
• if date of birth is prior to 01/02/1984 use this date 01/02/1984
• date of permanent residency or citizenship was granted
• End date - leave open
• Entitlement type - Australian Citizen

Government agencies post permanent officers overseas for varying periods of time to act as agency representatives. These representatives are Australian citizens who will return to their Australian employment at the conclusion of their overseas postings.

Overseas representatives are only temporarily absent from Australia and remain Australian residents for the purposes of the Health Insurance Act 1973. Medicare benefits are therefore payable during any short term return visit to Australia.

If a government employee has been absent from Australia for more than 5 years, they remain eligible for medical benefits incurred in Australia and are not required to satisfy the usual process for residency. They must provide documents to support they are a government employee.

Government employee will need the following to re-enrol in Medicare:

• Completed Medicare enrolment form (MS004)
• Identification, which can include:
• current Australian driver’s licence
• Australian birth certificate
• valid Australian passport
• Residential document, which can include:
• evidence of employment
• a completed statutory declaration to support their application where documents cannot be provided

The residency requirements for Australian citizens and permanent residents/New Zealand citizens applies to Missionaries.

A Missionary who has resided outside of Australia for longer than the allowable period is not eligible for Medicare unless they can provide evidence that they reside in Australia.

See: Ministerial Orders and Medicare eligibility and Permanent residents eligibility for Medicare.

An Australian Declaratory Visa (ADV) is issued in limited circumstances to Australian citizens who hold dual nationality. It is an administrative document that resembles a visa.

An Australian citizen may hold an Australian Declaratory Visa if they:

• have dual nationality and are under the age of 18 years
• are in an emergency, or
• are in a situation preventing travel on an Australian passport

When entering Australia on this visa type, the policy for Australian citizens returning to reside applies.

For details on Medicare eligibility for incarcerated customers, initial enrolment processes and replacement card requests received by or on their behalf, see Medicare number and Medicare card requests for incarcerated customers.