Medicare cards 011-44150000

Medicare eligibility is based on Australian residency. Under Section 3 (1) of the Health Insurance Act 1973, a person must meet one of the following requirements to be eligible for enrolment in Medicare as an Australian resident:

• An Australian citizen who resides in Australia
• A New Zealand citizen who resides in Australia
• A person with permanent residency status who resides in Australia (including return residents)
• An applicant for permanent residency status who resides in Australia (exclusions apply)
• Covered by a Ministerial order; or
• A resident return visa holder

A Medicare card has the administrative function of identifying customers who are eligible for Medicare benefits to health service providers. Benefits include:

• a range of medical services
• lower cost prescriptions
• free care as a public patient in a public hospital

See Medicare eligibility for enrolments for more details.

Medicare cards display a 10 digit number, the last digit indicates the card issue number. The card issue number goes up sequentially to 9 then reverts to 1.

Up to 9 people can be listed on a card number, with a maximum of 5 people on the first card and 4 people on a second card. Where there are more than 5 customers associated with the same Medicare card number, the remaining 4 names are embossed on a second Medicare card with the same Medicare card number as the first card.

When registering a person in CDMS and the error message '00685 Maximum Individual Reference Number (IRN) on card' appears, additional group members cannot be added as the Medicare card limit of 9 active IRNs has been reached.

CDMS allows up to 12 members to be associated with a Medicare card but only a maximum of 9 active members, and 3 non-active members. This means that a card can have an IRN of 10-12, if certain members (in the range of IRN 1-9) have been removed from the Medicare card.

Where more than one customer is to be associated with the same Medicare card number, the system will make sure that each customer has the same Medicare entitlement type with the exception of customers who have the following Medicare entitlement types:

• A - Australian Citizen
• E - Migrant
• ENZ - New Zealand Citizen

Customers who have Medicare entitlement types of A or E or ENZ can be associated with the same Medicare card number.

Where the customer's entitlement type is not one allowed in association with the entitlement types of the other members on the Medicare card, the customer must be transferred to a new Medicare card.

Where an inconsistency with the entitlement type exists, CDMS does not allow a:

• Medicare card (new or duplicate) to be produced, or
• Medicare enrolment to be updated

Service Officers must request a new Medicare card when an entitlement type is changed from one status to another. For example, applicant for permanent resident status (P) or (Z) to permanent resident status (E). If only one person is changing their entitlement type, they must be transferred off the card onto a card of their own.

Customers with different entitlement end dates cannot be on the same Medicare card. If a Medicare card has customers with different entitlement end dates, any card requests will automatically cancel.

Everyone enrolled on a card is allocated an Individual Reference Number (IRN) from 1 to 9. This number is against each person listed on the Medicare card.

By combining the Medicare card number with the person's IRN on the card, this uniquely identifies each person on the card. The names of the customers are embossed on the physical Medicare card in ascending order of their card reference number.

Service Officers processing enrolments for Medicare with more than one customer to be enrolled on the same card, must check the order in which the customer is attached to the card.

A CDMS error allows Service Officers to create Medicare cards with incorrect Individual Reference Number (IRN) positions. This occurs when customers with existing Australian Immunisation Register (AIR) records are added to the Medicare card. CDMS creates these records as IRN 1 instead of populating the card based on the order enrolled.

Some Service Officers swap the group names on the card to align with the requested position, this:

• creates intertwined records
• causes privacy breaches, and
• impacts claims and program entitlements

Service Officers cannot change an IRN on a Medicare card once it has been created.

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

When a person first enrols in Medicare, they are allocated a Personal Identification Number (PIN). As a person's Medicare card number may change if they are transferred or copied to a different card. The PIN links the person to all card numbers to maintain claims history. The PIN allocated when the person first enrolled stays the same.

On initial registration in CDMS, every customer is allocated a Consumer Identification (ID) number. This is system generated and cannot be amended, the consumer ID is the systems’ key to an individual person.

A customer is registered for Medicare using CDMS. A Medicare card issues to the customer depending on their entitlement type. There are 3 types of Medicare cards:

Standard Medicare card (green)

Issued to a customer residing in Australia and:

• an Australian citizen
• New Zealand citizen
• Migrant, or
• Diplomat

All standard Medicare cards (including new enrolments, automatic re-issued cards, and operator re-issued cards) are issued for a period of between 5 and 7 years.

Interim Medicare card (blue)

Issued to a customer residing in Australia and:

• are applicants for permanent resident status
• under Ministerial Orders

All interim cards (including new enrolments and re-issued Medicare cards) are issued in accordance with the policy and procedures that surround these enrolment types.

RHCA Medicare card (yellow)

Issued to a customer visiting from a Reciprocal Health Care Agreement (RHCA) country.

All RHCA cards (including new enrolments and re-issued Medicare cards) are issued in accordance with the policy and procedures that surround these enrolment types.

See the Resources page for more details.

A Medicare card is posted to the group contact and usually takes 3-4 weeks.

Where a card is required immediately and the customer is in a service centre, Service Officers can print a temporary card and issue it to the customer.

Medicare will send a notification to a customer's myGov inbox where they have:

• submitted a digital Medicare enrolment (DME) application, and
• it has been processed, but they do not have Medicare linked to a myGov account

This notification contains a link to the Medicare digital access page where the customer can view Medicare card details. See Digital Medicare enrolments (DME) and the MEE Portal.

Customers can find and use a digital copy of the Medicare card in the Express Plus Medicare mobile App, or add it to their myGov app.

Digital Medicare card in myGov app

Customers can add the digital Medicare card(s) to the wallet in the myGov app. The digital Medicare card in the myGov app has protections against fraud and theft including a myGov hologram, QR code and time stamp.

The digital Medicare card is a verifiable credential. This means that customers can use it to prove identity and to access Medicare services.

See Using myGov accounts for more details on adding digital Medicare cards to the wallet.

The digital Medicare card has not replaced physical cards. Health professionals can choose whether to accept a patient's digital Medicare card. Accepting a digital Medicare card is voluntary, so customers should be encouraged to carry the physical Medicare card.

Health professionals can scan the QR code using the myGov app on a mobile device if the practice or location has one. There is no requirement to sign into the app to scan the QR code.

For more details on how to scan the QR code on the digital Medicare card, see Help using the myGov app.

When a Medicare card is about to expire, a card will automatically be sent to the group contact's address. This is subject to a check of the returned mail flag in CDMS and if the group contact is current on the card.

If there is:

• no return mail flag:
• the system automatically reissues a Medicare card and sends it to the group mailing address recorded in CDMS
• a return mail flag:
• the system will not send out a replacement card as the address is known to be incorrect. It is the responsibility of the group contact to contact Medicare, and update address details and request a new Medicare card

The interim Medicare (blue) card replacement program will continue to automatically reissue blue Medicare cards. However, this will depend on whether the:

• Medicare record has been linked to Department of Home Affairs, and
• application has not been withdrawn or refused within the full cycle of cards

After this, Medicare cards will need to be reissued manually if required.

See the Resources page for details about the allowable periods for interim Medicare cards.

Service Officers must change the Group Eligibility End date in card request in CDMS, and issue a new card:

• if there is no change in entitlement type, and
• an entitlement period is to be extended

This date will then show in Entitlement.

A new entitlement type does not need to be added or amended.

Medicare Reciprocal Health Care Agreement (RHCA) cards are not automatically replaced. Where a request over the telephone or face to face to re-issue a RHCA card due to being lost or damaged is received, the Service Officer must check the expiry date of the Medicare card.

If the card is:

• not due to expire for over a month, a Medicare card can be reissued to the address given by the customer
• due to expire in less than a month, the card can be re-issued. However, the production control address must be used to prevent a Medicare card being produced, while still enabling the customer to make a claim

Where the RHCA card has expired, the Service Officer must confirm that the customer continues to meet the relevant RHCA country’s criteria to remain eligible for continued Medicare cover.

See Reciprocal Health Care Agreements (RHCA) eligibility for Medicare and Pharmaceutical Benefits Scheme (PBS) for more details.

Medicare can issue a replacement card where the original card is:

• worn, destroyed, damaged
• lost
• stolen
• outdated, expired

Customers can use different methods to request a replacement Medicare card. The Process page has more details.

For Medicare cards that have a Business Integrity (BI) flag, see Suspected Medicare fraud and Business Integrity (BI) flags for more details.

Note: when a BI Flag is applied to a customer's Medicare card, it will stop a replacement card from issuing.

A BI flag can indicate possible fraudulent activity linked to a Medicare card.

When a BI flag has been applied to a customer's Medicare card, it may stop the normal operation of the card, even when a replacement card has issued.

See Suspected Medicare fraud and Business Integrity (BI) flags for more details.

A duplicate card is a reproduction of the current card showing the same details. Medicare can only issue a maximum of 2 cards showing the same details. A duplicate card should only be issued where there is more than one person over the age of 15 years enrolled on the card. Customers can use different methods to request a duplicate Medicare card.

When a customer contacts Medicare for re-issue of the Medicare card, and the expiry date in CDMS is greater than 6 months, Service Officers must ask if the customer has been residing outside of Australia. See New card requests for expired cards on the Process page.

If the customer is quoting an expired Medicare number and it can be confirmed a new card has been issued, see the Process page for new card requests for expired cards.

CDMS no longer has the suppressed function. Where a customer on a Medicare card is suppressed, it stops the customer from being printed on a physical group Medicare card.

Where a customer previously suppressed requires a Medicare card, Service Officers must escalate to Medicare Eligibility Local Peer Support (LPS). See Medicare and Aged Care - Local Peer Support (LPS) for more advice.

If an Australian Government employee or a member of the Australian Defence Force has been absent from Australia for more than 5 years, see Table 2 Step 8 on the Process page for more details.

If the person has not returned to Australia to reside, Medicare cannot issue a card.

See Australian citizens eligibility for Medicare for more details.

Replacement of a Medicare card

Where a customer is a resident of a nursing home or long-term care facility, the administrator may apply on behalf of the customer if meeting the following conditions:

• the customer is not enrolled with another person on their Medicare card, and
• there is no:
• Power of Attorney
• Guardianship Order for a person or organisation other than the nursing home or long-term care facility, or
• Authorised Representative

To apply, the administrator must provide a signed written request on a letterhead. It must explain why they are applying on behalf of the customer and state that there is no other person who may apply on the customer's behalf. A request cannot be actioned over the telephone.

Send replacement requests to Medicare Enrolment Services.

Note: long-term facilities may include Mental Health Inpatient Units, Assisted Care, and Disability Care.

Request for release of Medicare card number or expiry dates

Service Officers cannot release a customer's Medicare card details, including the number and/or expiry date, to a nursing home or long-term care facility where it is used for their administrative purposes.

The group contact on a Medicare enrolment record has no particular status and no advantage over any other customer on the enrolment. Persons are eligible for Medicare benefits by virtue of the provisions of the Health Insurance Act 1973, and whether or not they are the group contact is irrelevant.

A group contact is to identify a customer on the Medicare card who receives Medicare correspondence.

Changing a group contact on an existing enrolment can be processed over the telephone or at a service centre. The customer must be enrolled on that Medicare card and be over 15 years of age. The Process page has more details.

Note: where the group contact is deceased or leaves the Medicare card, the group contact must be changed to another person on the Medicare card who is over the age of 15 years.

See Amend deceased persons Medicare enrolment or Copy or Transfer a person or child to another Medicare card for more details.

Medicare cards can be issued in error because a person has been enrolled:

• in Medicare but is not eligible
• on the incorrect Medicare card number
• in Medicare but has not provided sufficient documents to confirm eligibility or identity

Where a Medicare card has been issued in error, Service Officers must identify what action to take (depending on what type of error has occurred) to prevent issuing of the card.

Where a Service Officer identifies that the customer has been issued a Medicare card incorrectly, they can have the Medicare card extracted by completing the Card Extract request form no later than 12 o’clock midday (AEST) the following day.

The extracted card does not need returning to the Service Officer, as the enrolment must be rectified immediately and a new Medicare card issued.

The Process page has details on Medicare cards issues in error. The Resources page contains a link to the Card Extract Form.

Medicare cards should only ever be stopped in extreme circumstances as stopping a Medicare card affects the ability to claim benefits. This results in rejected medical claims for all customers listed on the card.

Service Officers must:

• contact Medicare and Aged Care - Local Peer Support (LPS) to identify the action to take, (depending on what type of error has occurred) to prevent the card from being issued before stopping a card
• enter detailed comments in the Group Comments field in CDMS, as all stop cards appear on a daily report

Medicare cards may be returned by the public or health professionals by post or in person at a service centre.

Returned Medicare cards received are set with a Return mail indicator flag in CDMS. See Return to sender (RTS) mail for Medicare.

The indicator on the customer's record alerts the system not to send correspondence or cards to the address. See Return to sender (RTS) mail for Medicare.

There are 6 special card numbers available for use in a Pharmaceutical Benefits Scheme (PBS) claim in certain circumstances where eligible customers cannot produce a Medicare card or number. For example, emergency situations.

For more details about the 6 special card numbers to use in a PBS claim, see Claims processing in the Pharmaceutical Benefits Scheme (PBS) Claims Processing System.

Service Officers must not:

• enrol a customer using a Special Medicare card number
• update a Special Medicare card number with customer details
• issue or release a Special Medicare card number to anyone, or
• use a Special Medicare card number for claims