Medicare

Medicare is Australia's health care system. Medicare ensures that all Australians have access to free or low-cost medical, optometrical and hospital care while being free to choose private health services and in special circumstances allied health services.

Medicare provides access to:

  • free treatment as a public (Medicare) patient in a public hospital
  • free or subsidised treatment by practitioners such as doctors, including specialists, participating optometrists or dentists (specified services only).

Medicare covers all permanent residents and Australian citizens. Temporary residents and foreign diplomats and their dependants are excluded.

Accessing Medicare

To access Medicare, you need a Medicare provider number. This number allows your patients to claim Medicare benefits for the services you provide.

Your eligibility to access a Medicare benefit will change as you progress through your career in Australia. The eligibility requirements are set out in the Health Insurance Act 1973 (the Act).

The key sections of the Act that determine a doctor’s eligibility for a Medicare benefit are Section 19AA and Section 19AB.

Vocational Specialty (Section 19AA)

From 1996, doctors wishing to access a Medicare benefit are required to have Fellowship of an Australian medical specialist college. These requirements are set out in Section 19AA of the Act. Section 19AA encourages vocational specialty with an aim to improve the quality of doctors working in Australia.

Doctors who do not hold a specialist qualification are unable to access Medicare benefits unless they participate in an approved training or workforce program. These programs are sometimes known as ‘3GA programs’. This is a reference to Section 3GA of the Act.

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Workforce and Training Programs (3GA Programs)

Doctors undertaking placements on approved workforce or training programs, set out in Section 3GA of the Act, can access a Medicare benefit at a specific practice location for the period of the approved placements.

Programs under section 3GA have been designed to support doctors during specialist training and to meet the workforce needs of the Australian communities. Some examples of 3GA programs are:

General Practice Training Programs:
  • Royal Australian College of General Practitioners Fellowship Program – (PEP)
  • Australian College of Rural and Remote Medicine Fellowship Program – (IP)
  • Australian General Practice Training Program - AGPT
  • Remote Vocational Training Scheme - RVTS
Workforce Programs:
Specialist Programs:
  • Approved Private Emergency Department – APED
  • Specified specialist medical colleges training programs

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Restrictions for Overseas Trained Doctors & Foreign Graduates of an Accredited Medical School (Section 19AB)

Section 19AB limits Medicare access for Overseas Trained Doctors (OTDs) and Foreign Graduates of an Accredited Medical School (FGAMS) who became permanent Australian residents or citizens on or after 1 January 1997. These doctors are required to work in a District of Workforce Shortage (DWS) for a minimum period of 10 years. These restrictions are commonly known as the 10 year moratorium.

Scaling

For more information on Scaling see the scaling page.

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Medicare Provider Numbers

To work as a doctor in Australia, you may need to have a Medicare provider number. This number allows your patients to claim Medicare rebates for the services you provide.

A Medicare provider number may allow you to:
  1. raise referrals for specialist services; and
  2. make requests for pathology or diagnostic imaging services.
If you satisfy the legislative requirements, a provider number may also be used to:
  1. attract Medicare rebates for professional services rendered (that is, treat private patients).
    A Medicare provider number does not automatically allow you to attract Medicare rebates for your services. You should ask your Australian employer which level of Medicare access for a provider number you need.

    A Medicare provider number uniquely identifies both you and the place you work.

    How to apply for a provider number

    Medicare provider numbers are issued by Medicare Australia after an OTD has been offered a medical job in Australia. You’ll find application forms on the Medicare website.

    Provider number application forms

    Contact Medicare Australia for more information

    Phone: 132 150 (within Australia)
    Email: medicare.prov@humanservices.gov.au (Type 'Application for Medicare provider number' in the subject heading, and include which State or territory you’ll be working in in the body of the email.)

    Specialists

    Specialists requiring access to Medicare rebates that attract a higher 'specialist' payment need to apply for recognition as a specialist for Medicare billing purposes.
    Phone: 132 150 (within Australia)
    Email: srac@humanservices.gov.au