Medicare Benefits Schedule - Note GN.3.9

Last reviewed: 1 February 2024

This note sets out who can access Medicare services.

ELIGIBLE GROUPS

To be eligible for Medicare, a person must ordinarily live in Australia, be located in Australia at the time of the service, and be:

• an Australian citizen
  
  
• an Australian permanent resident
  
  
• a New Zealand citizen
  
  
• a Resident Return visa holder
  
  
• an applicant for permanent residency (conditions apply) or
  
  
• a temporary visa holder covered by a Ministerial Order.

Ministerial Orders made under Section 6(1) of the Health Insurance Act 1973 grant eligibility to groups including Australian citizens who have been absent from Australia for up to five years and holders of particular temporary visa types.

Note: access to Medicare by visitors to Australia who are covered by a Reciprocal Health Care Agreement is subject to the specific conditions of each Agreement (see below).

ENROLLING IN MEDICARE

The patient must enrol with Medicare before receiving Medicare benefits. Once enrolled, they will receive a Medicare Card. There are three types of Medicare cards, in the following colours:

Green – this is the standard Medicare card for Australian citizens, permanent residents and New Zealand citizens living in Australia and Resident Return visa holders.

Blue – this is the card for people who have applied for permanent residence or who hold a temporary visa covered by a Ministerial Order.

Yellow – this is the card for visitors to Australia from a country with a Reciprocal Health Care Agreement.

More information about enrolling in Medicare and the different Medicare cards is available from Services Australia.

RECIPROCAL HEALTH CARE AGREEMENTS

Under Section 7 of the Health Insurance Act 1973, the Australian Government has agreements with 11 other governments to cover the cost of certain medical care when Australians and overseas residents visit each other’s countries.

Eligible overseas visitors from these countries generally receive:

• inpatient/outpatient services as a public patient in a public hospital
  
  
• out of hospital care
  
  
• Pharmaceutical Benefits Scheme (PBS) prescription medicines

Exceptions: Visitors from New Zealand and Ireland are entitled to public hospital care and PBS drugs only (not MBS services).

Reciprocal Health Care Agreements do not cover the cost of treatment as a private patient in a public or private hospital.

People visiting Australia for the specific purpose of receiving medical treatment are not covered.

Eligible Countries:

As at 1 February 2024, Australia has Reciprocal Health Care Agreements with the following countries:

• Belgium
  
  
• Finland
  
  
• Italy (eligibility limited to six months from date of arrival)
  
  
• Malta (eligibility limited to six months from date of arrival)
  
  
• Netherlands
  
  
• New Zealand (public hospital care and PBS medicines only, not MBS services)
  
  
• Norway
  
  
• Ireland (public hospital care and PBS medicines only, not MBS services)
  
  
• Slovenia
  
  
• Sweden
  
  
• United Kingdom

Eligible patients from these countries need to enrol in Medicare to access MBS services. Once enrolled they will have a yellow Medicare card.

• Visitors from New Zealand and Ireland do not need to enrol in Medicare to access public hospital services and PBS medicines under the Reciprocal Health Care Agreements. They are not eligible for MBS services unless they hold a green Medicare card.

More information about access to medical care under each Reciprocal Health Care Agreement is available from Services Australia.

OTHER VISITORS AND TEMPORARY RESIDENTS

Other visitors and temporary residents are not eligible for Medicare and should arrange private health insurance cover.

RELEVANT LEGISLATION

Information about the legislative arrangements applying to Medicare and the Reciprocal Health Care Agreements is set out in the Health Insurance Act 1973, which can be found on the Federal Register of Legislation.

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