Medicare

What is Medicare?

You may have heard the term Medicare but are not really sure what it is or you may know a bit about it and what to know more.

Medicare is Australia's health care system which was introduced to provide eligible Australian residents with affordable and accessible health care.  Medicare was established based on the idea that all Australians should contribute to the cost of health care according to how much they earn.

Medicare provides access to:

• free treatment as a public (Medicare) patient in a public hospital, and
• free or subsidised (Medicare pays for a portion of the fee) treatment by medical practitioners including general practitioners (GPs), specialists (such as psychologists), participating optometrists or dentists (for specified services only)

Can I apply for Medicare?

You can apply for your own Medicare card anytime after you turn 15 years old.  You will need to complete a form to get your own card.  There are two forms to choose from depending on your situation.

1. If you have not been listed on another Medicare card or are unsure about whether you have, you will need to enroll for Medicare and get your own card.  You can download a form by following this link here
2. If you have been listed on another card but would like your own, then you would need to complete a Medicare Copy/Transfer Application form.  You can download one from this link here.

If you can't download a copy of these forms you will have to go down to your local Medicare Office and pick up a copy, or call (toll free) Medicare on 132 011 to find your local office.

I've finished the form, now what?

You will need to take the completed form into your local Medicare office and the staff there will need to see some ID. The ID needed are items such as a license, a school card or a passport. You will find all the ID that Medicare requires at the top of the form you have completed and it is important to bring all of these items.

If you can't get to a Medicare office, you can mail the form along with a statutory declaration (stat dec) signed by a justice of the peace (JP). The statutory declaration, which is signed by a JP, is needed because it shows Medicare that some one with authority has viewed your ID and have confirmed that you are who your ID says you are. You need to photocopy your ID and get the JP to sign these photocopies too.

Once you have completed the form and been to see a JP, you can mail your form, your statutory declaration and signed photocopies of your ID to Medicare. Their address is Medicare, GPO Box 9822, in your capital city.

Where do I find a JP?

You can contact your local council office to find a JP or you can call your local police station to find out when the JP is available.

If you want a copy of a statutory declaration before you go to the JP, you can download one by following this link here.

I have a card, but I need to get some money back.

Bulk billing

You do not need to claim from Medicare as the doctor will bill Medicare directly. You can ask at the practitioner's reception if they bulk bill. Medical centres usually bulk bill.  At these centres, where there are lots of doctors working, you will normally be able to just walk in and ask to see a doctor without an appointment. However, when you first walk in, it is a good idea just to check if they bulk bill.

Bulk-billing means the doctor bills Medicare directly, accepting the Medicare benefits as full payment for a service. In other words, all you will need to do is present your card and sign a form and you will not have to pay for the visit. The doctor can not charge you extra, nor can any other person or company. So, this means if the doctor bulk bills, you cannot be charged a booking fee, administration fee, a charge for bandages, record keeping or a charge by the doctor's company.

Most doctors will bulk bill some of their patients, such as pensioners or health care (Centrelink) cardholders. You should always be given a copy of the completed form.

I am seeing someone who does not bulk bill.

If you are seeing someone who does not bulk bill, you will usually be entitled for a rebate from Medicare. A rebate is the money that you get back from Medicare after a medical service. There are a few different ways you can get your rebate.

Online

Many medical practices can organise for your rebate to be transferred to your bank account. Once you've agreed have the rebate transferred, your claim will be sent online to Medicare for processing. Your benefit can be deposited into your bank account within four working days.

Here's what you do:

1. Check that your medical practice offers online Medicare claiming.
2. Bring your Medicare card to your appointment. Your Medicare card number will be used to lodge the claim. If the details on your Medicare card are not up-to-date this could delay the processing of your claim. To check if your details are current, call Medicare on 132 011.
3. Bring your bank account details and BSB number to have your claim deposited directly into your account. If you choose not to provide your bank account details, you will receive a cheque in the mail.

So next time you have an appointment at your medical practice, find out if they are offering online Medicare claiming.

By mail

You can send your completed claim form together with the original accounts and receipts, to Medicare, GPO Box 9822 in your capital city. Do not send your Medicare card when you claim by mail.

Telephone

You can call Medicare, give your claim details and then post your receipt and account - no claim form is required. Medicare will process your claim and pay your benefits into your nominated bank or send you a cheque. You can call 1300 360 460, 24 hours a day, seven days a week.

Medicare Australia Access Points

Medicare Australia Access Points are located throughout Australia in Rural Transaction Centres, state government agencies, pharmacies, post offices, locally based shops and even service stations. As with telephone claiming, you speak directly to a Medicare operator who will take down all of your details and begin processing your claims. Your documents are sent to Medicare and once these documents have been verified, the payment will be made. To find your nearest Medicare Australia Access Point, visit other Medicare claiming facilities.

Medicare two-way

If you are a member of a private health fund, you may be eligible to claim a rebate from Medicare and get the rest covered by your private health fund.  If your private health fund participates in this, you just have to go into your private health fund office and they will send the claim on to Medicare.

Or, you can go into your local Medicare office, fill in a Medicare two-way claim form and leave your participating private health fund accounts and receipts with Medicare. Medicare will pay any Medicare benefit owing to you and will send the rest of the claim to your private health fund for payment.

How will Medicare pay my benefit?

Electronic funds transfer (EFT)

If you have paid in full for your medical service, your Medicare benefit can be deposited directly into your financial institute account. Payment by EFT is faster than payment by cheque through the mail. To receive your payment by EFT you will need to provide your account details, including the BSB (branch identification number). Medicare claiming is strictly confidential. Your bank details will only be used to deposit your Medicare benefit.

Cash

If you have paid in full for your medical service and you claim at a Medicare office, you can request payment by cash (up to the branch cash limit) and you don't have to fill in a claim form.

Cheque

If you have not fully paid the account for your medical service, or you do not wish to receive your Medicare benefit by EFT or cash, a cheque will be sent to you by mail. For accounts that have not been paid, a cheque will be sent to you made payable to the doctor. You should give the cheque to your doctor along with any outstanding balance.

Claiming in rural & remote areas

Medicare now has a network of self-service 'telephone claiming booths' & pharmacy based 'fax machines' which you can also claim at. Just go to Medicare website to find out more www.hic.gov.au

Health Care cards

A Health Care card entitles people to benefits such as cheaper health care, cheaper medicines and travel concessions.
If you are receiving Centrelink payments, you will automatically receive a Health Care card.  However, if you are under sixteen but parents have a Health Care card, you will be able to use their card.