How to enrol in Medicare

The core group is Australian citizens, permanent residents, and New Zealand citizens living in Australia. If you are in one of those categories you are entitled to enrol from the day you arrive or from the day your permanent visa is granted.

Applicants for permanent residency can enrol if they have applied for a permanent visa and hold either a valid visa allowing them to remain in Australia or have applied for a parent visa. This catches a large number of people who assume they must wait for the grant.

Temporary visa holders from eleven countries with Reciprocal Health Care Agreements can enrol for limited cover: the United Kingdom, Ireland, New Zealand, Sweden, the Netherlands, Finland, Norway, Belgium, Slovenia, Malta and Italy. What is covered varies by agreement and generally extends only to treatment that is medically necessary while visiting — not to routine or elective care. Ireland and New Zealand do not issue a card at all; you present your passport at a public hospital.

Other temporary visa holders — most students, most working holidaymakers, most temporary skilled workers — are not eligible and need private health cover instead. Student visas require Overseas Student Health Cover as a condition; several skilled temporary visas require adequate health insurance.

You need identity, immigration status and residence. Bring originals, not copies — Services Australia will sight and return them.

That means your passport with the relevant visa, or your Australian citizenship certificate or full birth certificate; and proof that you live in Australia, such as a lease, a bank statement, a utility bill or an employment contract showing your Australian address.

If you are enrolling children, bring their birth certificates or passports and, where relevant, evidence of your relationship to them. Newborns are usually added through the Newborn Child Declaration completed at the hospital, which also starts the immunisation register record.

The simplest route is in person at a Services Australia service centre, where staff can sight your documents and enrol you on the spot. You will be given your Medicare number immediately, which means you can claim before the physical card arrives.

Enrolling online is possible through myGov if you already have a Centrelink or Medicare record to link, but for a first enrolment most people will need the in-person or postal route because there is nothing to verify against.

You can also enrol by post using the Medicare enrolment form with certified copies of documents. This is slower and it is the route that most often stalls on certification problems.

Once enrolled, add Medicare to your myGov account and download the Express Plus Medicare app. This gives you a digital card, which is accepted at most practices and pharmacies and is genuinely useful in the three weeks before the plastic arrives.

Medicare pays a scheduled fee for each listed service, set out in the Medicare Benefits Schedule. Doctors are free to charge more than that fee.

If a doctor bulk bills, they accept the Medicare benefit as full payment and you pay nothing at all. If they do not, you pay the full fee and Medicare refunds the scheduled benefit, leaving you with the gap. Bulk-billing rates vary enormously by region and by specialty, and gap fees for specialists can run into hundreds of dollars.

In a public hospital, treatment as a public patient is free — including emergency, surgery, and specialist care — but you do not choose your doctor and you wait according to clinical priority. Ambulance transport is not covered by Medicare at all; it is a state matter, free to residents in Queensland and Tasmania and charged elsewhere.

Prescription medicines are covered separately through the Pharmaceutical Benefits Scheme, which caps what you pay per script, with a much lower concession rate and an annual safety net.

The gaps are consistent and worth planning for: most dental care for adults, ambulance transport, physiotherapy and most allied health outside a care plan, glasses and contact lenses, most cosmetic procedures, elective surgery in a private hospital, and treatment overseas.

Some of these are what private health insurance 'extras' cover, and some — private hospital admission and choice of doctor — are what hospital cover buys. Whether that is worth the premium depends heavily on age, income and circumstances.

A Chronic Disease Management plan from your GP can unlock a limited number of Medicare-subsidised allied health visits a year for people with a chronic condition, and a Mental Health Treatment Plan does the same for psychology sessions. Both require the GP to prepare the plan first.