How you apply for medicare Australia, what are you entitled to, what are the costs of healthcare, medicines through PBS, and more?

Medicare is a publicly funded universal health care scheme in Australia. Operated by the government authority Medicare Australia, Medicare is the primary funder of health care in Australia, funding primary health care for Australian citizens and permanent residents (except for those on Norfolk Island).

Residents are entitled to subsidised treatment from medical practitioners, eligible midwives, nurse practitioners and allied health professionals who have been issued a Medicare provider number and can also obtain free treatment in public hospitals.

As an NZ Citizen, you are eligible for Medicare Australia. However, you need to either live in Australia for 6 months or provide proof that you’ll be living here for the next 6 months.

I’ve been advised by mutliple visitors that there is a 2 to 3 months wait for Medicare applications to be processed. This is inconsistant with their website, which states 16 calendar days to process an application from the date they recieve it.

They do state that, some applications may take longer if the Department of Health and Aged Care need to assess them.

Therefore, get your application ready to go before you leave NZ and apply asap when you arrive in Australia. However, make sure you application is complete (see below).

The info you will find below in this post:

• Medicare Enrollment for NZ Citizens
• The process to enroll in Medicare Australia
• Medicare Australia Entitlements
• Medicare Eligibility
• Costs of healthcare through Medicare
• Pharmaceutical Benefits Scheme (PBS)
• Continence Aids Payment Scheme (CAPS)
• Medicare Australia Contact Details 

Medicare Enrollment for NZ Citizens

Here is all the information you will need for Medicare enrollment for New Zealand Citizens: https://www.humanservices.gov.au/individuals/enablers/medicare-enrolment-new-zealand-citizens.

It is recommended that you wait one week after your arrival in Australia before applying. This allows time for Medicare to receive your visa details from the Department of Immigration and Multicultural and Indigenous Affairs.

You get a Medicare card when you enrol in Medicare. They’ll usually tell you your Medicare number straight away and send your card in 3 to 4 weeks. They’ll send it to the address you give them. You can use a digital copy of your Medicare card as soon as you enrol.

You can get a digital copy of your Medicare card. You’ll need to sign into the Express Plus Medicare app to access it. To use the app, you need a myGov account linked to your Medicare online account. If you don’t have these, set them up and then download the app.

The process to enrol in Medicare Australia

Complete a Medicare enrolment form and mail or email it with your documents to Medicare Enrolment Services. You don’t need to get your supporting document certified. You can still apply in person in a Medicare Office. Please remember to take your passport.

Medicare Australia Entitlements

• Free treatment as a public hospital patient.
• An 85% rebate on the scheduled fee for treatments when you haven’t been admitted to the hospital (ie. A visit to the doctor).
• Medicare Safety Net – If you pay over and above the Medicare rebate you may be eligible. To find out more visit Medicare Safety Net.
• Health Care Cards are available from Centrelink for those requiring additional financial help. Permanent residents are usually subject to a 2-year waiting period before one will be provided. 

Medicare Eligibility

You can find the below information on the Medicare’s eligibility criteria webpage.

You can enrol in Medicare if you live in Australia and you’re any of these:

• an Australian citizen
• a New Zealand citizen
• an Australian permanent resident
• applying for permanent residency
• a temporary resident covered by a ministerial order.

You can also enrol if you’re a citizen or permanent resident of any of these: Norfolk Island, Cocos (Keeling) Islands, Christmas Island or Lord Howe Island. You may be able to enrol if you’re visiting from a Reciprocal Health Care Agreement country. 

Costs of Healthcare through Medicare

Prescription Medicine

The PBS rebate is deducted before being sold to you. From 1 January 2024, you may pay up to $31.60 for most PBS medicines or $7.70 if you have a concession card. The Australian Government pays the remaining cost (except brand premiums and certain other allowable charges).

The PBS Schedule lists all of the medicines available to be dispensed to patients at a Government-subsidised price. The Schedule is part of the wider Pharmaceutical Benefits Scheme managed by the Department of Health and Aged Care and administered by Services Australia.

Find out exactly how much your medication will cost in my costs of medication and operations in Australia post.

Doctor Visits

If your doctor has Bulk Bills (rather hard to find but more common for concession card holders), you should not have to pay anything for an appointment with your doctor.

If they do not bulk bill, you will need to pay the ‘gap’ between the Medicare rebate and the fee if the surgery will do the rebate on the spot, or the entire amount (most common). If you pay the entire amount you need to apply to Medicare for the rebate, in person or via the post.

The Medicare scheduled fee for a standard appointment is approximately $29.45 and the doctor’s fee can be around $40. Your out-of-pocket expenses are what is taken into account if you register for the Medicare Safety Net.

Operations and specialist services

The Australian Government Department of Health website has a tool for finding and understanding the costs of medical specialist services across Australia, including operations. You can search for a procedure or service or browse by category.

Find out how much your operational or specalist will cost in my costs of medication and operations in Australia post.

Pharmaceutical Benefits Scheme (PBS)

Under the PBS, the government subsidises the cost of medicine for most medical conditions. Most of the listed medicines are dispensed by pharmacists, and used by patients at home. Some medicines are dangerous to administer and need medical supervision (such as chemotherapy drugs) and are only accessible at specialised medical services, usually hospitals.

The PBS Schedule lists all of the medicines available to be dispensed to patients at a Government-subsidised price. The Schedule is part of the wider Pharmaceutical Benefits Scheme managed by the Department of Health and Aged Care and administered by Services Australia.

They now have the schedule online and it is updated every month. This online searchable version contains:

• All of the drugs listed on the PBS
• Information on the conditions of use for the prescribing of PBS medicines
• Detailed consumer information for medicines that have been prescribed by your doctor or dentist
• What you can expect to pay for medicines.

The Scheme is available to all Australian residents who hold a current Medicare card. Overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement (RHCA) are also eligible to access the Scheme (New Zealand).

You will need to provide your Medicare card every time you present your script to the pharmacist to receive subsidised medication.

You can read more about PBS on their website and search the PBS schedule to see if your medication is covered and what you can expect to pay. 

Continence Aids Payment Scheme (CAPS)

In Australia, the government has a Continence Aids Payment Scheme, which is a yearly non-taxable payment to assist eligible people who have permanent and severe incontinence to meet some of the cost of their continence products.

As a New Zealand citizen who holds a Special Category Visa (SCV), you have permanent residency rights under the Australian Citizenship Act 2007, therefore you are eligible for the scheme.

You should be able to find everything you need to know on the Continence Foundation of Australia website. 

Medicare Australia Contact Details

For more information on Medicare visit: https://www.servicesaustralia.gov.au/individuals/contact-us.

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• Private Health Insurance
• Having a baby in Australia
• Can an NZ citizen get an Australian benefit or pension?

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