[WWW - 2023.07.31]

Data Element Detail

Person-Medicare eligibility status
Identifying and Definitional Attributes
QH 040058 v2
Data Element
Data Element
Draft
29-May-2012		Current
02-Nov-2012		Superseded
03-Aug-2014
Standard
01-Jul-2012
30-Jun-2014
An indicator of a person's eligibility for Medicare at the time of an admitted patient episode or non-admitted patient occasion of service, as specified under the Commonwealth Health Insurance Act 1973.
Health services
Medicare eligibility status
Payment class (HBCIS)
Representational Attributes
Numeric
Code
N
1
1
Permissible Values

Permissible_values

CodeDescription
1Eligible
2Not eligible
Supplementary Values

Supplemenary_values

CodeDescription
9Not stated/unknown
Collection and Usage Attributes
Eligible persons are:

Permanent residents of Australia.

Persons who have an application for permanent residence (not an aged parent visa), and have either:
- a spouse, parent or child who is an Australian citizen or permanent resident, OR
- authority from Department of Immigration and Multicultural and Indigenous Affairs to work.

Foreign spouses of Australian residents:
- must have an application for permanent residence, as above.

Asylum seekers who have been issued with valid temporary visas. The list of visas is subject to changes which may be applied by the Department of Immigration and Multicultural Affairs.

American Fulbright scholars studying in Australia (but not their dependents).

Diplomats and their dependants from reciprocal health countries (excluding New Zealand and Norway) have full access to Medicare without the restrictions for American Fulbright scholars.

Reciprocal health care agreements:

Residents of countries with whom Australia has Reciprocal health care agreements are also eligible under certain circumstances. Australia has Reciprocal Health Care Agreements with Ireland, Italy, Finland, Malta, the Netherlands, New Zealand, Norway, Sweden and the United Kingdom. These Agreements give visitors from these countries access to Medicare and the Pharmaceutical Benefits Scheme for the treatment of an illness or injury which occurs during their stay, and which requires treatment before returning home (that is, these Agreements cover immediately necessary medical treatment, elective treatment is not covered). The Agreements provide for free accommodation and treatment as public hospital services, but do not cover treatment as a private patient in any kind of hospital.

- The Agreements with Finland, Italy, Malta, the Netherlands, Norway, Sweden and the United Kingdom provide free care as a public patient in public hospitals, subsidised out-of-hospital medical treatment under Medicare, and subsidised medicines under the Pharmaceutical Benefits Scheme.

- The Agreements with New Zealand and Ireland provide free care as a public patient in public hospitals and subsidised medicines under the Pharmaceutical Benefits Scheme, but do not cover out-of-hospital medical treatment.

- Visitors from Italy and Malta are covered for a period of six months from the date of arrival in Australia only.

Eligible patients may elect to be treated as either a public or a private patient.

A newborn will usually take the Medicare eligibility status of the mother. However, the eligibility status of the father will be applied to the newborn if the baby is not eligible solely by virtue of the eligibility status of the mother.

For example, if the mother of a newborn is an ineligible person but the father is eligible for Medicare, then the newborn will be eligible for Medicare.

Not eligible/ineligible: means any person who is not Medicare eligible. Ineligible patients may not elect to be treated as a public patient.

Prisoners are ineligible for Medicare, under Section 19 (2) of the Health Insurance Act 1973.
In practice, the primary method for ascertaining Medicare eligibility status is undertaken by the healthcare organisation sighting the patient's Medicare card.
Relational Attributes
Related Metadata References

Related Metadata References_IR

  • 1 - 2
ViewRelationshipMetadata Item TypeMetadata Item SubtypeNameIdentifier & VersionApproval Status
SupersedesData ElementData ElementMedicare eligibility statusQH 040058 Version 1Superseded
Has been superseded byData ElementData ElementPerson-Medicare eligibility statusQH 040058 Version 3Current
Implementation in Metadata Sets

Implemented

  • 1 - 1
ViewMetadata Item TypeMetadata Item SubtypeNameIdentifer & VersionObligationApproval StatusEffective FromEffective To
Information AssetData CollectionQueensland Hospital Admitted Patient Data Collection (QHAPDC)QH 020001 Version 1MandatorySuperseded01-Jul-201230-Jun-2014
Source and Reference Attributes
Australian Institute of Health and Welfare
METeOR data element: Person-eligibility status, Medicare code N, identifier 481841, Health, Standard 08/02/2012 https://meteor.aihw.gov.au/content/index.phtml/itemId/481841/meteorItemView/long
Eligibility; Medicare;