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Data Element Detail

Medicare eligibility status
Identifying and Definitional Attributes
QH 040058 v1
Data Element
Data Element
Current
15-Jan-1998		Superseded
01-Nov-2012
Standard
01-Jul-1984
30-Jun-2012
An indicator of a person's eligibility for Medicare services as specified under the Commonwealth Health Insurance Act 1973.
Institutional health care: to facilitate analyses of hospital utilisation and policy relating to health care financing.
Medicare eligibility status
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
An eligible person includes a person who resides in Australia and is one of the following:
- an Australian citizen
- a permanent resident
- a New Zealand citizen
- a temporary resident who has applied for permanent residency and who has either an authority to work in Australia or an immediate family member who is an Australian citizen or permanent resident
- a person, or class of persons, who has been declared eligible for Medicare for the purposes of the Health Insurance Act 1973.

Other persons, as temporary residents, who are fully eligible for Medicare include:
- a person who is a head or member of a diplomatic mission or consular post or is a member of such a person's family, where there is a Reciprocal Health Care Agreement (RHCA) in place between Australia and the country they represent (currently United Kingdom, Republic of Ireland, the Netherlands, Malta, Italy, Sweden and Finland) - with the exception of New Zealand diplomats.

Other persons, as visitors or temporary residents, who are eligible for Medicare, in certain circumstances, include:
- persons who are visiting Australia and are eligible persons because there is a RHCA in place between Australia and their usual country of residence (currently United Kingdom, Republic of Ireland, the Netherlands, Malta (eligibility limited to 6 months), Italy (eligibility limited to 6 months), Sweden, Finland and New Zealand - it should be noted that the RHCA with New Zealand and the Republic of Ireland limits the access to medical services for their residents to that of public patients in public hospitals) - with the exception of New Zealand diplomats.

With respect to hospital services, persons covered by an RHCA (except RHCA diplomats as they have full Medicare eligibility) are eligible only as public patients in a public hospital and are ineligible persons if they are admitted as a private patient in either a public or private hospital;

It should also be noted that some patients can be both an 'eligible person' and either personally or a third party liable for the payment of charges for hospital services received; for example:
- prisoners
- patients with Defence Force personnel entitlements
- compensable patients
- Department of Veterans' Affairs beneficiaries
- Nursing Home Type Patients.

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.
An eligible person means: - a person who resides in Australia and whose stay in Australia is not subject to any limitation as to time imposed by law; but - does not include a foreign diplomat or family (except where eligibility is expressly granted to such persons by the terms of a reciprocal health care agreement); or - persons visiting Australia who are ordinarily resident in the United Kingdom, New Zealand, Sweden, Malta, Italy and the Netherlands are covered by reciprocal health care agreements. However, persons from Malta or Italy are covered for 6 months only.
Relational Attributes
Related Metadata References

Related Metadata References_IR

  • 1 - 2
ViewRelationshipMetadata Item TypeMetadata Item SubtypeNameIdentifier & VersionApproval Status
Has been superseded byData ElementData ElementPerson-Medicare eligibility statusQH 040058 Version 2Superseded
Is used in conjunction withData ElementData ElementMedicare card numberQH 040164 Version 1Superseded
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-198430-Jun-2012
Source and Reference Attributes
Australian Institute of Health and Welfare
METeOR data element: Person-eligibility status, Medicare code N, Identifier 339084 https://meteor.aihw.gov.au/content/index.phtml/itemId/339084/meteorItemView/long
Eligibility; Medicare;