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Australians and certain overseas visitors are eligible for free or subsidised health services through Medicare, Australia's universal health scheme. Medicare claims can be made in several ways, including at the doctor's office, online, by mail, or in person at a Services Australia office. To process a claim, individuals must provide a doctor's invoice and proof of payment for services paid in full. Claims can be made through the Express Plus Medicare mobile app or online via a myGov account, with benefits typically received within 7 days. For those without access to digital options, claims can be made by mail or in person at a service centre, with benefits received within 21 days. It is important to ensure that bank details are correct and up to date to receive benefits.
| Characteristics | Values |
|---|---|
| Quickest way to make a claim | At your doctor's office straight after you pay |
| Other ways to make a claim | Online, by mail, or in person at a Services Australia office |
| Requirements to process a claim | Doctor's invoice, proof of payment if you paid for the services in full |
| Claim for someone else | Yes, if they are on the same Medicare card as you |
| Claim for multiple items | Yes, by selecting "Add another item" |
| Claim for services over 2 years old | No |
| Time taken to receive the benefit | Usually within 7 days for online claims, 21 days for claims at a service centre or by mail |
| Payment method | Electronic payment into the bank account registered with Medicare |
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What You'll Learn
Claiming at the doctor's office
When claiming at the doctor's office in Australia, there are a few simple steps to follow to ensure you receive your Medicare rebate promptly and efficiently. Firstly, ensure you have your Medicare card with you when attending your appointment. This is important as it contains your Medicare number, which is required to process your claim. After your consultation, proceed to the reception or billing area to pay for your medical service. Present your Medicare card to the practice staff, who will then swipe or enter your card details into their system.
You will then be asked to confirm your personal details, such as your name, date of birth, and address, to ensure that the information on file is accurate and up-to-date. The staff will then process your claim electronically through the Medicare online claiming system. This system allows for prompt processing of your rebate, usually resulting in a swift deposit into your nominated bank account.
In most cases, you will not need to submit a manual claim as the doctor's office will handle the claiming process on your behalf. However, it is always good to review your Medicare Benefits Statement, which you can access through your Medicare online account, to ensure that the claim was processed correctly and that you received the appropriate rebate. This statement will outline the details of the service provided, the amount claimed, and the rebate paid.
If for some reason, the doctor's office is unable to process your claim electronically, you may need to submit a manual claim. This can be done by completing a Medicare claim form and either posting it to Medicare Australia or submitting it in person at a Medicare service centre. However, this is quite rare, as most medical practices in Australia are set up for electronic claiming, making the process convenient and efficient for patients. Always remember to keep your Medicare card safe and inform Medicare of any changes to your personal details to ensure a smooth claiming process at the doctor's office.
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Claiming via the Express Plus Medicare mobile app
To make a Medicare claim via the Express Plus Medicare mobile app, you'll first need to download the app and create an account. You'll also need a Medicare online account linked to myGov.
Once you've downloaded the app and have the necessary accounts set up, you can open the app and log in to your Medicare online account. From your homepage, select 'Make a claim'. Before you start, check that you haven't already submitted a claim by viewing your claims history.
If you're claiming multiple items, select 'Add another item' and enter the details. If you need to delete an item, select 'Remove'. When you've added all the items, select 'Next'. You may need to provide referral details, including the provider number and the date of referral.
Next, you'll need to tell us what type of patient you were during the treatment. If you received treatment in a hospital, this will show up after any of the item numbers on your invoice or receipt. Select 'Next' again, and we'll give you a summary of the details you've provided. We'll also display the last four digits of your bank account number to protect your personal information. Please read through the details on this page and make sure they're correct.
If you need to make changes, select 'Edit'. If all the information is correct, read the declaration. If you understand and agree with the declaration, select 'Submit'. If you select 'Cancel', you'll exit the claim process and lose all the information you entered. We'll let you know if you've successfully submitted your claim. You can track the progress of your claim from your homepage.
After submitting your claim, you'll usually get your benefit within 7 days. We'll pay your benefit electronically into the bank account you've registered with us.
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Claiming online
To make a Medicare claim online in Australia, you need to have a myGov account linked to your Medicare online account. If you don't have either of these, you will need to create them.
Once you have set up your accounts, sign in to myGov and select Medicare. From your homepage, select 'Make a Medicare claim'. Before you start, check that you haven't already submitted a claim by viewing your claims history. You can only make a claim for one person on your Medicare card at a time. You will also need to check that your bank details are correct.
Next, tell the website whether the services have been paid in full. If they have, you will need to provide proof of payment in the form of a paid invoice. You can upload documents in PDF, JPG, GIF, PNG, or BMP format, with a maximum file size of 5MB.
After you complete your claim, remember to delete your documents if you are using a public computer. You will usually receive your benefit within 7 days.
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Claiming by mail
If you can't claim at the doctor's office or online, you can claim by mail. To do this, you must complete a Medicare claim form and post it. The address is on the form. When you submit your claim by mail, you will usually get your benefit within 21 days from when your form is received. You will be paid electronically into the bank account you have registered. If you need to claim an individual Medicare benefit of $10,000 or more, complete the Medicare claim form (MS014) and either email or mail it to High Value Medicare Claim Services.
You can also use the Medicare Two-way claim form (MS001) to submit your in-hospital and ancillary claims with Medicare and your private health fund. You can download and fill in the form and electronically sign it. You can also submit your claim online if your myGov account is linked to Medicare. Attach an image of your original accounts and receipts if paid, and an image of the completed form.
You can claim all Medicare services that aren't bulk-billed. You will need to send a copy of your invoice and receipt with your claim. Scan or take a photo of these documents and save them as a PDF, JPG, GIF, PNG or BMP format of less than 5MB in size. You will also need to provide your bank account details.
You can find the item number on your invoice or receipt. If there are multiple items, you will need to add them separately. If you are claiming multiple items, select 'Add another item' and enter the details. If you need to delete an item, select 'Remove'. You may also need to provide referral details, including the provider number and the date of referral.
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Claiming in person at a Services Australia office
If you can't claim online or at your doctor's office, you can claim your Medicare benefit in person at a Services Australia office. To do this, you'll need to submit a Medicare claim form in person at a service centre. You can also submit this form by mail. When you submit your claim in person at a service centre, you'll usually get your benefit within 21 days.
To process your claim, you'll need to provide Services Australia with a doctor's invoice for the service you want to claim and proof of payment if you paid for the services in full. You can download the Medicare claim form and complete it so that it can be processed quickly. You can also electronically sign some of the forms. Help is available if you use assistive technology or need an interpreter.
If your doctor bulk bills, you don't need to pay. When you pay at the doctor's office, ask if they can make an electronic claim for you. They'll do it on the spot, and your Medicare benefit will be paid into your registered bank account.
If you're claiming multiple items, select 'Add another item' and enter the details. If you need to delete an item, select 'Remove'. When you've added all items, select 'Next'. You may need to provide referral details, including the provider number and the date of referral. You'll then need to select the type of patient you were during the treatment.
You can also make a claim with the Express Plus Medicare mobile app on your mobile phone. To use the app, you need a Medicare online account linked to myGov. If you don't have these accounts, you'll need to create them.
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