General eligibility requirements

We determine eligibility to access Medicare benefits using the Health Insurance Act 1973 and related regulations.

To provide a service that attracts a Medicare benefit, you as a health professional must:

  • have a Medicare provider number for each practice location
  • meet eligibility requirements set out in the Health Insurance Act 1973 (the Act) or the relevant legislation relating to your specific health profession
  • have been advised in writing that you’re eligible to access Medicare benefits for your services.

If you don’t meet these requirements

If you don’t meet these requirements, you can still practise medicine. You still have to satisfy requirements set out by your registration body. You just can’t claim a Medicare benefit for your services.

You must let patients know that they won’t get a Medicare benefit before you provide a service to them. It’s an offence under section 19CC of the Act to provide a service without doing this.

Page last updated: 3 March 2022.
QC 48196