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International medical graduates (IMGs) working in private practice often have restrictions associated with accessing a provider number and claiming Medicare benefits.
IMGs include both:
- overseas trained doctors (OTDs)
- foreign graduates of an accredited medical school (FGAMS)
Under section 19AB of the Health Insurance Act 1973 (the Act), there’s a 10 year restriction on Medicare provider numbers.
Section 19AB restrictions and exemptions
Under section 19AB of the Act, access to Medicare benefits is restricted for IMGS who either:
- got their first medical registration on or after 1 January 1997
- became a permanent Australian resident or citizen on or after 1 January 1997.
If this applies to you, there’s a restriction for 10 years. You can apply for an exemption from this restriction. If you get an exemption, you can claim Medicare benefits at the location where you’ll practice.
The 10 year moratorium
To apply to access Medicare benefits while under the moratorium, you need an exemption to get Medicare benefits at your practice location.
To get the exemption you’ll also need to practice in either:
- a distribution priority area (DPA) for general practitioners
- a district of workforce shortage (DWS) for specialists.
If you’re a temporary resident, you must always meet the criteria in section 19AB.
Once you’re a permanent resident or Australian citizen there’ll be an end date on your restriction. This will be 10 years from when you registered with an Australian medical board.
It’s important to tell us if you change residency because this impacts your access to Medicare benefits.
Find out more about the 10-year moratorium and scaling on the Department of Health and Aged Care website.
Assessing for a section 19AB exemption
We’ll assess you for a section 19AB exemption when you apply for an initial Medicare provider number and each time you apply for a new provider number.
You must tell us if you become a permanent resident or Australian citizen. Then we’ll either:
- add your name to a class exemption under section 19AB if you’re eligible
- apply to the Department of Health and Aged Care (Health and Aged Care) for an individual exemption on your behalf.
If Health and Aged Care needs to assess your application, it may take up to 28 days.
If Health and Aged Care grants you an exemption, it’s sent back to us so we can either:
- give you a Medicare provider number
- confirm your eligibility to use your existing provider number.
You can still provide medical services but you can’t claim a Medicare benefit until you have an exemption in place. The exemption has to be for the location where you’re practicing and it can’t be backdated.
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.