Person—eligibility status, Medicare code N
Identifying and definitional attributes
|Metadata item type:||Data Element|
|Short name:||Medicare eligibility status|
An indicator of a person's eligibility for Medicare at the time of the episode of care, as specified under the Health Insurance Act 1973 (Cwlth), as represented by a code.
Admitted patient care:
To facilitate analyses of hospital utilisation and policy relating to health care financing.
|Data Element Concept:||Person—eligibility status|
Value domain attributes
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Data element attributes
Collection and usage attributes
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Eligible persons are
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 Republic of 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 (Cwlth).
In practice, the primary method for ascertaining Medicare eligibility status is undertaken by the healthcare organisation sighting the patient’s Medicare card.
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