Information for health professionals who got their medical qualification outside Australia or New Zealand, or who were not citizens at the time of enrolment.
Under section 19AB of the Health Insurance Act 1973 (the Act), there’s a 10 year restriction on Medicare provider numbers for:
- overseas trained doctors (OTDs)
- foreign graduates of an accredited medical school (FGAMS).
To be eligible to claim Medicare benefits, OTDs and FGAMS may also have to meet the requirements of a general practitioner (GP) or specialist. Read more about GP and specialist eligibility requirements.
You’re an OTD if you got your primary medical qualification from a medical school outside Australia or New Zealand.
You’re an FGAMS if you:
- got your primary medical qualification from an accredited medical school in Australia or New Zealand, but
- weren’t a permanent resident or citizen of Australia or New Zealand when you enrolled in the medical school.
Under section 19AB of the Act, access to Medicare benefits is restricted for OTDs and FGAMS who either:
- obtained their first medical registration on or after 1 January 1997
- became a permanent Australian resident or citizen on or after 1 January 1997.
The section 19AB restriction is for 10 years, and it’s also called the 10 year moratorium. You can apply for an exemption from this restriction. The exemption lets you access Medicare benefits at the location where you’ll practise.
The 10 year moratorium
To apply to access Medicare benefits while under the moratorium, you need:
- to be practising in a district of workforce shortage (DWS)
- an exemption to get Medicare benefits at each location.
While you’re a temporary resident you must always satisfy section 19AB.
Once you’re a permanent resident or Australian citizen there will 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.
Applying 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 or
- apply to the Department of Health (Health) for an individual exemption on your behalf.
If Health needs to assess your application, it may take them up to 28 days.
If Health 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. The exemption has to be for the location where you’re practising and it can’t be backdated.
Districts of workforce shortage (DWS)
A DWS is a geographical area where the population has less access to Medicare-subsidised services than the national average.
Health identifies these areas using the latest Medicare billing statistics. They update the statistics every year to account for:
- changes in the make-up and geographic distribution of the Australian medical workforce
- an estimate of the residential population from the Australian Bureau of Statistics (ABS).
You can find out more about DWS on the DoctorConnect website.
Reducing the 10 year moratorium with scaling
OTDs and FGAMS can reduce their 10 year moratorium through a non‑cash incentive called scaling.
We work out your eligibility for scaling each month. You’re eligible if you meet all of these criteria:
- your moratorium period has started
- you have a section 19AB exemption for your practice location
- your total Medicare billing claim value equals or is above the $5,000 monthly threshold
- you work in an eligible Australian Standard Geographical Classification - Remoteness Area (ASGC-RA) 2-5 category.
The ASGC-RA is a geographic classification system developed by the ABS. It allows measureable comparisons between city and country Australia.
Doctors who practise in more remote areas get a bigger scaling bonus.
You can check the ASGC-RA classification of your medical practice using the locator map on the DoctorConnect website.
Scaling discounts and thresholds
You don’t need to apply for scaling discounts. You’ll get them automatically if you meet monthly eligibility criteria, including:
- meeting a schedule fee threshold of $5,000 each month
- practising in an eligible regional or remote practice.
If you practise at more than one location, we’ll base the scaling discount on the ASGC-RA with the highest claiming activity.
We base claiming activity on dates of service and schedule fee totals for eligible services. The result determines if you’ve met the value of schedule fee threshold for the month.
We make scaling calculations on the last day of each month. Calculations include that month and the previous 3 months. For example, a scaling calculation made on 30 June 2017 will include June, May, April and March.
This means we can see claims even if they’ve been submitted to Medicare after we’ve finished the monthly scaling.
Read more about Medicare benefits for health professionals.