How do I claim Medicare and can I do it online?

In Australia, we’re lucky to have a public health care system – Medicare – that gives us access to medical services, subsidised prescriptions and free care as a public patient in a public hospital.

Regardless of whether you’re treated in a private or public hospital, if you’re admitted as a private patient, Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee for medical costs associated with your treatment and your private health insurance pays the remaining 25% of the MBS fee.

So, if you need to make a Medicare claim – what’s the simplest way to do it?

At nib, we like to keep things simple, so we’ve put together an easy-to-follow guide for claiming Medicare.

How to claim Medicare as an ‘out-patient’

An out-patient is someone who receives medical treatment, but has not been admitted to hospital. If you’re an out-patient, you can claim Medicare by following these steps:

1. Have your medical invoice ready.
2. Download the Medicare Claim form and fill out using the details on your invoice.
3. Once you’ve completed the Medicare Claim form, you can submit it to Medicare by post, in a Medicare branch, online or by using the Express Plus Medicare smartphone app.
4. If your bank account details are registered with Medicare, your benefit will be paid directly into your account within five business days.

How to claim Medicare as an ‘in-patient’

An in-patient is someone who is admitted to hospital for treatment. To claim Medicare as an in-patient, follow these steps:

1. Have your medical invoice and your nib membership number ready.
2. You have two Medicare forms to fill out. The first is the Medicare Claim form and the second is the Medicare Two-way Claim form.
3. Once you’ve completed both these forms, you can submit them to Medicare by post, in a Medicare branch, online or by using the Express Plus Medicare smartphone app.
4. If your claim is successful and your bank details are registered with Medicare, it will pay back a portion of your benefits directly into your account within five business days. Medicare will then send nib your claiming details for us to reimburse the remainder of your eligible benefits.
5. Once Medicare sends us the details of your claim, nib will process any payments directly into your nominated bank account within one business day. To update or review the bank details you’ve given us, head to Online Services.

Need to head to hospital?

If you're an nib member heading to hospital soon, make sure you check out our Going to Hospital page. This tool gives you information on health insurance, tips on how to reduce any out-of-pocket expenses and helpful questions to ask your specialist. To find out the details of your current policy, chat to someone about your upcoming hospital visit or get some guidance, call us on 13 16 42.