Enrolling in Medicare

I recently had to enrol in Medicare, Australia’s universal healthcare scheme. Medicare covers citizens, residents and international visitors from 11 countries with reciprocal arrangements. The latter is me, a tourist from the UK.

If I need to see a doctor, get treatment or prescription then this would be covered or partly subsidised under the reciprocal arrangement with the UK.

Travel insurance policies, like mine, also stipulate Medicare enrolment for treatment in Australia.

I had a few minor medical issues which ended up costing around $200 for a consultation and treatment. I paid upfront as I wasn’t enrolled in Medicare and was advised I could claim back some or all of the costs once I was.

Once enrolled, there’s a few ways to make a claim, outlined on this Services Australia page. Online seemed quickest and easiest.

I had actually submitted a Medicare enrolment application a few months prior as a matter of course after reading the small print on my travel insurance. Hadn’t heard anything back.

Checked my email to see if anything had come back since I’d submitted the application, in case I’d missed it. Nothing apart from an auto-acknowledgement email.

The enrolment process I’d gone through is the same for citizens, residents or visitors. There is a single route to enrolment for everyone. It’s a 13 page PDF form. Download, fill it in and then email or post with the relevant supporting documents (depends on individual eligibility and circumstances).

The steps are:

• Read the Enrolling in Medicare guidance and check if eligible via relevant links on page.
• If eligible, download the MS004 Medicare Enrolment Form from this page.
• Complete the relevant sections of the form.
• Sign the declaration and email the form to MES@servicesaustralia.gov.au with “Enrolment” in the subject line along with the relevant supporting documents.

I’d done all of that. So I checked the email I’d sent to see if anything was missing or wrong.

The PDF form was password protected! Odd. I checked the original file on my MacBook. Password protected too. Very odd.

I downloaded a fresh MS004 PDF. Opened it using Preview, the default macOS PDF viewer. Filled in a few fields and saved it.

Password protected! With an unknown password. Unreadable.

That explains why nothing had happened with my application, they couldn’t open the form.

I dug around online. Looks like the PDF was created with password security enabled and this is a known issue with Preview and Services Australia forms. Other examples of the same problem here and here.

No mention of this on the Services Australia site. They do recommend using Adobe Acrobat Reader, including on the form itself.

PDF is an open standard so I was surprised to find the form was designed to only work with a specific vendor product. Especially from a government agency. But then it looks like Adobe were chosen even before a business case was started for myGov and related. Shady stuff.

Anyway, back to my enrolment. Time to redo it. I downloaded Adobe Acrobat Reader, filled out a fresh MS004, attached supporting documents and emailed. Double checking the PDF was not password protected.

Nothing after the auto-acknowledgement email. So let a couple of weeks pass and then decided to call to see if my application had been received. My time in Australia was drawing to an end and I wanted to have all this resolved before I left ideally.

The phone line is 24/7, number found here.

Tried calling a few times over the space of a week but the call was dropped by the automated system, saying all lines were busy. Persisted and eventually got through.

Spoke to an agent. He found my application. Form and supporting documents were fine. He also confirmed my first application had been unreadable due to the password protection. A known issue. Shame there’s no official guidance or help on this. Or better, a fix.

While I had the agent on the line I mentioned that I’ll be leaving Australia in about a month and need to make a claim. He confers with a colleague and says they can process my application and get me enrolled over the phone. Wonderful!

I’m transferred to a friendly member of the enrolment team. She asks for my basic details and then gets to work on enrolling me. Puts me on hold but checks in every five minutes or so. I continue holding. I’ve assumed she’s doing this with me in real time in case additional information or clarification is needed.

I’ve been on the phone for just over an hour but have been successfully enrolled in Medicare. Hooray!

I have a Medicare number. A Medicare card will be sent out to me. Fantastic. I really only need an online account to file my claim.

I’d already done my homework so have set up a myGov (digital identity) account and also have the app installed. I just needed a Medicare link code to link my Medicare account with my myGov account.

The staff member I’ve been on the phone with tries to generate the link code. It doesn’t work. Seems it won’t generate one for me because I have less than a month remaining on my current visa (a new visa is pending approval). Medicare is linked to visa expiration. I had pointed out my current visa was going to be running out a few times at the start of the call.

Without a link code I can’t access Medicare via myGov. Which means I won’t be able to submit my claim online.

I am advised on a few options:

• Print, fill out and post a claim form along with receipts and evidence before my current tourist visa expires, i.e. before my Medicare also expires.
• Go in person to a Services Australia centre. There is one 30 minutes away from me in South Yarra (I’m in the Melbourne CBD). I can make a claim in person.
• Wait until my new tourist visa is granted, then re-enrol for Medicare (using the MS004 13 page PDF again). Processing times were up to two months. Once re-enrolled I can get a link code for myGov and submit my claim online.

The in person service centre option intrigued me. It’s not just for Medicare but for everything under the social services umbrella. Welfare, pensions, child support. I know places like this very well from the UK.

Looking into some Google reviews for the service centre paints a bleak picture not dissimilar to what I’ve seen in the UK. Understaffed, low morale, apathetic, belligerent members of the public.

I didn’t like the idea of going to a place like that with my brown face and then sitting around for however many hours it may take to be seen.

So I decided to leave it. I’d try to re-enrol once my new visa came through and then make a claim online, likely after I’d left Australia.

I could live without $200. I feel for those who can’t simply brush it off as easily.

So.

I have certain expectations of services, online or otherwise. I did spend a decade working in the UK on just that kind of thing.

The lack of end-to-end service design here is disappointing. Actually, the lack of service design altogether.

This is the primary route for healthcare enrolment for Australians and non-Australians. It needs to be a service and not just a PDF form.

It needs clear and visible ownership. An empowered team plugged directly into users. It needs to be done in the open with user feedback resulting in continuous improvement.

Borrowing some good work and guidance from the UK (inline links), this could be a simple service, an online form (with document upload) for enrolment which could be completed in minutes on a computer or mobile. Step-by-step, one question per page. Bit of conditional logic. Tested with real users and iterated. Using lightweight design system components.

Application tracking later possibly. Backend for staff to enrol faster. A deeper look at the existing processes in the organisation… You know, real transformation. Driven by what the users need.

Citizens don’t have a choice about what public services they can use. It’s not a market, they can’t just switch to a different government. They have to use what’s provided. They expect services to be good. At least as good as what they can expect online for banking or shopping. And they paid for those services through their taxes.

I am being a little disingenuous here, I already know a fair bit about the internals of Services Australia, their capabilities and operating model. Professional curiosity. I did flirt with the idea of living in Australia for a bit. But this experience with Medicare enrolment has jarringly made all this very real.

This is a broader problem and one with seemingly no political will to solve.

A proper discovery and service line mapping in this area could be a good start. Maybe it’s happened already but then didn’t go anywhere. I’m just looking in from the outside.

Then there’s capability. That’s a problem.

Services Australia, you deal with some of the most vulnerable people in your society. They deserve better. They deserve services.

But maybe you’re just contract managers. Suppliers and consultancies have you over a barrel.

Doesn’t have to be that way. Can be better. Cheaper too.

I know. I’ve seen it. I’ve lived it.

Hugs to anyone inside Services Australia trying to change all this.