Health care options? Confused!!

[Nearlythere1]

Hi All,

Just as i thought I had covered all the bases with regards to my impending move to Qld in November.... I read some health care threads regarding insurance and Medicare, Gap? and insurance etc... Now unfortunately I'm more confused than I was before lol...

We are moving on a 189 PR visa and I wondered if anyone could give some advice on the following? I realise that each individual has different requirements and am not looking for definitive answers, more, advisable scenarios.. Many thanks, in advance of any assistance given..

 

1, What is Gap?

2, What the most cost effective method of ensuring decent cover? (Comprehensive cover incl Dental)

3, Given that we originate from the UK, are there elements that we don't require due to the reciprocal arrangement between AUS and UK?

4, Would dental cover only, be a good option?

5, My OH had breast cancer in 2010, is this likely to vastly inflate the cost for her medical cover/insurance etc?

6, What cover did you go for and why?

 

Thanks again...

[Nearlythere1]

Wow.. This isn't a popular subject then.. :cry:

[Quoll]

Wow.. This isn't a popular subject then.. :cry:

The Aussies have all been asleep!

What is Gap? - the gap is when the doctor charges you $x and Medicare refunds you $y the gap is x-y and could be a few dollars, could be hundreds.

Cost effective? Check out iselect.com.au

Reciprocity? You're going to be permanent residents (and I will say you were very lucky given your OH has had cancer!) so Medicare will probably do the job. Private health cover is really only of value for elective procedures when waiting lists can be long and you don't get your doctor of choice necessarily. Private health insurance is a matter of choice - perhaps more of a no brainer if you are a high income earner. Your wife's previous illness will be a pre-existing condition and may be excluded from cover by private health or incur a waiting period (usually 12 months). Non related conditions aren't subject to the same restrictions.

Dental only? If you like. I never found dental cover that effective. Optical was a bit more generous.

 

We had top cover hospital with a hefty excess along with extras - cost around $250pm but gone up now no doubt. Was very grateful for it with a couple of elective surgeries that relieved considerable pain but lots of people do without. Be sure you have ambulance cover, that can cost you hundreds if not thousands in some states.

[boganbear]

1, What is Gap? - the difference between what you are covered for and what you need to pay. essentially it is an excess where you make up the difference

2, What the most cost effective method of ensuring decent cover? (Comprehensive cover incl Dental) most healthcare funds have a package which includes dental. make sure you get your teeth sorted before you leave the uK

3, Given that we originate from the UK, are there elements that we don't require due to the reciprocal arrangement between AUS and UK? No, you will be PR so this arrangement is irrelevant. its good for tourists for A&E treatment at a hospital only.

4, Would dental cover only, be a good option? its rare to find it

5, My OH had breast cancer in 2010, is this likely to vastly inflate the cost for her medical cover/insurance etc? don't know but probably

6, What cover did you go for and why? haven got any. i do worry about what would happen if something serious happens but I'll cross that bridge if it happens

[Nearlythere1]

Hi Quoll & Boganbear,

Thanks very much for the info, cleared quite a lot up for me.. Just a couple of follow up queries really... Mainly with Gap.. Is the Gap system something you have to sign up for? Or is it part of Medicare? does it relate to your insurance cover etc? I'm a bit thick so a scenario; I go to my doctor with the flu (because it's so cold in Qld), I have to pay him upfront, then Medicare refund a portion? If I have insurance, my insurance would cover the gap, if not i would wear the gap in costs? Hope that makes sense.. Thanks again for your input..

Edited September 1, 2014 by Nearlythere1

[Pumpkin]

Hi Quoll & Boganbear,

Thanks very much for the info, cleared quite a lot up for me.. Just a couple of follow up queries really... Mainly with Gap.. Is the Gap system something you have to sign up for? Or is it part of Medicare? does it relate to your insurance cover etc? I'm a bit thick so a scenario; I go to my doctor with the flu (because it's so cold in Qld), I have to pay him upfront, then Medicare refund a portion? If I have insurance, my insurance would cover the gap, if not i would wear the gap in costs? Hope that makes sense.. Thanks again for your input..

 

It isn't a "Gap" system, it is just a gap between what you are charged and what your medical will cover. Private Heath insurance in Australia is nothing like UK, it usually leaves you worse off as far as I can tell. The only reason I have it is because you get taxed more for not having it, so I might as well.

[Nearlythere1]

Hi Pumpkin,

Thanks for that.. The fog is starting to lift now.. Reading some older threads, it appears that if you have health insurance you don't pay an extra tax levy for Medicare (which is rated depending on your income, ie; 1.5%, 2% extra etc)? I understand that I might have 12 months to decide which way to go before having to pay the additional medicare tax levy? Obviously the level of private care is dependant on the level of insurance purchased, do the insurance policies generally cover the simple things like short term illnesses and one off prescriptions or are they tailored around the major medical needs, operations and long term care etc? Thanks again..

[Quoll]

Hi Pumpkin,

Thanks for that.. The fog is starting to lift now.. Reading some older threads, it appears that if you have health insurance you don't pay an extra tax levy for Medicare (which is rated depending on your income, ie; 1.5%, 2% extra etc)? I understand that I might have 12 months to decide which way to go before having to pay the additional medicare tax levy? Obviously the level of private care is dependant on the level of insurance purchased, do the insurance policies generally cover the simple things like short term illnesses and one off prescriptions or are they tailored around the major medical needs, operations and long term care etc? Thanks again..

They are essentially for hospital treatment. Prescriptions are rarely covered and even then not at full cost. Do a search on iselect and see what packages there are. I was with HCF - check them out for starters so you can see the sort of thing they offer.

 

The Medicare levy is paid by all. The Medicare surcharge is paid by high income earners who don't have private health insurance. You can take out insurance at any time but if you do it within the first 12 months your premiums are capped at the rate they would be if you were 31 - after that there is a loading for every year you are over 31.

[Guest]

I was about to mention the lifetime loading as a migrant moving over the age of 30 really is making a 'forever' decision on whether they want Private Health Insurance of not in the first 12 months - if you don't get it and later decide to you are charge a lifetime loading on the policies of 2% per year that you are over 30 i.e. if you take it out at 40 it would cost an additional 20% per year for the next 10 years (I think it stops after that - can't quite remember)

 

Although Quoll is right in saying the surcharge is for high earners - it is not that high in a dual income family and if you go over that threshold having PHI is a no-brainer, it would cost you more in tax not to. This is where it gets tricky as most people's income in Australia is lower in the first couple of years as they establish their careers, contacts and reputation - so you may be below the threshold but if after a couple of years you creep over it you then get slugged with either the surcharge or the lifetime loading - it's a 'lose-lose' situation!

 

I don't think anyone else has mentioned it yet but depending where you live you may be able to find a bulk-billing GP and this means no 'gap' for GP services - you still have to pay for prescriptions though and these aren't fixed price like the UK - I was on a drug that was over $40 a month (actually the recommended one was $30k er annum, I couldn't afford that!)

 

PHI doesn't really help with those costs anyway though! We had 'gap saver' as part of ours which essentially meant a savings pot held by HBF (our insurer) which we could use to cover gap payments - we used it for things like physio where the gap was $70 and my son went monthly.

 

It is absolutely a personal choice and probably more financially driven than anything else because even without PHI you can access private clinics etc. and all you pay is the gap.

 

My son needed to see a specialist, I could wait for Medicare which I was told might be up to a year (& then I may see a registrar) or see the specialist of my choice pretty much immediately privately - the GP suggested I phoned and asked what the gap payment would be (ie see the specialist privately and Medicare refund the payment Medicare would make anyway) - it was $100. To see a similar specialist in the UK is £500 (mind you when we got back I only waited 8 weeks on the NHS and where we were paying in total about $2k a year for his care - and that was with PHI - here everything has been free)

 

I do think once you go down the private route you spend much more though as my OH had a football injury before our HBF kicked in and was treated entirely on medicare, his physio, splints etc. were all free whereas when I needed splints the PHI covered the first $400 and I had to find the other $350!!!

[starlight7]

One of the problems is what they class as urgent with the free system. A friend of ours had pancreatic cancer and it took 6 months before they operated and of course during that time it spread. Many people take out private insurance if they are planning to have children because you have more choices. All up to the individual- if I was young I wouldn't bother but as you get older there is more chance you'll need it.

[Nearlythere1]

Hi All,

Thanks Quoll, Lady Rainicorn and Starlight7 for the info. I've just had a quick read through your posts having just got up. Still a bit fuzzy with sleep i'm afraid, I will give it an hour then re-read when fully awake as much of it didn't sink in.. Thanks again for your responses.. :SLEEP:

[Guest]

Nearlythere1 - do remember to breathe too - I understand the desire to get this all clear before you land, I was exactly the same, still catching up from the deficit of sleepless nights 6 years on :laugh: but what appears confusing becomes much clearer when you are on the ground - imagine trying to explain the income tax and NI system to someone outside the UK. One of the biggest challenges I found in migrating was being an adult with the knowledge of a 5 year old in terms of how things work but you do learn quickly even if you make some mistakes along the way.

 

This forum is great for getting opinions and everyone (myself included) are doing there very best to get their facts correct but we all make mistakes - once you arrive you can go into the Medicare offices and the offices of the Health Insurers and get the information you need from the horses mouth so to speak. Even then be careful - we were advised by a HBF consultant at our workplace that we were not entitled to medicare on a 457 visa and were sold a very expensive overseas visitors insurance, when we got out PR we then found out this had been completely unnecessary....I suspect because the HBF consultant was a migrant herself she based it on her personal experience coming from a country without a reciprocal agreement.

 

I would be tempted to take out a basic hospital policy when you arrive - almost everyone has dental and ambulance cover anyway as medicare doesn't cover that for anyone, don't bother with any other 'extras' (or 'essentials' as HBF like to call them!) such as physio or podiatry and then once you've got your head around both the health and tax system you can adjust (or entirely cancel) the policy accordingly.

[Nearlythere1]

Hi Lady Rainicorn,

Thanks very much for that advise. It does all seem quite daunting at first. Trying to get a handle on everything. We have good friends and relatives where we are moving to (Townsville or Brisbane) and I imagine that they will help to guide us down the right path, when the time comes. I think that I'm just trying to get a decent head start so that I don't have a completely vacant look on my face when having these things further explained on arrival.. I have found all your advice is helping my vacant look recede significantly lol.. :notworthy:

[Petkula73]

Don't worry about not understanding half of the terminology here. Australians have a love of making everything hugely complicated and using oblique and misleading terminology. If you have any "daft" questions, ask them on here. We've all been in the same boat when we suddenly realised that life here is so much more complicated than the UK. You'll soon get the hang of it though.

[Marisawright]

1, What is Gap?

Medicare (the equivalent of the NHS) and all the private health funds set standard fees for every service, but doctors, dentists, therapists etc can charge what they want. You are only covered for the standard fee, so the "gap" is the difference between that and what the practitioner charges.

 

2, What the most cost effective method of ensuring decent cover? (Comprehensive cover incl Dental)

There isn't such a thing as "decent cover", IMO, because of that "gap". If you have private health insurance it covers you for (a) treatment for things not covered under Medicare and (b) treatment in the private system. The private system is far more expensive than the public system, so even though you have PHI, the "gap" is often higher. So you get the crazy situation where if you get treated under Medicare, you might pay a "gap" of $250 for a knee operation, whereas if you go private, you're covered by your PHI but the "gap" is $750.

 

3, Given that we originate from the UK, are there elements that we don't require due to the reciprocal arrangement between AUS and UK?

No because you are going to be resident in Australia

4, Would dental cover only, be a good option?

Impossible to get

5, My OH had breast cancer in 2010, is this likely to vastly inflate the cost for her medical cover/insurance etc?

No, private health insurance rates are set for everyone. However it will count as a pre-existing condition and won't be covered at all for six months to a year.

 

6, What cover did you go for and why?

I went for the minimum possible PHI, plus dental and optical. It's really essential to have PHI because otherwise you'll be hammered with surcharge when you get older, but most funds have a minimum policy designed to allow you to avoid the tax penalty without breaking the bank. I chose an extras package because I wear glasses and have old-style British teeth (lots of fillings!).

 

Many people will tell you that you MUST have private health insurance, because waiting lists are long in the public system yadda yadda. Most of that is scaremongering by the health funds themselves. I have always had private health insurance, my husband never has, nor did anyone in his family. They have never had a problem getting treatment in the public health system. They have paid to have operations in the private system out of his own pocket when necessary - and overall, when you look at what he's paid out vs what I've paid out, I think he's ahead! He may regret it eventually, though, because it's now impossible for him to take out private health insurance - because he'd be charged 40% extra on top of his premiums because he didn't opt in to the system in his 30's.

Edited September 16, 2014 by Marisawright