Health insurance - what is it sensible to buy?

This is a pretty basic question which I'm sure has been asked before, so apologies if that's the case (I did try searching).

We're moving to Australia shortly, from the UK, under a 444/461 combination (NZ passport holder + family). I think we'll be entitled to Medicare under the reciprocal arrangements, and I've read that it's not compulsory to buy any additional health cover unless that is stipulated on your visa, which it isn't. But, assuming that's true, is it sensible anyway to buy extra health cover on top of what's provided by Medicare? If so, what level of cover would people recommend? Our prospective employer's information pack mentioned "medical repatriation", would that be a minimal thing? And what sort of organisations/companies might be the best to go to for health insurance?

Firstly I think it depends where you are moving to. If you are going to be in a large city and your health is good I wouldn't bother. If you are moving rural then it is a must as I found out myself. Since I moved to FNQ I think we worked it out I will have had well over 20 operations in the last three years. 90% of them could not be done in the hospitals up there so I chose my own specialist and went to both Sydney and Brisbane for treatment. Please note though that even with private health you can be out of pocket thousands. So public is probably the best way to go unless you are a medical disaster like me.

I recently emigrated on a 189 visa and have purchased platinum extra cover only which iam so glad i did! Recently had toothache and needed fillings, x rays and what not bill came to $1300! Private extras covered half thankfully so got my money back already! This was a shock as had a check up prior to leaving UK and no problems!

Medicare as been good to everything minor as happened sinc we arrived after all being really healthy in the UK haha!

Being a family of four we have each had to see the doctor and only had to pay for antibiotics, no additional charges! I also had a skin check as i have lots of moles and only had to pay half! Both children have had the vaccines required to oz with no charge and my son has kust fractured his foot no charge! Think the extras is required though for dentist, physio, ambulance etc !

Thanks for the quick replies.

We're not going to the back of beyond so will definitely think about TPQ's suggestion. I've had a look at "platinum extra" and it seems to be contrasted with "hospital cover". Is the hospital cover the same as in the UK, i.e. you'll get to go into an NHS/Medicare hospital, and won't be charged for it, if you're not covered, but will get to go to a fancier hospital, possibly more quickly (and might still have to pay extra) if you are?

And can I take it that if you haven't bought at least "extra" cover, you'll be charged if you ever need to go in an ambulance?

Loulou's post reminds me that I forgot to ask about our toddler. Would his dental care be covered by Medicare, or would we need to pay/insure for his dentistry as well? [And thanks in particular for the indication of how much dental treatment costs if you're not insured.]

I've also spotted one or two other relevant threads now, and have had a quick look at them. All sounds very complicated, with bulk billing, claiming back unpredictable amounts of money etc.! I guess bulk billing GPs are like NHS dentists in the UK, you can get to see one in theory but not always in practice, depending on where you live?

I would always ensure you have ambulance cover.

We downgraded our private cover this year. Paying almost $200 for a heap of extras we never used. Pay $90 or so now.

We we use a bulk billing GP and any scans, X-rays or ultrasounds they refer us for are bulk billed also. Along with quite a lot of other things like blood work, steroid injection with ultrasound and more. We use them as our regular GP and make appointments ahead of time or on the day if urgent.

Dental we we don't have cover now. We figured the $110 we save each month would cover any dental and so far it's been well within the saving made. Of course we fully expect a big bill for dental at some point which is IMHO on a par with private dental in the UK cost wise. Not everyone uses NHS dentist in the UK for one reason or another but if you are not familiar with how it costs etc it can be a shock when moving here.

Eye test was free. So was a mammogram. So were vaccinations for child (however no chicken pox vaccine in stock so paid for it rather than having to go back again).

If if we need a referral to something that isn't under the bulk billing then we have the cover to help with some of the costs mostly.

I pay $45 a month for the four of us with hcf for platinum extras and like i say got my money back already this also includes ambulance cover and much more so i feel definatly worth while. As for hosital cover i have researched and researched and cannot see the difference between medicare and nhs other than paying for prescriptions. We are aware we would be put on a list for non emergency surgery but this is the same in the UK! I work in both private and public hospitals in WA and cant see a difference. As for claiming money back its all been easy i just go to a bulk billing practice up the road and job done walk in appointments to much easier than UK. Claiming my extras was easy 2 just swiped my card and came up what i had to pay after the extra cover added so wasnt even out of pocket the full amount initially. As far as the children i know there is a free school dentist but only covers certain treatments not sure to what extent i am going to take mine to where i go though as we are insured and mycson needs braces at some point $$$$

I pay $45 a month for the four of us with hcf for platinum extras and like i say got my money back already this also includes ambulance cover and much more so i feel definatly worth while. As for hosital cover i have researched and researched and cannot see the difference between medicare and nhs other than paying for prescriptions. We are aware we would be put on a list for non emergency surgery but this is the same in the UK! I work in both private and public hospitals in WA and cant see a difference. As for claiming money back its all been easy i just go to a bulk billing practice up the road and job done walk in appointments to much easier than UK. Claiming my extras was easy 2 just swiped my card and came up what i had to pay after the extra cover added so wasnt even out of pocket the full amount initially. As far as the children i know there is a free school dentist but only covers certain treatments not sure to what extent i am going to take mine to where i go though as we are insured and mycson needs braces at some point $$$$

I have never heard of health insurance in Australia costing as little as $45 per month for a family. Just looking at HCF website and the platinum extra starts at $32 per week and it is an add on, so you have to buy the full insurance first and those start at $36 per week so you must surely be paying more like $250-300 per month for platinum level cover?

I really would check you have this right because that just doesn't sound right or maybe you have an introductory offer or something. Health insurance in Australia is pretty expensive and it can also be pretty useless and leave you worse off for having it. We opted to get the basic only and that was only do we didn't get hammered for tax.

I would always ensure you have ambulance cover.

Ambulance cover is included in our Rates where we live in SE Queensland so check whether it is necessary. I can't say I would have bothered anyway as neither I nor any of my immediate family have ever been in an ambulance. No doubt it will happen one day but unless you expect to call ambulances to get to hospital it seems a bit excessive.

Ambulance cover is included in our Rates where we live in SE Queensland so check whether it is necessary. I can't say I would have bothered anyway as neither I nor any of my immediate family have ever been in an ambulance. No doubt it will happen one day but unless you expect to call ambulances to get to hospital it seems a bit excessive.

I always thought the same until my youngest son got tackled while playing with friends on his way home from school one day. He's a bit weird my son (possibly Aspergers) and he just lay on the floor and refused to move because his knee hurt. Some of the parents around went to help and decided to call an ambulance for him. A trip to A&E later and nothing more serious than a slightly strained knee and we had an ambulance bill for over $900. Fortunately covered by our extras cover.

In the states where ambulance costs aren't included in any taxes you can buy seperate ambulance cover for just a few dollars a year. Well worth taking out even if you don't have any other health cover as you never know when something might happen and even if you don't think you need an ambulance someone else may call one for you and you are responsible for the costs.

We have extras cover and pay about $32 a fortnight for silver cover with Health Partners. With the ambulance cost and $1000 towards braces we are well in front this year. It also gives us free dental check ups for the kids and rebates on dentists and opticians. We use the Health Partners practices which means even if something costs more than the rebate from the health cover we get discounts on the remaining costs. As three out of the four of us wear glasses and my OH and kids don't have great teeth we get our money's worth from the cover. We used to have hospital cover but it is expensive and we felt that it offered little for the money. We will take our chances with the public system.

Depends entirely on how old you are and whether you are likely to want elective surgery. Whereas you can get a knee replacement in three weeks with private health, you may have to wait a year or two in the public system. Also getting an appointment at out patients in the hospital is very difficult unless you have an ongoing condition which they are already treating. My daughter has had brain cancer and she has no problems with appointments and mris that is because her doc arranges them all for her at the hospital. If you wanted to get an MRI at a hospital non urgent you would have to wait some considerable time. Me I took out health insurance again after I retired and I have used it. Some docs charge over the scheduled fee and you can be out of pocket for a few thousand dollars with them and there are other surgeons who you will not be out of pocket with. So if you do have private health find a surgeon who has no gap fees. There are a lot of them about. I have had two ops this year and paid nothing. When I say paid nothing my health insurance premium for the year is ni on $3000. For me this is money well spent at my time of life.

Private health insurance in Australia can be a minefield - so many providers with so many options....and they vary from state to state. This is a government website which includes selection and comparison tools for choosing something which best suits your particular situation:

http://www.privatehealth.gov.au/

If your income is above a certain level you will be taxed a Medicare Levy Surcharge if you do not have private hospital cover.

There is also a premium loading which increases for each year you are aged over 30.

http://www.privatehealth.gov.au/healthinsurance/incentivessurcharges/default.htm

As well as age and general health status, many people who opt for private insurance do so because of long waiting periods for non emergency treatment in public hospitals. But that varies tremendously from one area to another and will depend on your location.

Sorry $45 a fortnight and nope extras only.

The OP is right as far as I'm concerned - Medicare and the NHS are very similar, in that you'll get treated promptly and free if you have a serious illness - and if you need to have elective surgery, you'll have to wait.

In the UK, people just take that for granted. In fact I was surprised to see my sister resignedly waiting a year for an elective op under the NHS, when she could well have afforded to get it done privately and it would've been done in a fortnight.

Medicare is different in that GP's can charge more than the standard fee, and if they do, you have to pay the extra. However if you can find a GP that "bulk bills", it's exactly like the NHS.

Australians have been brainwashed by private health fund advertising, to think they'll get better care in the private system. I haven't found that to be the case at all, in fact on more than one occasion I've had better care in the public system.

You will see posters who say they were so grateful for their private health insurance because they had cancer or other serious illness and they had such wonderful care. I'm pleased for them - but for all they know, they might've got exactly the same care in the public system. For instance, I went private for my neck operation. I had a marvellous surgeon and a successful outcome, so I felt it was well worth the $10,000 I had to pay (my private insurance only paid $25,000 of the $35,000 costs, which is not uncommon - private health insurance rarely pays the full cost of any treatment).

Then my friend's dad needed the same op. No health insurance, so he had it done on Medicare. He thought he'd be waiting for years - he got the call in six weeks. His outcome was just as successful as mine. His cost? Zero.

So to me, having private hospital cover in Australia is the same as in the UK - a nice luxury if you can afford it. However, there is a snag - the Australian government will punish you if you don't have it. So you need to look into that aspect and decide whether it's financially beneficial for you to have it. But you have a year after you arrive to decide whether to take it or not.

I was nodding my head whilst reading your post Marisa. The longest OH had to wait was 6 to 8 weeks. He had a stomach tumour and was operated on immediately and he's had a couple of other things where he entered hospital for immediate treatment. I've only had a couple of stays in hospital and didn't have long to wait either. Once here in Tasmania I was admitted for a minor op after a wait of 3 weeks. A friend who has cataracts being treated next week in Launceston after a 4 week wait. Maybe it all depends on the area where you live.

Maybe it all depends on the area where you live.

Yes, it does depend on your location - and varies tremendously throughout the country. This has been a hot topic recently on ABC local radio talkback in Hobart - where Urgent/Category 1 patients (meaning they have a high chance of bowel cancer) are having to wait 12 months for a colonoscopy in the public health system - by which time the cancer may have killed them. I have a friend who was referred to the public Gynae clinic for possible hysterectomy in March last year. She waited 2 months to see a specialist...and the verdict was...yes, you need the operation...but it won't be before September. It is now September 12 months later - and she still hasn't had her operation and still no indication when it will be. No, it isn't life threatening - but it does majorly interfere with her quality of life. Ditto for the many people waiting years for knee and hip operations: it's not life threatening but they have to endure a lot of discomfort, pain and inconvenience while waiting.

Australians have been brainwashed by private health fund advertising, to think they'll get better care in the private system.

 

I think that's patronising to those of us who know what's happening in the public health system in our local area ....and make the choice, not necessarily for better care, but for timely care...without having to endure months or years before treatment. Or - and this happens frequently - having the operation regularly cancelled and rescheduled because the public health system has to give priority to emergency/urgent cases which it can't possibly foresee. That can really play havoc with those trying to plan around family and jobs.

My husband nearly cancelled his private health insurance because he used it so rarely. Then he suddenly became ill at the age of 56 and was in and out of hospital for the last 14 weeks of his life. He spent one night in the public system for a certain procedure - and that made me realise how glad I was that he had kept his private cover. Not because the treatment was necessarily better in the private system but the conditions in the ward were markedly better (both for him and for us). To me, all that private cover was worth it for the comfort and dignity he had for those last few months.

Yes, it does depend on your location - and varies tremendously throughout the country. This has been a hot topic recently on ABC local radio talkback in Hobart - where Urgent/Category 1 patients (meaning they have a high chance of bowel cancer) are having to wait 12 months for a colonoscopy in the public health system - by which time the cancer may have killed them. I have a friend who was referred to the public Gynae clinic for possible hysterectomy in March last year. She waited 2 months to see a specialist...and the verdict was...yes, you need the operation...but it won't be before September. It is now September 12 months later - and she still hasn't had her operation and still no indication when it will be. No, it isn't life threatening - but it does majorly interfere with her quality of life. Ditto for the many people waiting years for knee and hip operations: it's not life threatening but they have to endure a lot of discomfort, pain and inconvenience while waiting.

Re my gynae op .................. I visited our GP who sent me for a scan the next day (this was in Devonport). Went back to GP the day after that - he had the scan results then he booked me in to see a specialist at Latrobe Hospital the next week. Two weeks after that I had the op. Day surgery only. I don't know what the waiting time is for hip/knee replacements. We now have private health just in case. It's not one of those over the top covers though but may be useful in the future.

I think that's patronising to those of us who know what's happening in the public health system in our local area ....and make the choice, not necessarily for better care, but for timely care..

I deliberately chose the word "better". Of course you will get more TIMELY care if you pay for private health insurance - but as I mentioned, the waiting lists in Australia are no different to the waiting lists in the UK so the OP will know what that's like.

Hey, thanks folks for all the really helpful information. It's useful also to get different opinions and hear about different experiences.

I guess the next things I need to research are: What are "gap fees"? What's public provision like where we're moving (NSW), how many bulk billing GPs are there here? What are the tax implications for us? Are ambulances covered by the rates (or land tax in NSW)? And the one-year window for deciding on whether to take out any health insurance, e.g.what happens if you miss the window?

It does all sound very complicated.

Hey, thanks folks for all the really helpful information. It's useful also to get different opinions and hear about different experiences.

 

I guess the next things I need to research are: What are "gap fees"? What's public provision like where we're moving (NSW), how many bulk billing GPs are there here? What are the tax implications for us? Are ambulances covered by the rates (or land tax in NSW)? And the one-year window for deciding on whether to take out any health insurance, e.g.what happens if you miss the window?

 

Both Medicare and the private health insurers have standard fees that they will reimburse, but doctors and hospitals can charge what they like. The difference is the gap fee.

I've never had a problem finding a bulk-billing GP. If you go to a bulk billing GP, there is no gap fee because they are charging the standard Medicare fee. There will always be a gap fee with private health (unlike the UK where if you've got private cover, they cover 100% of the treatment) and sometimes it can be large - like me having to pay $10,000 of my $35,000 operation.

No ambulances are not covered by the rates.

The government has introduced tax penalties to try to push people into private health care, to ease the burden on the public system. If you don't have private health insurance and you earn over a certain amount, you have to pay a higher Medicare levy.

The other problem the government has, is that people won't take out private health insurance while they're young - they wait until they're old and start having more health problems. So if you delay joining and then join when you're old, you will pay a penalty on top of your insurance premium. For instance, my husband has never had private health insurance. He's now 64 and did think about getting some - but he would have to pay a 35% loading on his premiums! That is the consequence if you miss your one-year window - you'd be subject to that penalty for not having insurance when you were younger. Whereas if you join within a year of arriving in the country, they let you off.

..... There will always be a gap fee with private health .....

Not necessarily. Lots of Health funds now have special arrangements with private hospitals and other providers to ensure there is no gap to be paid, so there are zero out-of-pocket expenses for the member.

Both Medicare and the private health insurers have standard fees that they will reimburse, but doctors and hospitals can charge what they like. The difference is the gap fee.

 

I've never had a problem finding a bulk-billing GP. If you go to a bulk billing GP, there is no gap fee because they are charging the standard Medicare fee. There will always be a gap fee with private health (unlike the UK where if you've got private cover, they cover 100% of the treatment) and sometimes it can be large - like me having to pay $10,000 of my $35,000 operation.

 

No ambulances are not covered by the rates.

 

The government has introduced tax penalties to try to push people into private health care, to ease the burden on the public system. If you don't have private health insurance and you earn over a certain amount, you have to pay a higher Medicare levy.

 

The other problem the government has, is that people won't take out private health insurance while they're young - they wait until they're old and start having more health problems. So if you delay joining and then join when you're old, you will pay a penalty on top of your insurance premium. For instance, my husband has never had private health insurance. He's now 64 and did think about getting some - but he would have to pay a 35% loading on his premiums! That is the consequence if you miss your one-year window - you'd be subject to that penalty for not having insurance when you were younger. Whereas if you join within a year of arriving in the country, they let you off.

Ah, I see, so you're exempt from the penalty if you purchase health insurance within a year of arriving (or, to be precise, signing up for Medicare), even if you'd otherwise be too old. That's good to know. It was actually mentioned in one of the links that I think was posted earlier, I just hadn't registered it. That link also says that the penalty only applies to hospital cover, i.e. presumably not to more basic policies only covering things like ambulance rides, and gives other details of how it's calculated.

Another question arising from that link is that it mentions "blue" vs. "green" Medicare cards. I can probably Google this for myself (though I am a bit busy, in the throes of packing etc. ...), but I wonder what that's all about? And as nobody has talked about "medical repatriation" (which was mentioned as a health insurance must-have in the materials we had through from our employers-to-be), I guess that's not really a big deal?

Thanks again to everybody. The more information we have about this kind of thing, the better.

What's public provision like where we're moving (NSW), how many bulk billing GPs are there here? What are the tax implications for us? ....... And the one-year window for deciding on whether to take out any health insurance, e.g.what happens if you miss the window?

 

Tax implications and what happens if you miss the window are covered in the link in my first post above (about 9 posts up) : you just need to click on the 4 hypertext links within it -

http://www.privatehealth.gov.au/healthinsurance/incentivessurcharges/default.htm

In addition to that information - all taxpayers pay a basic Medicare levy ....deducted as part of regular taxation. You don't have to make any special payment.

Do you know where in NSW you are moving? You can get information about hospitals - including average waiting times for public hospitals here (although the data can lag by a couple of years) :

http://www.myhospitals.gov.au/search/hospitals

Again, the availability of bulk billing doctors will vary from one area to another and often depends on how well the area is serviced by GP practices. Newly established areas with many young families can have high demand and close their books to new patients. Some bulk bill only for those on Centrelink benefits and children.

Re my gynae op .................. I visited our GP who sent me for a scan the next day (this was in Devonport). Went back to GP the day after that - he had the scan results then he booked me in to see a specialist at Latrobe Hospital the next week. Two weeks after that I had the op. Day surgery only. I don't know what the waiting time is for hip/knee replacements.

Yes, but Devonport/Latrobe is in the very rare position of having a hospital directly funded by the federal (not state) government - a pork barrelling exercise par excellence fabricated by John Howard at an election when the hospital was going to be closed. AFAIK it is the only general hospital outside Canberra in that position. Good luck when the funding runs out in a year if the agreement is not renewed. :wink:

Average waiting times for knee replacement here in Hobart is 700+ days...hip replacement more than a year. And that's after you've seen a specialist - for which there may be a wait of several months.

Yes, but Devonport/Latrobe is in the very rare position of having a hospital directly funded by the federal (not state) government - a pork barrelling exercise par excellence fabricated by John Howard at an election when the hospital was going to be closed. AFAIK it is the only general hospital outside Canberra in that position. Good luck when the funding runs out in a year if the agreement is not renewed. :wink:

 

Average waiting times for knee replacement here in Hobart is 700+ days...hip replacement more than a year. And that's after you've seen a specialist - for which there may be a wait of several months.

The maternity unit at Latrobe may be closing so women in the area will have to go to Burnie to have their babies. Yes, we are hearing all the time about the hospital funding running out. Such a shame as it is a lovely little community hospital and the staff are lovely.