Pre-existing health conditions and insurance companies

[seasea]

Hi,

 

Health insurance is totally alien to me.

 

My wife has arthritis and crohn's disease so how do insurance companies deal with this? Are premiums more expensive or will they refuse to insure?

 

I have been trying to make sense of the Australian health system and I'm struggling to wrap my head around it all.

 

The medication that she has appears to be on the PBS list and I think I understand that we would be liable for something like the first $1300, but I could be wrong.

 

Medicare just bamboozles me.

 

Can anybody put this into simple terms for me?

[Petals]

Medicare pays for all medical fees for doctors, specialists and care in public hospitals.

 

General Practice - some doctors bulk bill which means that when you go you do not pay anything, others charge the AMA fees that means if you choose one of those doctors when you go you will have to pay about 20 - 30 dollars more than the medicare rebate.

 

Specialists that you see in a public hospital are free, specialists that you see privately you will get the medicare rebate but most charge a lot more than that which you will have to fund. They will tell you at the time you book the appointment. You need a general practitioner to refer you to a specialist.

 

Drugs that are on the PBS are not free, the usual fees is about $33.00 per month for one prescription so if you have several like I have then you would be up for over $100.00 a month.

 

The amount you refer to is the amount you need to spend before you get fully refunded by medicare and PBS. Usually at the end of the year so not a lot gets paid.

 

If you take out health insurance with pre-existing conditions you have to pay for a full 12 months before any claims can be made for those conditions. Two months is the waiting time for non pre existing conditions. Going to private hospital you will be up for 2 - 3 grand a year for fees and then you have to pay for all the extras like any equipment they provide, xrays, over the medicare fee, surgeons all charge more than the medicare fee.

 

Just as an example I had my knee replaced by health insurance cost over 2 grand a year, fully covered, The money I had to pay out of my pocket was nearly four grand.

 

Had another operation private hospital had to front up five grand.

 

So really with pre existing conditions like your wife has its prudent to use the public system.

[seasea]

Are we entitled to use the public system before we get PR? What are waiting times like if you need an operation and cannot afford to go private?

[NickyNook]

Are we entitled to use the public system before we get PR? What are waiting times like if you need an operation and cannot afford to go private?

 

People from the UK can get access to Medicare for urgent issues at all times under the reciprocal agreement so your visa status doesn't matter (that's assuming, of course, that you are from the UK). Waiting times vary depending on how urgent the op is.