Medicare vs Private Health Insurance

[weaseltron]

Hi all

 

So, just arrived in Sydney - hooray!

 

In order to get our Visas we signed up for private health care. Now we are here I am wondering if it is worth keeping this or if we will be ok with Medicare (we are from UK).

 

Can anyone offer any advice as to the pros/cons of having the additional cover? Also, what exactly (in plain english) is covered by Medicare?

 

Thanks in advance for your help

 

A

[Gilllian]

I don't know anything about visas and requirements, but I think it's only worth taking out private healthcare if: it's a tax advantage to you, if your medical bills are high, and/or if you feel the public medical service does not meet your needs. My partner has private health insurance for tax reasons, I do not. I've never had an issue with Medicare, but then I've been healthy so far.

[Pumpkin]

I don't know anything about visas and requirements, but I think it's only worth taking out private healthcare if: it's a tax advantage to you, if your medical bills are high, and/or if you feel the public medical service does not meet your needs. My partner has private health insurance for tax reasons, I do not. I've never had an issue with Medicare, but then I've been healthy so far.

 

It doesn't make sense for one of you to have it not the other surely? Because the medicare surcharge is levied on your joint incomes.

[Gilllian]

thanks for that info, I obviously need to look into it a bit more! This was one of things I haven't got around to investigating thoroughly, there's so much to do to re-establish yourself back in Oz when you've been away! :err:

[weaseltron]

Oh no! Thanks for that info

 

So what exactly is covered by Medicare? Myself and my wife are generally pretty healthy.....

[ekf]

If you need treatment or to be referred to a specialist then your GP can refer to into the public system where your treatment will be provided free, however depending on your condition you could be on a long (think years in some cases) waiting list. If you have private cover you can see whichever consultant you like, be seen & treated pretty much immediately and in a private hospital.

Medicare unlike the NHS does not cover cost of GP visits (unless they bulk bill) or prescriptions, the cost of which vary greatly depending on the particular drug.

[weaseltron]

If you need treatment or to be referred to a specialist then your GP can refer to into the public system where your treatment will be provided free, however depending on your condition you could be on a long (think years in some cases) waiting list. If you have private cover you can see whichever consultant you like, be seen & treated pretty much immediately and in a private hospital.

Medicare unlike the NHS does not cover cost of GP visits (unless they bulk bill) or prescriptions, the cost of which vary greatly depending on the particular drug.

 

Thanks for the info, so can you register with any doctor using Medicare or is there a specific list?

[ekf]

There is no concept of registering with a GP, you can see whoever you like provided the practice is accepting new patients. I haven't come across one so far that I couldn't get an appointment with. Some GP bulk bill which means that you won't pay for the consultation but others charge more than the set Medicare fee for a consultation so you will have to pay the difference. For example if a GP charges $50 for a consultation, Medicare only funds approx $37 for a consultation so you have to pay the difference. Hope that helps.

[Quoll]

If you're young enough and "healthy" I'd be inclined to self insure but you'd have to be rigorous - put your $250 pm into a dedicated account against the day when you decide you don't want to wait 18 months to have your gall bladder out or whatever. If you're liable for the surcharge as a family then it's a no brainer, take out private cover! We had private insurance for years and whilst some times I resented the monthly outlay I was incredibly grateful for it a couple of times! Insurance is always a gamble and it depends how risk averse you are.

 

Medicare will cover anything medical but there is a gap for regular GP visits and occasional other services - it was designed as a co-pay system, not a "free" NHS system (I know the NHS isn't "free" btw!) - bulk billing was designed initially to support those who couldn't pay the co-payment not those who thought it their right not to! Essential medical interventions are implemented at once but other conditions may be deemed "elective" ie you won't kick the bucket if they're not done this week. The consequence of that is that elective procedures get shuffled down the list and only eventually pop up when everything else has been covered - hence the abysmally long waiting lists (some places worse than others!)

[Paul1Perth]

Thanks for the info, so can you register with any doctor using Medicare or is there a specific list?

 

As far as I know you can register or go and see any doctor. We have one right across the road that bulk bills, so no charge when we go for a check up or don't need any prescription medicine. Worth shopping around for one that bulk bills I reckon.

[Diane]

Just like to add that uf you don't have private medical insurance, you can still see a specialist privately (without the long wait) and Medicare then refunds something like 80% of the cost of this to you.

 

I have done this - I do have medical issues which are a little complicated, so most things would have been excluded as pre-existing conditions on private cover anyway. I try to avoid the medical profession as much as I can, but every now and again I have seen specialists and claimed most of the cost back through Medicare. You can get specialist dental cover through a company such as Smile if you wish. Also, my son had a free eye check up every year covered by Medicare. Once my kids were teenagers, we were also sent a dental checkup voucher for them each year.

[Naomi from Manchester]

In NSW, I don't think Medicare covers ambulances. So if you haven't got private cover for this you would have to foot the bill.

[NickyNook]

I have done this - I do have medical issues which are a little complicated, so most things would have been excluded as pre-existing conditions on private cover anyway.

 

If you believe that, you are wrong.

 

Private health funds in Australia cannot refuse to insure you if you have a pre-existing condition.

 

They have to insure you if you want insurance - they just say you cannot claim for those conditions for a 12 month exclusion period. After that time, the pre-existing condition is covered and you can claim. And you won't be charged any more for the policy that anyone else (who doesn't have any pre-existing condition).

 

http://www.privatehealth.gov.au/healthinsurance/howitworks/waitingperiods.htm

 

"Even if you have a pre-existing condition, health funds must allow you to purchase any type of cover, at the same price as every other person. Once you have served any waiting periods, you will be entitled to claim."

[Guest The Pom Queen]

If you believe that, you are wrong.

 

Private health funds in Australia cannot refuse to insure you if you have a pre-existing condition.

 

They have to insure you if you want insurance - they just say you cannot claim for those conditions for a 12 month exclusion period. After that time, the pre-existing condition is covered and you can claim. And you won't be charged any more for the policy that anyone else (who doesn't have any pre-existing condition).

 

http://www.privatehealth.gov.au/healthinsurance/howitworks/waitingperiods.htm

 

"Even if you have a pre-existing condition, health funds must allow you to purchase any type of cover, at the same price as every other person. Once you have served any waiting periods, you will be entitled to claim."

This is correct they have to insure pre existing conditions but they have a waiting period.

[Guest The Pom Queen]

Personally I think if you are in Sydney and don't need it for the tax reasons I would just stay with Medicare. I never had private until we moved to Cairns as in Melbourne I didn't need it. Up in Cairns is different as we just don't have the surgeons or specialists that I've needed so it has meant travelling.

[airry87]

the taxes are not affected by your health insurance.

Medicare costs 1.5% of your income (called Medicare levy).

 

 

Private insurance can be worth it, but that's a decision you have to make for yourself.

Do some research on what you pay and what you get. And then decide whether you want it.

[Notts]

the taxes are not affected by your health insurance.

Medicare costs 1.5% of your income (called the Medicare Levy)

 

If your income is above $88,000 as an individual or $176,000 as a family then if you don't have health insurance then on top of the Medicare Levy you pay the Medicare Levy Surcharge at 1%, 1.25% or 1.5%, depending on income.

[Petkula73]

It depends really on your circumstances. What visa are you on and how long will you stay for? If you've got PR, or when you do get it you can't really avoid paying for private health insurance if your income as a family is reasonable. I can't give you an exact limit, but it's something like $150K a year where the cost of the Medicare Levy Supplement becomes higher than taking out the lowest policy. Better to pay for extra for something you don't have than to pay extra for something you already get in my opinion. Also, don't forget about Lifetime Loading payments. For every year over the age of 31 you go without private insurance, you'll pay 2% extra on any policy when you do take a policy. We were given an 18% load on our policy, but got this reduced to 0% as we took the policy in the same tax year as getting PR. If we'd opted not to do this it would have been 20% from this year onwards.

 

Like most things in Australia, health care is unnecessarily complicated and likely to drive you slightly mad. You'll wonder how the UK manages to do things like tax and health with so little fuss... They certainly love their bureaucracy, red tape and hugely complicated rules here!

 

That said, in my opinion health care is better here. Without going in to details, I have been referred to a surgeon for an examination here. In the UK this would involve the GP writing to the hospital and the hospital coming back with a date for a clinic in around six months time - and tough luck if you've got other plans on that day. Here, the GP provided a letter of referral, I phoned the surgeon directly and got an appointment the following week at a time that suited me. The appointment is also for the time it states, so no sitting around for three hours in the waiting room like the UK. The downside? Well, it cost me $78 to see the GP, of which I got roughly half refunded. I have BUPA fortunately, so Medicare and BUPA between them cover most of the upcoming treatment, but there's still a potential $500 gap to pay - ouch! In the UK I'd have been better off financially, but who knows, by the time I got to see someone it might have gone from being a minor issue to something much worse. Personally, I'll pay the money and have the better service.

[bonza2211]

It depends really on your circumstances. What visa are you on and how long will you stay for? If you've got PR, or when you do get it you can't really avoid paying for private health insurance if your income as a family is reasonable. I can't give you an exact limit, but it's something like $150K a year where the cost of the Medicare Levy Supplement becomes higher than taking out the lowest policy. Better to pay for extra for something you don't have than to pay extra for something you already get in my opinion. Also, don't forget about Lifetime Loading payments. For every year over the age of 31 you go without private insurance, you'll pay 2% extra on any policy when you do take a policy. We were given an 18% load on our policy, but got this reduced to 0% as we took the policy in the same tax year as getting PR. If we'd opted not to do this it would have been 20% from this year onwards.

 

Wow!!!! Can someone please help me understand this? My brain seems to be melting....

 

From what I gather, even with Medicare I still need to take a private insurance cover and that too within the year of my PR? Can I take the policy out even though I haven't made my medicare card yet so that I don't get stuck with the tax burden?

 

I turn 32 in April 2015, I got PR on 7/11/13 and did not bother applying for my Medicare card (I will take an appointment tomorrow).

P.S. I am undecided whether I will stay in Australia forever (i.e. retirement) for now at least that's the plan.

[james784]

I have had Medicare since about 1999/2000. Medicare pays 80% of what they consider is "reasonable cost." Believe me - that isn't much. For example: Suppose I have a bill of $1000. Medicare determines that reasonable cost is $400; they pay 80% of that. And even though I have a private insurance which supplements Medicare, Medicare still sets the reasonable cost which means in my example that my private insurance will pay 20% of $400. Whoever performed the service (doctor, hospital, whoever) is out $600. When my doctor retired about five years ago I called four places which wouldn't take me on as a patient because I have Medicare.

 

 

Even though private insurance companies are in it for profit, because they charge much higher premiums than the government does for Medicare, they can afford to pay more out because of those higher premiums. It's truly a case of you getting what you pay for.

 

 

Because I don't work, Medicare is primary and my Blue Cross/Blue Shield is secondary so Medicare sets the reimbursement rate. Secondary insurers REQUIRE that a person be entitled to Medicare if they are eligible to cut down on the costs of the secondary insurance.

 

 

If I didn't have Medicare and I wasn't eligible for it, my Blue Cross/Blue Shield would be reimbursing my doctors and hospitals at a much higher rate than what Medicare does.

 

 

Now why doesn't everyone in the United States have Medicare? The insurance companies wouldn't stand for it and the medical community would be backing them up. Our representatives and senators wouldn't dare extend Medicare to all Americans!

 

 

Frankly I think Medicare should be extended to everyone with increased premium rates and higher payments to providers of services and it could be administered through the private companies. But who am I?

[NicF]

I have had Medicare since about 1999/2000. Medicare pays 80% of what they consider is "reasonable cost." Believe me - that isn't much. For example: Suppose I have a bill of $1000. Medicare determines that reasonable cost is $400; they pay 80% of that. And even though I have a private insurance which supplements Medicare, Medicare still sets the reasonable cost which means in my example that my private insurance will pay 20% of $400. Whoever performed the service (doctor, hospital, whoever) is out $600. When my doctor retired about five years ago I called four places which wouldn't take me on as a patient because I have Medicare.

 

 

Even though private insurance companies are in it for profit, because they charge much higher premiums than the government does for Medicare, they can afford to pay more out because of those higher premiums. It's truly a case of you getting what you pay for.

 

 

Because I don't work, Medicare is primary and my Blue Cross/Blue Shield is secondary so Medicare sets the reimbursement rate. Secondary insurers REQUIRE that a person be entitled to Medicare if they are eligible to cut down on the costs of the secondary insurance.

 

 

If I didn't have Medicare and I wasn't eligible for it, my Blue Cross/Blue Shield would be reimbursing my doctors and hospitals at a much higher rate than what Medicare does.

 

 

Now why doesn't everyone in the United States have Medicare? The insurance companies wouldn't stand for it and the medical community would be backing them up. Our representatives and senators wouldn't dare extend Medicare to all Americans!

 

 

Frankly I think Medicare should be extended to everyone with increased premium rates and higher payments to providers of services and it could be administered through the private companies. But who am I?

 

This is a site for people in Australia not the US. What you have posted has no relevance to the thread because the thread is about the health system in Australia not the US.

[jessicaalderson]

Health care can be expensive. And while Medicare covers for a range of health care costs, it doesn't cover everything. Here are some of the added benefits that come with taking out private health insurance.

• More choice in hospital treatment

• Savings on out-of-pocket expenses

• Cut down on waiting times

• Incentives & avoid surcharges

• Cover for non hospital-related costs

For this, I prefer private health insurance except Medicare and I also have my health insurance which I take from my Edmonton Dentist.

[james784]

This is a site for people in Australia not the US. What you have posted has no relevance to the thread because the thread is about the health system in Australia not the US.

 

oh my bad i am sorry i didn't see it, i will keep it in my mind from next time when ever i write comment

[jessicaalderson]

ok fine.....................