Health insurance/cover.

[Guest cc]

Hi,

When I arrive in oz i will have to have regular bloods tests and medication due to inflammatory arthritis. Does anyone know if i can get cover for these things.

I have read about medicare but find it confusing.

Blood tests should get less regular but i will still have to take medication.

Any info would be a great help.

Thanks

Claire :?

[Guest Fraser]

Medicare is like a cheapo version of the NHS.

 

Medicare is financed by a 1.5% levy on your wages (just like the NI contribution) ...and if you are a high salary earner... unless you have private health insurance cover you pay an extra levy ...so for some higher wage earners it is a straight choice... give the money to a health insurance fund..or to the government.)

 

The whole health system here can be confusing ...ever after 10 years in the country... but here goes....

 

Every year Medicare sets a value for each and every procedure medical test or doctor visit. Any time you have such a procedure or test or visit you are entitled to a Medicare rebate toward the cost.

 

Doctors all work for either themselves or for a hospital or clinic. Some doctors decide that the Medicare rebate is not enough to cover their services (or what they want to charge) and will give you a bill at the end of the session. You pay that bill, and then take or send the receipt to Medicare, who will refund to you the value of the Medicare rebate for that visit, test or procedure. (In my experience the diffence between the Docs who charge, and the rebate is about 5 quid...and that is what you are left out of pocket).

 

Some doctors do what is called "Bulk Billing". They agree that the amount set by Medicare is fine by them and they don't want any more, and instead of giving you a bill they send the bill straight to Medicare...so you pay nothing to the doctor at all.

 

Doctors who Bulk Bill, generally have a large sign outside their surgery proclaiming that they do.

 

If the doc decides to do tests or send you for x-rays or whatever, the test labs work exactly the same way... some will charge an "extra-over" cost on top fo the Medicare set amount and others will "Bulk Bill".

 

So... if this is t be a regular thing... find a Bulk Billing Doctor and ask him to use a Bulk Billing lab for your tests.

 

Prescription medication (i.e. against a prescription given out by a doctor) is generally covered under a thing calle dthe Pharmaceutical Benefits Scheme (The PBS). The PBS is a subsidy system that covers the cost of most drugs that are not "Over the counter". Just like the UK, you take the prescription to the chemit to get filled and pay a nominal scheduled fee for the prescription, with the PBS picking up the rest of the cost.

 

 

Some day I will try to explain about Private Health cover and when to deny vehemently that you have any..... if I ever work that bit out myself! :?

[Guest Gollywobbler]

Gi Claire & Fraser

 

I've been investigating Medicare too, on behalf of my elderly Mum who takes various drugs for things like high blood pressure and other odds & ends.

 

Fraser's description is the best I've read about how Medicare works, so thanks for that, Fraser. I'm a lot clearer now, thanks to you.

 

Compared to the UK, where we think £6.80 per item or whatever is naffing expensive, the cost of drugs in Australia is something like $28 per item, regardless of your age, which was a bit of a shock to me! Please see here:

 

http://www.health.gov.au/internet/wcms/publishing.nsf/Content/About+the+PBS-1

 

There is something called the PBS safety net that kicks in once you have spent £x on prescriptions in one year, but £x is a means-tested amount and seems to be nearly $1,000 for anyone who cannot claim to be on a low income and therefore entitled to a Healthcare card.

 

Although Mum only activated her PR visa a week ago, she has spent much of the laast 15 years in Oz making extended visits to my sister out there. Whilst there, she has been entitled to temporary Medicare cover under the RHCA between Oz & the UK. One of the drugs she takes is a bone-strengthening agent. She is allergic to nearly all the brands of this stuff, but there is one that she can take, though it is very expensive and is not subsidised under the PBS scheme. I gather that my sister's GP wrote to somebody in Canberra about this explaining that it is a case of either taking the very expensive one or taking nothig at all. He managed to get some sort of dispensation that Mum can have this stuff at the same price as if were on the PBS list. So there is some sort of flexibility if the doctor insists that there is clinical need for the drug and a genuine reason why the cheaper versions won't do.

 

I believe that some of the drugs used for arthritis are in the same general sort of category - not everyone can take the cheaper ones and some of them are very expensive, so Mum's experience may be worth bearing in mind.

 

Do you think the climate in Oz is likely to help ease your arthritis? It would be great if it does.

 

Cheers

 

Gill

[Guest Fraser]

Private hhealth cover in Australia is a real pain in the @r$e!... ..because it is not simple!... I do not fully understand it, even after 10 years...and I doubt if anyone does.... :cry:

 

Like the UK you can choose to join an equivalent of BUPA for private health cover. There are lots of different health funds to choose from, and lots of insurance plans under each fund.

 

The basic cover is "Hospital Cover" that provides funding toward a hospital admission. You can also opt for higher level of cover including Dental, Optical.... in fact, if a doctor can do it.... someone, somewhere will insure it. You can elect to have an "excess", that is, you will pay the fist $X of any cost, and the fund will pick up the rest (-ish)... and reduce your premium that way.

 

Also, there is Ambulance cover. Ambulances here need to be paid for, so many people take out an ambulance fund membership just in case they ever need to use one. You can have ambulance cover even of you have no private health insurance.

 

Medicare public hospitals are very good if you have an acute or emergency condition... you will be admitted, attended to, and made every bit as healthy as the NHS could do for you.... all under your Medicare levy and no additional cost.

 

However, like the UK, if you are non-urgent, there can be a waiting list. This can be lengthy in certain places for elective (i.e. non-urgent or non life-threatening) surgery.

 

Like the UK, if you have private health cover you can "jump the queue" and get into a private hospital or public hospital in a private area, or even in a public hospital in a public area ...after all, you *have* paid your Medicare Levy too...it just so happens you have a specialist who is prepared to put you to the top of his/her list.

 

That was the easy bit!

 

Now, how it works in practice!.....

 

Insurers are not stupid. For anyone taking out a new policy there is a declaration covering existing medical conditions... and very often a "Waiting Period"... which in effect means that you can take out dental or optical cover, but they won't pay out for the first X months for any treatment other than routine check-ups... because you might have known you needed dentures or new spectacles... or needed a brain transplant.. ...and just signed up the day before you ordered them! The waiting period can be anything from 6 months to two years depending upon the condition and the cover. (This does not generally affect accidental injuries or previously undiagnosed diseases or conditions).

 

Next thing... Like Medicare, the insurance companies will insure you for scale-fees based upon a rate agreed with Government and certain hospitals. If you chose Hospital X for your procedure and your fund has an agreement with them, then you are mostly OK. The fund pays the hospital. If you chose Hospital Y and your fund does not have an agreement with them, and they charge more than the agreed rate, you are left to pay what is called "THE GAP".

 

This is where the confusion starts big-time... Your specialist or surgeon may or may not have an agreement with the hospital or your fund. If he does, you are okay, because the hospital pays him and your fund pays the hospital... if not, you may still get a separate bill, that you send to your insurer, who will only pay whatever the scale fee is and you are left to pick up "THE GAP".

 

So.. If you are acutely ill, and have had no choice on where you are taken, and they ask if you have medical insurance, if you say yes it might cost you "Gap fees"... If you say no, you will get exactly the same treatment for nothing extra at all.

 

Some real life examples of this nightmare follow..... :?

[Guest Fraser]

Dental and Optical cover...

 

I pay for Dental and Optical cover.

 

Just like medicare, the fund rebates me a certain amount against fees paid.

 

For a dental examination, I get all of it back (preventative stuff y'see).

 

For a filling or extraction I get whatever the scale fee is, and I need to pay the "GAP"

 

There is a maximum amount I can claim per familiy member per year... so the more I get done, the more I can claim, and the closer I get to the maximum claim value per year the more of my premiums I get back in the form of treatment...

 

For Optical, there is a Medicare benefit against an eye test, so that is very often Bulk-billed by opticians wanting to get people in the door.... the fund kicks in when I ned glasses. Like dental, it will pay a certain amount per family member per year for new lenses... but the frames are not a medical expense...so they are up to you.

 

If you don;t claim against the optical one year, a percentage will roll-over to the next and you can claim more that year... I sort of "Spectacular No Claims Bonus!" :?

[Guest Fraser]

Hospital - Example 1. My wife.

 

She went to her Doctor (a paying doctor, so a GAP between Medicare rebate and Doctor's fee). Doc referred her to a specialist.

 

She went to her Specialist (all specialists are "paying", so a GAP between Medicare rebate and Specialist's fee). Specialist referred her to a hospital for an out-patient procedure.

 

MEDICAL INSURANCE FUND KICKS IN HERE.

 

She elected to go to a local Medicare Public Hospital as a private patient. The Specialist, The Aneasthetist and all other hospital services have an agreement with our fund.

 

She gets treated... the fund pays all of it. We get no GAP bills. 8)

[Guest Fraser]

Hospital - Example 2. Me

 

I went to my Doctor (a paying doctor, so a GAP between Medicare rebate and Doctor's fee). Doc requested some tests. tests were done by a Bulk-Billing lab... No GAP.

 

Results were not good. Second consultation. GAP Doc referred me to a specialist.

 

I went to the Specialist (all specialists are "paying", so a GAP between Medicare rebate and Specialist's fee).

 

Specialist requested some X-Rays. X-rays referred from a specialist were done privately... I got a bill, a Medicare Rebate and paid a GAP.

 

Specialist requested some tests. Tests were done by a the same lab that had previously bulk billed my own Doc... but this time, referred from a specialist test were done privately... I got a bill, a Medicare Rebate ...and paid a GAP.

 

I went to the Specialist for a second consultation. I got a bill, a Medicare Rebate ...and paid a GAP..

 

Specialist referred me to a hospital for an out-patient procedure.

 

MEDICAL INSURANCE FUND KICKS IN HERE.

 

I elected to go to a local Private Hospital as a private patient. The hospital services have an agreement with our fund.... The Specialist and all other services have an agreement too ...but the anaesthetist did not.

 

I get treated... get more X-rays and more tests while in hospital ....the fund pays all of it because of the fee agreement with the hospital. ...including the fee to my specialist...who I had had to pay for the previous two consultations, but this time I am in a hospital!!! We get no bills....except from the anaesthetist.

 

The anaesthetist (selected by the specialist) is not part of this deal. I get his bill, send it to the Medical Fund, who pay most of it... and I pay the GAP.

 

Lunacy in action.... :roll:

[Guest Gollywobbler]

Hi Fraser

 

This is all fantastically useful info which I shall study closely on my mother's behalf.

 

Meanwhile, I've a query about a slightly different aspect of this, which I'll put in a separate thread so as not to hijeck this one. If you can bear to te a look at my new thread, I would be grateful.

 

Many thanks

 

Gill

[Guest cc]

Hi, thanks fraser for taking the time to explain all about medicare. Its very much appreciated.

Hopefully the hot weather will sort things for me.

Many thanks

Claire