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Tom Amin

Pre-existing Condition

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Hi guys, 

I immigrated recently to Australia with my wife (We have Permanent Residence) and I have a pre-existing condition (Psoriasis) which requires expensive medicine. We just arrived last month and we are in the process of looking for jobs, but this is a lengthy process so I want to know from your experience : If I land an appointment with a doctor and he prescribes the medicine to me. Will I be able to get the medicine under Medicare? or should I pay for it myself? or is there a system for co-payment? 

I appreciate your response and thank you in advance. 

Amin

Edited by Tom Amin

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As PR you will be entitled to drugs under Medicare but there is a co-payment, max about $35 per fill if the drug you want is on the Pharmaceutical Benefits Scheduled but if it’s not on the PBS and you still want it, you pay the full price. Doctors will generally try and change to one that is on PBS. There is a family threshold for medications if you spend more in a year (about $5k pa I think) then they reduce the cost to you to concession rates.

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Thanks a lot for your reply. 

I found my medicine on the PBS medicine under this link :  https://www.pbs.gov.au/pbs/search?term=Adalimumab

But I don't understand this part regarding Family threshold

There is a family threshold for medications if you spend more in a year (about $5k pa I think) then they reduce the cost to you to concession rates.

Does this mean that the health care system supports the family for only 5000 Dollars? or what did you mean by it.

I appreciate your answer.

Amin 

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It means that you pay for your prescriptions around $35 an item roughly until you reach the $5000 limit.  If you reach this limit you then get reduced price for each prescription item, think its around $6.  Then your limit resets at the beginning of the year again. 

 

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Okay that's clear now. 

Do people do something to avoid paying 5000 per year? Like subscribing to a co-payment insurance scheme or a private insurance to help them with the cost of maybe 4500 dollars a year? 

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4 hours ago, Tom Amin said:

Okay that's clear now. 

Do people do something to avoid paying 5000 per year? Like subscribing to a co-payment insurance scheme or a private insurance to help them with the cost of maybe 4500 dollars a year? 

It takes a while to get to the safety net threshold $5k, you might never do it. Private health insurance doesn’t cover PBS meds and only covers a small part of the gap of non PBS meds.  If you have one of the benefits cards (which you probably wouldn’t be eligible for anyway being new migrants) then they discount the cost of meds but that’s generally for low income or elderly folk. You can go cheap and get generic brands rather than name brands but, no, in general, people accept that in Australia there is a co-payment for meds and they pay it. 

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I came from Germany and there also there is a co-payment between 5 and 20 Euros and I used to happily pay it. So I guess it is the same in Australia too. 

Thanks a lot for your response. 

Amin

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Have you registered with Medicare yet?  You need to actually go to an office and register to get the benefits.  Appointments with doctors are easy.  You can go and see any doctor you like anywhere that is happy to see you and you don’t have to keep going to the same place.

 

Different chemists charge different amounts for the same prescription drugs so you can shop around for a good price for the thing you need.  Generally Chemist Warehouse tend to be the cheapest but there are other discount chemists that have good prices as well.  My private health insurance gives us a discount on items at particular chemists but to be honest those same items are often cheaper at the discount chemists even after the discount anyway.


Any fool can criticize, condemn, and complain but it takes character and self control to be understanding and forgiving.

Dale Carnegie – 1888-1955, Author and Lecturer

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I have but I didn't start looking for a doctor. 

The info about medicine is really useful. Thanks a lot Nicf

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