Reciprocal Health Cover, Private Insurance, & Medical Levy Surcharge

[Guest The Pom Queen]

On 20/01/2020 at 02:03, kamb1ng said:

 

So now I'd like to understand what private medical cover is actually necessary for someone with Medicare. I know I want to get the "extras cover", which includes dental, optical, and also definitely Ambulance cover. But for the rest it's not clear to me whether I need any or not. For example is it easy enough to get GP appointment using Medicare like an NHS GP in the UK? 

My family is generally quite healthy. The only ongoing thing is asthma control for my daughter and wife.

What's the best way to know if private medical cover is suitable or not?

Any suggestion highly appreciated. 

For me 101% yes, in fact I’ve hit the stumbling block where I would probably die without it and unfortunately that’s not me being a drama queen I have a very rare disease and to get a grasp on it you have to know my complex medical history or have the 27 Manila folders full of notes, reports etc put on your desk. Therefore if I end up going to the emergency department at a public hospital they spend 5 minutes with me and think they have all the answers. Even though I have letters telling them to call my specialists immediately if I should present at any hospital they still ignore them and won’t start treatment soon enough.  So for me I get my monies worth by having my specialists on speed dial. 
Also having the private health enabled me to start the treatment last year thanks to all the lovely members and my son who helped, although I had to pay for the drug we didn’t have to pay for the hospital stay etc. 

If I was a healthy individual then I don’t think I would bother with private. Something you do need to be aware of is that you are only covered on your private for admissions. So if you see a specialist as an outpatient some may charge up to $300 for the first appointment. You do get some of it back from Medicare but not all. 

[kamb1ng]

4 hours ago, The Pom Queen said:

Something you do need to be aware of is that you are only covered on your private for admissions. So if you see a specialist as an outpatient some may charge up to $300 for the first appointment. You do get some of it back from Medicare but not all. 

Can you elaborate what you meant? If I am only on Medicare, how would the above apply?

Also one more question, since I've decided to just go with Medicare for now, is it likely that when I land the border control officer will ask for evidence of visa condition 8501? And if she does, can I answer that I will be applying for Medicare as a UK citizen?

Thank you!

[AliQ]

37 minutes ago, kamb1ng said:

Something you do need to be aware of is that you are only covered on your private for admissions. So if you see a specialist as an outpatient some may charge up to $300 for the first appointment. You do get some of it back from Medicare but not all. 

 

37 minutes ago, kamb1ng said:

Can you elaborate what you meant? If I am only on Medicare, how would the above apply?

Hi kamb1ng, I worked in the private health care sector for many years, and what The Pom Queen means, is that, private health cover covers you for admission to a PRIVATE hospital for an elective procedure / operation / treatment. If you had a car accident, fell off a ladder, etc. then an ambulance would take you to a public hospital first. BUT, in some instances, and depending on the size and facilities of the private hospital in your area, you MAY be able to ask to to be taken to a private hospital A&E, but that is not the norm.

And, having private health insurance cover does NOT mean that your costs are 100 % covered. Nearly ALL private Drs and hospitals have a GAP to pay. And, they can be HUGE !

It's a complex issue and you have to assess your own needs, health and finances as to whether or not you wish to join a private health care company.

[Marisawright]

14 hours ago, kamb1ng said:

Also one more question, since I've decided to just go with Medicare for now, is it likely that when I land the border control officer will ask for evidence of visa condition 8501? And if she does, can I answer that I will be applying for Medicare as a UK citizen?

My understanding is that you will have to take out insurance because you must prove that you meet visa condiition 8501, and border control has no way of knowing if you'll get Medicare or not.  Once you're settled, then you can cancel and get a partial refund.

Edited January 26, 2020 by Marisawright

[Fanatic278]

I am currently very deeply involved with the Australian Tax Office (ATO), Private Healthcare Ombudsman and my Member of Parliament to rectify the ridiculous mess of Brits having to pay the Medicare Levy Surcharge (MLS). I haven't read all the posts above, but I can categorically state the following:

1) Reciprocal Medicare is sufficient to satisfy your 8501 visa condition. But as stated above, you need to have valid cover to show the immigration officer when you arrive, so take out some cover and cancel after you have registered with Medicare (if that's what you want to do).

2) Overseas Visitors Health Cover does not exempt you from the MLS. It is considered as non-compliant according to both the ATO and Ombudsman. This is a ridiculous anomaly, hence why my MP is pushing for changes in the regulations on my behalf.

3) You can take out any local medical insurance policy that is available to an Australian. Some providers I spoke to were misinformed about this, but I know it is true. There will be gaps between what Reciprocal Medicare covers you for and what a local healthcare policy will cover for you though, as you are not entitled to full Medicare. What those gaps are, I am not sure. In any case ALL local healthcare policies will exempt you from the MLS. The current cheapest policy is from AHM for $1,600 (family of 5), which in your case is slightly cheaper than the MLS. It is very basic cover, but seeing as you are not going to claim against it that is irrelevant.

 

My recommendation is to take out BUPA Overseas Visitors Health cover and Top 60 Extras. BUPA have been a pleasure to deal with when we have claimed. It is a comprehensive starting point and you can evaluate your requirements after a year here.  You should also apply for AHM Essential Basics Plus so you can avoid the MLS.

 

Edited February 4, 2020 by Fanatic278

[kamb1ng]

Thank you Fanatic278 for the thorough response.

So we landed in Melbourne two weeks ago and I wanted to share that the immigration officer did not mention or ask anything about health cover. In fact he didn't say a single word to us. Just looked at our passports, held it to compare with our faces, then stamped our passports.

We registered for Medicare in the local service centre quite easily and it was a straightforward process. We got given the Medicare numbers straight away.

Thank you for the BUPA recommendation. We have been looking at that exact cover.

[DrDougster]

On 04/02/2020 at 16:12, Fanatic278 said:

I am currently very deeply involved with the Australian Tax Office (ATO), Private Healthcare Ombudsman and my Member of Parliament to rectify the ridiculous mess of Brits having to pay the Medicare Levy Surcharge (MLS). I haven't read all the posts above, but I can categorically state the following:

1) Reciprocal Medicare is sufficient to satisfy your 8501 visa condition. But as stated above, you need to have valid cover to show the immigration officer when you arrive, so take out some cover and cancel after you have registered with Medicare (if that's what you want to do).

2) Overseas Visitors Health Cover does not exempt you from the MLS. It is considered as non-compliant according to both the ATO and Ombudsman. This is a ridiculous anomaly, hence why my MP is pushing for changes in the regulations on my behalf.

3) You can take out any local medical insurance policy that is available to an Australian. Some providers I spoke to were misinformed about this, but I know it is true. There will be gaps between what Reciprocal Medicare covers you for and what a local healthcare policy will cover for you though, as you are not entitled to full Medicare. What those gaps are, I am not sure. In any case ALL local healthcare policies will exempt you from the MLS. The current cheapest policy is from AHM for $1,600 (family of 5), which in your case is slightly cheaper than the MLS. It is very basic cover, but seeing as you are not going to claim against it that is irrelevant.

 

My recommendation is to take out BUPA Overseas Visitors Health cover and Top 60 Extras. BUPA have been a pleasure to deal with when we have claimed. It is a comprehensive starting point and you can evaluate your requirements after a year here.  You should also apply for AHM Essential Basics Plus so you can avoid the MLS.

 

I think the two bits in bold are the most important things to note when coming to Aus. The first seems to be a fairly well kept secret that must be netting health insurance companies a hell of a lot of money. Get the cheap BUPA cover and cancel it as soon as you have your medicare number. The second regarding gaps between full medicare and reciprocal cover means that for example (I think) routine blood tests in a private hospital are not covered. If you apply to medicare they will reply refusing to pay as "no reciprocal cover" and you then don't have a gap statement for your health insurance to pay out.

Another cautionary tale I'd relate is regarding my depression. Things got really tough at one point after being stable for years and I needed some emergency treatment and more recently an admission. We were able to ring HCF and upgrade our super basic policy to cover this immediately and have subsequently easily recouped the costs. Health insurance is invaluable when you need it and it probably isn't an over statement to say it likely saved my life.

So my advice would be make sure the money you spend in it is in the right place and not some bollocks overseas policy that covers very little and is sold on the basis that you must have it for your visa!