Medication prices

[Aussiebird]

Am I right in saying your doctor will give you a prescription,  then you take it to any pharmacy to get a price?  Our medications will be quite expensive,  so can we ask for a cheaper brand? Are the prices dependent on having a Medicare card?

I've heard about the PBS, do you have to register and be registered with Medicare?

I get confused with Medicare, Health insurance, levy etc etc......so much more complicated that the UK!!

Also, is private health insurance compulsory? What are the advantages and disadvantages of having it or not?  

I really cant remember how it all works now, been a long time!!

Thanks for any replies. Xx

[Marisawright]

You can ask for the "generic" (i.e. no-name) brand if there is one available.   

The PBS is the body that sets the prices for medications.  If you have a Medicare card, then you automatically get prescription medication at that price.  There is a "safety net" you can register for - if your medications go above a certain threshold in the year, you then get cheaper prices.  I seem to remember that it's up to you to keep track of your expenses and put your hand up when it gets to the level (which is stupid really, as you'd think they could do it for you!):

https://www.servicesaustralia.gov.au/individuals/services/medicare/medicare-safety-nets

Private health insurance is not compulsory.  Whether it's worth it depends a lot on where you live.  Many people don't realise that it covers ONLY procedures that are done in hospitals and some clinics - and even then, it doesn't cover the whole cost, there is always an excess to pay.  You can take out "Extras" cover, which covers you for things like dentists, spectacles, physiotherapy etc., but that is separate and extra.  Note that dentistry is not covered by Medicare so it is very expensive if you don't have extras cover.

If you don't have private health insurance and need to go to hospital, you will be treated free of charge, often by the same doctors. The advantage of private health insurance is that you get to choose your doctor and choose a private room. Coming from the UK, that might seem like an unnecessary luxury, but a lot of Australians have become used to the idea, they feel it's worth paying for. 

The other advantage of private insurance is that, like the UK, the public health system has long waiting lists for elective surgery.   But in most of the country, the waiting lists are no better or worse than the UK - so if you don't take out private health insurance and rely on the public system, you'll basically be in the same position you were in the UK using the NHS.

The other reason people take private insurance is the Medicare levy.  You can reduce or avoid the Medicare levy by taking out private health insurance - but first, work out if your income is going to make you liable in the first place, and second, compare the cost of paying the levy vs the cost of the health insurance.  

https://www.ato.gov.au/Individuals/Medicare-levy/

Edited September 28, 2020 by Marisawright

[AJ]

You need to remember that if you dont take out Private within 1 year of arriving in the country as PR you have to pay a supplement which is worked out on how many years you are over 31.  This is charged for 10 years.  We have had to take hospital and extras because of income, but have only ever used for Dental and Optical!  If your income is over the threshold and you dont have private you have to pay a further medicare charge at tax time which works out not much more that paying your premium for a year.

What is the Medicare Levy Surcharge?

Initiated by the Government, the Medicare levy surcharge aims to encourage Aussies to take out private hospital cover – therefore reducing the load on the public Medicare system.

Not everyone is required to pay the Medicare levy surcharge, but if you’re single and earning more than $90,000 or part of a family earning $180,000, you may be charged. We’ve put together a handy online table that lets you calculate exactly how much your surcharge will be, but to give you an idea, if your taxable income is $100,000, you might expect to pay an extra $1,000.

Annual taxable income	Medicare levy surcharge
$90,000 or less	0.0% (no extra tax)
$90,001-$105,000	1.0%
$105,001-$140,000	1.25%
$140,001 or more	1.5%

Above table: Thresholds for individuals for 2019/20 financial year¹

Combined annual taxable income	Medicare levy surcharge
$180,000 or less	0.0% (no extra tax)
$180,001-$210,000	1.0%
$210,001-$280,000	1.25%
$280,001 or more	1.5%

Edited September 28, 2020 by AJ

[Aussiebird]

10 minutes ago, AJ said:

You need to remember that if you dont take out Private within 1 year of arriving in the country as PR you have to pay a supplement which is worked out on how many years you are over 31.  This is charged for 10 years.  We have had to take hospital and extras because of income, but have only ever used for Dental and Optical!  If your income is over the threshold and you dont have private you have to pay a further medicare charge at tax time which works out not much more that paying your premium for a year.

What is the Medicare Levy Surcharge?

Initiated by the Government, the Medicare levy surcharge aims to encourage Aussies to take out private hospital cover – therefore reducing the load on the public Medicare system.

Not everyone is required to pay the Medicare levy surcharge, but if you’re single and earning more than $90,000 or part of a family earning $180,000, you may be charged. We’ve put together a handy online table that lets you calculate exactly how much your surcharge will be, but to give you an idea, if your taxable income is $100,000, you might expect to pay an extra $1,000.

Annual taxable income	Medicare levy surcharge
$90,000 or less	0.0% (no extra tax)
$90,001-$105,000	1.0%
$105,001-$140,000	1.25%
$140,001 or more	1.5%

Above table: Thresholds for individuals for 2019/20 financial year¹

Combined annual taxable income	Medicare levy surcharge
$180,000 or less	0.0% (no extra tax)
$180,001-$210,000	1.0%
$210,001-$280,000	1.25%
$280,001 or more	1.5%

So if we are on a combined income of less than say for example, $100,000 annually and we pay for just "extras" health cover, not including hospital cover, it would be 0.0% ??

Does everyone pay the 2% Medicare levy? Is this deducted from your income monthly? When we submit a tax return, how is it calculated with the levy?  

It's quite confusing!!

[Marisawright]

1 hour ago, Aussiebird said:

So if we are on a combined income of less than say for example, $100,000 annually and we pay for just "extras" health cover, not including hospital cover, it would be 0.0% ??

 

It's perfectly simple really.

If you are earning more than a certain amount, you are liable to pay the Medicare levy - but you can avoid it by taking out private health insurance (hospital cover).  The threshold is $90,000 for an individual, or $180,000 for a couple. 

If you are earning below that amount then you're not liable to pay the Medicare levy whether you have health cover or not. 

Edited September 28, 2020 by Marisawright

[NickyNook]

2 minutes ago, Marisawright said:

It's perfectly simple really.

If you are earning more than a certain amount, you are liable to pay the Medicare levy - but you can avoid it by taking out private health insurance (hospital cover).  The threshold is $90,000 for an individual, or $180,000 for a couple. 

If you are earning below that amount then you're not liable to pay the Medicare levy whether you have health cover or not. 

Not sure your terminology is quite correct.

Most people who qualify for Medicare pay for it via the Medicare Levy. This is the bog-standard 2% that is either withheld from your pay via your employer or paid at the end of the tax year via your tax return.

If you earn more than a $90k/$180k then you are also liable to pay the additional Medicare Levy Surcharge, if you don't have private hospital cover. This is in addition to the Medicare Levy.

 

 

[Marisawright]

25 minutes ago, NickyNook said:

Not sure your terminology is quite correct.

Most people who qualify for Medicare pay for it via the Medicare Levy. This is the bog-standard 2% that is either withheld from your pay via your employer or paid at the end of the tax year via your tax return.

If you earn more than a $90k/$180k then you are also liable to pay the additional Medicare Levy Surcharge, if you don't have private hospital cover. This is in addition to the Medicare Levy.

 

 

Thank you for correcting my terminology.  I missed out that important word "surcharge" after levy.  Just goes to show it IS a bit confusing in places!

Edited September 28, 2020 by Marisawright

[VERYSTORMY]

Also, be aware that what in covered by Medicare varies a bit by state. In WA ambulances are private and a trip in an ambulance can be very expensive if you don't have insurance. 

[ali]

There isn't a standard price for each item on a prescription, each medication will have a specific cost.  Also, if for example a medication is at a dose of 250mg and you are given that in strengths of  200mg and a 50mg tablet - you would pay for both .. we often assist our patients by asking it to be issued e.g. in 100mg strengths and prescribing it to be taken at  2 and a half - that way they're paying for just one lot of tables  (this would only be applicable if your medication doesn't come in a one strength dose.

You can check the prices of medication on the PBS website https://www.pbs.gov.au/info/about-the-pbs  as Marisa suggested some brands are cheaper.   Your doctor will let you know if a medication isn't PBS listed and they will be able to look up the cost for you.

[ramot]

9 hours ago, Marisawright said:

You can ask for the "generic" (i.e. no-name) brand if there is one available.   

The PBS is the body that sets the prices for medications.  If you have a Medicare card, then you automatically get prescription medication at that price.  There is a "safety net" you can register for - if your medications go above a certain threshold in the year, you then get cheaper prices.  I seem to remember that it's up to you to keep track of your expenses and put your hand up when it gets to the level (which is stupid really, as you'd think they could do it for you!):

https://www.servicesaustralia.gov.au/individuals/services/medicare/medicare-safety-nets

Private health insurance is not compulsory.  Whether it's worth it depends a lot on where you live.  Many people don't realise that it covers ONLY procedures that are done in hospitals and some clinics - and even then, it doesn't cover the whole cost, there is always an excess to pay.  You can take out "Extras" cover, which covers you for things like dentists, spectacles, physiotherapy etc., but that is separate and extra.  Note that dentistry is not covered by Medicare so it is very expensive if you don't have extras cover.

If you don't have private health insurance and need to go to hospital, you will be treated free of charge, often by the same doctors. The advantage of private health insurance is that you get to choose your doctor and choose a private room. Coming from the UK, that might seem like an unnecessary luxury, but a lot of Australians have become used to the idea, they feel it's worth paying for. 

The other advantage of private insurance is that, like the UK, the public health system has long waiting lists for elective surgery.   But in most of the country, the waiting lists are no better or worse than the UK - so if you don't take out private health insurance and rely on the public system, you'll basically be in the same position you were in the UK using the NHS.

The other reason people take private insurance is the Medicare levy.  You can reduce or avoid the Medicare levy by taking out private health insurance - but first, work out if your income is going to make you liable in the first place, and second, compare the cost of paying the levy vs the cost of the health insurance.  

https://www.ato.gov.au/Individuals/Medicare-levy/

Reference the safety net, we use the same pharmacy for all our prescriptions and we were told we had reached the safety net and were issued with an exemption card till the end of the year, $6 now per prescription. Our prescription costs are combined as it applies I think to the combined household  prescriptions cost, not just each individual. Please check this. I know my daughter kept her receipts for her prescriptions.

[BusbyBoo]

Hi,

Thought I’d add some clarity to health insurance.

It is cheaper if you get it within a year of arriving, if you’re over 30, after that they charge an extra 2% for every year above 30 (it’s a tax) after 10 years the extra is removed (we had 19% just been removed).

You can avoid long waiting lists, but may still have to pay some towards your treatment. This is because... Medicare have set prices for all procedures and they are all coded. You’re surgeon may charge more than this fee. So.... if Medicare say a procedure is e.g. $100. Medicare pay $75, health ins pay $25 and you pay nothing.... but... if you surgeon charges $125 you will need to pay a ‘gap’ $25. So you have to shop around as some surgeons don’t charge above Medicare fees. Hospital, anaesthetist are also charged separately and can vary, buyer beware and check for costs beforehand. You may also have insurance excess to pay depending on policy you choose.

if you see a specialist for a consultation or a GP many charge a ‘gap’ and private health doesn’t cover any of it you’ll  only get the Medicare schedule fee paid.

Dont confuse Hospital cover with extras cover. They are separate. The Medicare Levey Surcharge is only applicable to Hospital cover. Extras cover is for things like dental, physio and optical etc and again what you get back depends on your level of cover, beware it will still be expensive as Medicare do not cover these at all. They are private providers and charge what they like. E.g a dental check up code 011 first visit is approximately $70 and health fund may only pay $15 of that so a ‘gap’of $55 to be paid by you. Some places do ‘preferred provider’ then it may not cost anything to you but be aware, this usually only covers check ups and cleans maybe twice a year, any treatment will almost certainly charge a substantial gap.

so.... only you can decide if it’s worth the extra costs. However my own experience is yes. My 25yr son had bowel issues, because of his age etc he was told to have a colonoscopy, public system was an 18 month wait, we had private health so it was done in 2 weeks. He had 10 pre cancerous polyps some over 1cm. 18months doesn’t bear thinking about. Ive had very quick cancer treatment and OH had major surgery which would have been a never never wait.
 

Busby

[Loopylu]

If you use a lot of medication and it is expensive then the safety net may help you.  We have a local discount chemist who knows us well and, as we get all our scripts from there, they keep the safety net form for us and update it every time we submit a script.  When we hit the safety net, the chemist immediately starts charging us at the lower rate for the rest of the year. 

The other thing to note is, if you or your husband (I see you are returning to Australia) ever served in the Australian Forces, you should qualify for a White Card.  My husband did 6 years in the RAAF (never in a combat zone) and got this card about a year ago.  I think if you serve in a combat zone you may qualify for Gold Card which gets you even more medical benefits.   As we have had 48 scripts issued this year as a family, we now all qualify for free scripts for the rest of the year thanks to the White Card.  There are other perks associated with this White Card such as $50 of free postage stamps for use within Australia...

[ali]

Worth noting that the safety net is reviewed every year and usually increases (but did go down slightly to $1486.80 in 2020 from 15550)