Medicare

[DavidIII]

Hi,

I'm soon to be moving and would like to know when you can apply for Medicare.  I've looked online and have downloaded the form, but unsure if you can apply from abroad or if you need to wait until you have an address in Australia.

Also, if anyone has the time I'd like to explain in summary form how exactly medicare does work - bulk billing etc.

All help would be most appreciated.

[AliQ]

46 minutes ago, DavidIII said:

Hi,

I'm soon to be moving and would like to know when you can apply for Medicare.  I've looked online and have downloaded the form, but unsure if you can apply from abroad or if you need to wait until you have an address in Australia.

Also, if anyone has the time I'd like to explain in summary form how exactly medicare does work - bulk billing etc.

All help would be most appreciated.

Possibly best if you apply once you arrive and have an address.
Not sure if you can apply anyway before you arrive, but it's a pain having to complete change of address's all the time !

[ali]

You won't be able to apply until you arrive for medicare.  Some GP's will offer bulk bill which means you don't have to pay anything.  If private you will pay at the GP then get the medicare rebate ( a portion of the cost back).

[Loopylu]

As soon as you get here, fill out the paperwork/statutory declaration about residing in Australia and then head down to your local Medicare office to register in person.  If you are application is accepted, they give you a piece of paper there and then which you can show a GP to prove coverage until the plastic card is issued to you.

[Skani]

On 20/10/2020 at 19:00, DavidIII said:

Also if anyone has the time I'd like to explain in summary form how exactly medicare does work - bulk billing etc.

Once you have a Medicare card you will be entitled to many health care services for free or for reduced cost.

The Medical Benefits Schedule (MBS) lists the medical services covered by Medicare and each listed service has a fixed benefit refund paid by the government.  Some doctors accept this refund as payment in full =" bulk billing";  some doctors charge a higher fee and the patient pays the difference between the government refund and the total fee.

Some GPs accept bulk billing for certain categories of patients only, e.g those with Centrelink concession cards, or children under 16.  Some don't bulk bill at all.  Those who bulk bill all patients can be so busy that they don't accept new patients.  Access to bulk billing doctors can vary greatly between areas.

[Marisawright]

On 20/10/2020 at 19:00, DavidIII said:

Also, if anyone has the time I'd like to explain in summary form how exactly medicare does work - bulk billing etc.

@DavidIII, one thing that may surprise you is that most doctors don't work for Medicare.   You pay them per consultation.  They are all in business for themselves, so they can charge you whatever they like. 

In the old days, you had to pay the doctor in full, and then fill in a form to claim on Medicare. But you don't get all the money back - Medicare only pays the standard fees, which are less than what most doctors charge.   Nowadays, the receptionist will often have an online system whereby you sign a form authorising the practice to collect the standard fee straight from Medicare, and you only have to pay the balance. 

There is also a bulk billing system.  Under bulk billing, the GP agrees to charge the standard fees.  You pay nothing, and the GP collects the fees direct from Medicare.  That means the GP makes less money, but they are also allowed to "bulk bill" the government, which greatly reduces administration. They also don't need staff to handle or manage money.   Bulk billing saves you money, but there's an incentive for GP's on bulk billing to churn through large numbers of patients quickly.  

If you need to see a specialist, most GPs will refer you to a private specialist.   There are public specialist clinics, (and some of them are world class), but the waiting lists are long, and most Australians don't want to wait.  However, the waiting lists for public specialists are no worse than you're used to in the NHS - so if you're happy with that and would prefer free treatment, speak up and ask about being seen in the public system.  An example of the difference that can make - my spinal fusion cost $35,000 with a private specialist, whereas my friend's dad had the same op on the public system for absolutely no charge (before you swoon, I did get $25,000 back from my private health insurance). 

Edited November 6, 2020 by Marisawright

[rammygirl]

With anything medical the advice is to ask about cost upfront and be prepared to shop around, even if you have health insurance. Prices can vary enormously.  Same with medication, there is no standard fee like in UK. Pharmacists can and do charge a retail price. The same medication could cost $20 or $6 depending on where you buy it. Dentists are not covered by Medicare except for some specific procedures. Prices are not dissimilar to private dentists in UK.

BUT shop around and always ask about price upfront and what you get for it, they can add on things assuming you will be covered by insurance without bothering to ask!

I have learned not to be sensitive or shy about this, they are generally matter of fact and I have never been made to feel cheap or uncomfortable by a talking about money in a surgery or over the phone before committing.

[DrDougster]

19 hours ago, Marisawright said:

@DavidIII, one thing that may surprise you is that most doctors don't work for Medicare.   You pay them per consultation.  They are all in business for themselves, so they can charge you whatever they like. 

In the old days, you had to pay the doctor in full, and then fill in a form to claim on Medicare. But you don't get all the money back - Medicare only pays the standard fees, which are less than what most doctors charge.   Nowadays, the receptionist will often have an online system whereby you sign a form authorising the practice to collect the standard fee straight from Medicare, and you only have to pay the balance. 

There is also a bulk billing system.  Under bulk billing, the GP agrees to charge the standard fees.  You pay nothing, and the GP collects the fees direct from Medicare.  That means the GP makes less money, but they are also allowed to "bulk bill" the government, which greatly reduces administration. They also don't need staff to handle or manage money.   Bulk billing saves you money, but there's an incentive for GP's on bulk billing to churn through large numbers of patients quickly.  

If you need to see a specialist, most GPs will refer you to a private specialist.   There are public specialist clinics, (and some of them are world class), but the waiting lists are long, and most Australians don't want to wait.  However, the waiting lists for public specialists are no worse than you're used to in the NHS - so if you're happy with that and would prefer free treatment, speak up and ask about being seen in the public system.  An example of the difference that can make - my spinal fusion cost $35,000 with a private specialist, whereas my friend's dad had the same op on the public system for absolutely no charge (before you swoon, I did get $25,000 back from my private health insurance). 

Couple of points:

Doctors aren't all in business for themselves - many specialists work at public hospitals and have no other private practice or income.

Wait lists are not necessarily long - I triaged new referrals yesterday and will be seeing many routine referrals in the next month - this is practically unheard of in the NHS. These were almost all bulk billed appointments for people without health insurance. The other thing to bear in mind as an example is that your spinal fusion didn't actually cost $35,000 - that was what you were charged and what it cost you. The public system would have been able to fund the operation and perform it at a fraction of that cost.

The flow of funding and charges in the Aus system is very complex but at the point of care the advantages of it are easy to see from a service delivery point of view when you compare it to the NHS. How the system might cope with a high burden of pandemic respiratory virus cases remains to be seen...

[Marisawright]

29 minutes ago, DrDougster said:

Doctors aren't all in business for themselves - many specialists work at public hospitals and have no other private practice or income.

Wait lists are not necessarily long 

I said "most" doctors are in business for themselves, NOT all.  I think all GP's are, though, which are the doctors people will see most often. 

And the whole point of my second paragraph was to make people aware that public specialists do exist and are good - which a lot of people aren't aware of.   It angers me when I see pensioners fretting about affording their specialist treatment, when a more thoughtful GP could easily have referred them to the public system in the first place.

I agree that waiting lists are not necessarily long.  In the example I gave, my friend's father waited less than 2 months for his op.  However, when I've posted here to say that waiting lists aren't bad, I've been howled down. So now, I settle for saying "waiting lists are no worse than the NHS" rather than claiming they're better.

[DrDougster]

12 minutes ago, Marisawright said:

I said "most" doctors are in business for themselves, NOT all.  I think all GP's are, though, which are the doctors people will see most often. 

And the whole point of my second paragraph was to make people aware that public specialists do exist and are good - which a lot of people aren't aware of.   It angers me when I see pensioners fretting about affording their specialist treatment, when a more thoughtful GP could easily have referred them to the public system in the first place.

I agree that waiting lists are not necessarily long.  In the example I gave, my friend's father waited less than 2 months for his op.  However, when I've posted here to say that waiting lists aren't bad, I've been howled down. So now, I settle for saying "waiting lists are no worse than the NHS" rather than claiming they're better.

Waiting lists at TPCH in Brisbane are streets ahead of NHS and agreed that health insurance is a luxury.

I would contest that you did say doctors are "all in business for themselves". This is a verbatim quote and I strongly disagree with this notion / find it borderline offensive as it goes completely against the biggest motivation in my life aside from my family.

[Marisawright]

9 minutes ago, DrDougster said:

I would contest that you did say doctors are "all in business for themselves". This is a verbatim quote and I strongly disagree with this notion / find it borderline offensive as it goes completely against the biggest motivation in my life aside from my family.

My first line was "one thing that may surprise you is that most doctors don't work for Medicare" and the "all" in the second sentence was referring back to those doctors.  Badly worded, I agree.

I don't see how it's offensive.  The Australian system is set up so that if you want to be in general practice, you must run your own business. You seem to be implying that anyone who's in business for themselves is automatically fleecing their customers. 

[DrDougster]

19 minutes ago, Marisawright said:

My first line was "one thing that may surprise you is that most doctors don't work for Medicare" and the "all" in the second sentence was referring back to those doctors.  Badly worded, I agree.

I don't see how it's offensive.  The Australian system is set up so that if you want to be in general practice, you must run your own business. You seem to be implying that anyone who's in business for themselves is automatically fleecing their customers. 

I’m a doctor primarily to help people, not to be in business for myself. Saying I’m in business for myself, which you did by saying all doctors are is completely wrong. 
 

anyway, we’re gonna go see Gruffalo’s Child at the theatre now which will be far more useful than me taking offence on a forum

[Marisawright]

11 minutes ago, DrDougster said:

I’m a doctor primarily to help people, not to be in business for myself.

You're interpreting "in business for myself" to mean "in business to benefit myself".   That is not what I meant. My own GP is in business for himself, by which I mean he runs his own practice.   I can assure you I did not mean any negative connotations by it.

[Skani]

I read it clearly as Marisawright explaining  to someone unfamiliar with the  Australian system that doctors are not employed by Medicare but are independent operators - not at all implying that they have a self interested  business agenda.

[DrDougster]

3 hours ago, Skani said:

I read it clearly as Marisawright explaining  to someone unfamiliar with the  Australian system that doctors are not employed by Medicare but are independent operators - not at all implying that they have a self interested  business agenda.

I don't think "You pay them per consultation.  They are all in business for themselves, so they can charge you whatever they like." is an accurate explanation to someone unfamiliar with the system.

I'm not mad keen on going all Humpty Dumpty with a word "means just what I choose it to mean" rather than simply admitting when you might have got something a bit wrong - a lot of politicians could do with just saying "Yeah, sorry, got that a bit wrong" at the moment!

[Marisawright]

4 minutes ago, DrDougster said:

I don't think "You pay them per consultation.  They are all in business for themselves, so they can charge you whatever they like." is an accurate explanation to someone unfamiliar with the system.

I'm not mad keen on going all Humpty Dumpty with a word "means just what I choose it to mean" rather than simply admitting when you might have got something a bit wrong - a lot of politicians could do with just saying "Yeah, sorry, got that a bit wrong" at the moment!

You’re free to feel insulted by your misinterpretation of my words. 

 I’m equally free to feel insulted by your insistence that I’m lying about my intentions. 

Edited November 7, 2020 by Marisawright

[ramot]

Relax, we all know the written word can be sometimes interpreted in different ways. I see Marisa trying to explain Medicare, and DrDougster as a new very welcome Dr, to Australia explaining his viewpoint. 

[DrDougster]

Woah! I don’t think anyone was calling anyone a liar! Deep breaths...

[calNgary]

On 20/10/2020 at 19:00, DavidIII said:

Hi,

I'm soon to be moving and would like to know when you can apply for Medicare.  I've looked online and have downloaded the form, but unsure if you can apply from abroad or if you need to wait until you have an address in Australia.

Also, if anyone has the time I'd like to explain in summary form how exactly medicare does work - bulk billing etc.

All help would be most appreciated.

You can apply as soon as you arrive and have an address here to use.

Medicare is probably the only thing that i think is very confusing for new arrivals, in certainly took me a while to understand it. In 14 years ive only ever used Medicare, currently my GP charges me $74 and Medicare refund me $36? there and then on the spot. If i am popping into the GP for say my B12 jab or flu jab that will only take a few minutes, he bulk bills me so i dont pay anything. I see the same GP all the time and he is great.

I see a specialist every 6 months at the hospital. When i arrived and was first 'referred' it took just under 12 months to get the first appointment. I have regular blood tests, scans, biopsy's and x rays and because its all via the public system i do not have to pay. Just sign a paper after the appointment so the hospital can bill Medicare direct. 

The only thing i really pay for is prescriptions for my daily meds and B12 injections (you buy the injection at the chemist, take to GP who jabs you)

Hope this helps a bit

  Cal x

[mt9754]

As I understand it, if you want a "family doctor" that has time for you and listens to your previous history etc then you might want to pay for your appointments and go private.  Whereas if you don't really go to the doctors ever and you'll only go for a very specific problem, then go bulk billing and get a full refund back from medicare.

Make sure you login to the My Gov site and hookup:
- Medicare
- Add your bank account number

This will allow you to get automatic refunds for anything you spend at the doctors, otherwise you have to do all the paperwork manually!

[BusbyBoo]

The Medicare system is not the NHS, however it is similar in that it provides cost free treatment for you if you need it. But it is not the same.

1. If you see a GP, some will ‘bulk bill’ that means no cost to you they bill Medicare directly. Or you may choose a non bulk billing GP who charge a ‘gap’ so you will pay them say $70 and then Medicare will pay you say $36 back (can’t remember the exact fees). In Australia you can see any GP you can get an appointment with, unlike the UK where you are only allowed to use your own practice. So in effect if you need an appointment today you can shop around.

2. If you need to see a specialist e.g ENT Dr,  then usually you go to their private rooms and pay them roughly $170 and get roughly $80 back. (Sometimes they will also bulk bill if you can’t pay for whatever reason). However sometimes you can see a specialist through the hospital (it’s complicated) this is free to you. But you may wait longer. When a specialist decides you need an operation you will be asked if you have private insurance, if you do you can avoid the waiting list. However see my previous post about how that works.

3. it’s also worth understanding that if you are an emergency and you E.g fell and broke you arm, you can go to hospital and be fixed at no cost.

4. If you need blood tests and X-rays, MRI etc (unless you’re in hospital) these are also private clinics, so you’ll get a referral and go and get them. Many will incur a gap (between what Medicare pays and what is charged by practices). But it is much quicker than the UK wait.

4. Allied health such as dental (apart from government dental scheme where you need to be in a low socioeconomic position), physio, podiatrist etc are private and you pay, again unless in hospital.

So in reality Medicare is excellent and free if you need it. Private health is also great to avoid waiting lists for operations not classed as emergency, but can attract a further cost to you and you need to do research.

Having family struggling to get appointments in the UK and difficulty in even getting a blood test...... give me Medicare any day.

Can’t help much on prescriptions as it’s a rare need. It’s different but also great with some great Drs.

[BusbyBoo]

Just thought I’d add,  if you have a NHS dentist in the uk, get your check up, clean and any treatment done BEFORE you migrate. Dentistry is excruciatingly expensive. I once had a recent arrival nearly have a cardiac arrest at the cost when given an estimate and when my Aussie colleague asked him if he was a pensioner he took it as an insult and stormed out. Pensioner means on benefits here and not just old age (he was about 35), she was only trying to tell him he may be able to use the government clinic

[Loopylu]

14 hours ago, mt9754 said:

As I understand it, if you want a "family doctor" that has time for you and listens to your previous history etc then you might want to pay for your appointments and go private.  Whereas if you don't really go to the doctors ever and you'll only go for a very specific problem, then go bulk billing and get a full refund back from medicare.

Make sure you login to the My Gov site and hookup:
- Medicare
- Add your bank account number

This will allow you to get automatic refunds for anything you spend at the doctors, otherwise you have to do all the paperwork manually!

I disagree with the first paragraph of this post.  Just because a GP bulk bills this does not mean that the service is any less.  My husband has some serious health conditions (Stage 4 CKD, arthritis requiring knee replacements, gout and sleep apnoea) and has only seen the same bulk billing GP for the last 10 years and has stayed with that GP when he has changed practice. 

Unlike the UK, you can choose which GP you see which means that you can build up a relationship with your GP (bulk billed or not).  I used to see the same GP at a practice in Brisbane near work but when the fee for a 10 minutes consultation rose to $100 with only $37 back from Medicare, I kicked this into touch and now see a young former NHS GP who bulk bills and practices near my home.  I am not prepared to fund anymore investment properties and children's private schools studies for the former GP....

The problem with the GPs who charge large gaps is that they love to send you for unnecessary additional tests which are expensive.  When I turned 50 my GP referred me for a $250 bone scan (not covered by Medicare) as this was her standard practice.  I did not go and when I went to see the British GP I told her I had been referred but chose not to go.  She asked me whether I had a family history of osteoporosis, ever had broken bones, had low calcium -  all of which were not applicable.  She then said "Why would you pay for and submit yourself to an unnecessary dose of radiation?".

Talking to another bulk billing GP trained in NZ (similar medical system to UK) while my usual GP was on leave, she explained that Australian trained GPs are terrified of being sued as they are self-employed and not backed by the government (as they are in the UK and NZ) and so they send you for unnecessary tests just in case.  She said they are not very good clinicians as they rely on testing rather than their experience to diagnose you.

My view of the Australian health system is that it is very much a curate's egg - good and bad in parts.  It's great if you are rich and can afford private health insurance and to pay the gap where that insurance does not cover all costs (ie you can be several thousand out of pocket). Not so great if you are on benefits as you wait your turn in the queue for surgery and you only get reduced prescription fees (not free like in the UK). Often people on low incomes/benefits have to choose between medication or a procedure which is not fully covered by Medicare (ie their health needs) and eating/rent. Australian health care can also be a bit behind in terms of latest technology.  There was an ABC news article last night about a new form of chemotherapy that targets the cancer more effectively being based in Brisbane (first one in the Southern Hemisphere).  I know for a fact that my mother's friend had this treatment in Cardiff 7 years ago.  Finally, if you come from a family with the breast cancer gene, you cannot get the genetic test on Medicare and the cost is several thousand dollars which is usually not covered by insurance. My friend with breast cancer found this out a few years ago.

Australia's health system is somewhere between the UK and the USA.  As far as accessibility to affordable universal health care is concerned, Australia ranks much lower than the UK and other European countries in global studies.

[Marisawright]

1 hour ago, Loopylu said:

I disagree with the first paragraph of this post.  Just because a GP bulk bills this does not mean that the service is any less. 

My view of the Australian health system is that...It's great if you are rich and can afford private health insurance and to pay the gap where that insurance does not cover all costs. Not so great if you are on benefits as you wait your turn in the queue for surgery...Often people on low incomes/benefits have to choose between medication or a procedure which is not fully covered by Medicare

I agree that not all bulk-billing GP's are bad.  Over the years, I've had several good bulk-billing GP's (I've moved around a lot).  However in the bulk-billing practices, it's normal to book patients in at 10 minute intervals, so there's a lot of pressure on the doctor - and the patient - to hurry. 

If people on low incomes are struggling to afford prescriptions or procedures then it's ignorance more than anything.  There are safety nets for prescriptions, but you have to know about them and apply for them, adn they don't seem well-publicised.  Likewise, as I mentioned before, most GP's refer patients to private specialists without thinking - and I've met people who didn't even realise they could've gone public for nothing.

For older Australians, I think they still remember the scare campaigns by the health funds years ago, i.e. If you go public, you'll be waiting years and even when you do get seen, you'll be in some grotty ward with the great unwashed.  It's a load of cobblers IMO.  It's true there are waiting lists if you go into the public system, but how is that different to the NHS?   I don't believe the waiting lists are any worse.  I've only seen a specialist in the public system twice and  I waited about 3 months, which I don't think is long compared to the NHS.  In both cases, the care was top-class and free. 

As for testing - my mother had bowel cancer which can be hereditary, so I had a colonoscopy at 40 and they found a pre-cancerous polyp (I'm now screened every 5 years).  I was advised that my three sisters, all in the UK, should also be examined.  Two of my sisters had private health insurance through their/their husband's work, so they got tested. Both had polyps and are being monitored, like me.   My third sister still hasn't been checked.  Apparently on the NHS, you can't have a colonoscopy unless you have symptoms.  With bowel cancer, by the time you notice symptoms, it's usually too late, so what use is that?   

[AussieMum]

There are good and bad amongst both bulk-billing and private GPs.  My local private practice is my go-to and I've been going there for the last 18 years or so - I started when I knew we'd be starting a family soon and I wanted to build a relationship rather than just needing to pop in to get a certificate to confirm sick leave.  They bulk bill pensioners and kids under 16 as well as whenever the doctor decides they want to, eg, I've always been bulk billed for a followup visit to get test results.  We can pop in in an emergency and be squeezed in (eg when I grated a huge hole in my finger that didn't need to go to A&E at hospital but needed the nurse to check it didn't need stitches and dress it). 

I've had bulk billing GPs sign me up for a chronic health condition treatment plan with referrals to a dietitian and an exercise physiologist (when I just needed a doctor's certificate because I had gastro and my regular doctor's was full) because it meant they could charge Medicare for an extended appointment.  I was not well enough to be in the mood to argue but I haven't been back to them since. 

Quote

Finally, if you come from a family with the breast cancer gene, you cannot get the genetic test on Medicare and the cost is several thousand dollars which is usually not covered by insurance. My friend with breast cancer found this out a few years ago.

There are definitely publicy funded genetics tests looking for BRCA gene mutations, Lynch syndrome, etc, that are accessed through Hereditary or Familial Cancer Clinics.   But there are qualifying criteria for Medicare funding, eg, family history including how many and how close the relatives are, is there a family member who is better suited to testing (due to their position in the family tree), etc, and if you have a high-risk mutation then you may also qualify for early cancer screening, surveillance MRIs, etc.  If you don't qualify for free testing, you can elect to self-fund.