Does Medicare cover all surgery.?

[teejaybee]

I have read and digested many posts in relation to Medicare ,private health insurance etc but must admit to still being rather confused.

My partner and I wil be entering Australia on tourist visas then immeediately applying for Aged Parent (sub class 804) visas.

A bridging visa will be issued and Medicare applied for asap under UK- Australia reciprocal agreement.

I understand certain treatments  eg dental etc are not covered but my question is in respect of any elective surgery which may be needed

at a later date resulting from any non pre existing conditions other than accident/emergency which I presume as  covered being 'medically necessary.'

It seems rather a grey area as what is considered covered by Medicare in respect of elective surgery.

 Any clarification of whether any additional private medical cover is vital for certain surgeries is required.

Thanks in advance.

Terence.

 

 

[Quoll]

The reciprocal agreement covers only medically necessary interventions so elective surgery may well not be covered. So if you fell and broke a hip and needed a hip replacement, that would be covered but if your hip was just generally disintegrating they'd expect you to go home and get that done.  Personally I'd be getting private coverage - we do anyway and we are Australian but I'm very much a belt and braces gal - elective surgery around here is always a very long wait - over the years I have been very glad of the private cover. One in particular was life changing for me and I'm not sure I would ever have got to the top of the elective list. Not sure what the insurance options are for non PR but I'm guessing there will be some.

Of course, the Australian government will expect you to go home for your elective surgeries but the NHS will take exception to you rocking up for an elective surgery after living overseas. Bit of a conundrum that one

[Marisawright]

43 minutes ago, Quoll said:

Personally I'd be getting private coverage

I'm not sure I agree.  As you know, private health insurance does not usually cover everything.  

@teejaybee, I'm not sure if you're aware how private health insurance works in Australia.  It does not cover all fees.  Doctors, specialists and private hospitals can charge whatever they like, but the private insurance reimburses based on the fees they think are reasonable.  You pay the difference (called "gap fees").  To give you an example, I had a spinal fusion.  In total, it cost $35,000.   My health insurer reimbursed only $25,000.   Whereas my friend's father, who has no insurance, had the same operation done in a public hospital under Medicare, and it cost him nothing.

It's true there are waiting lists.  However, they are no worse than the NHS, so if you're happy with the NHS in the UK, you won't have an issue here with staying in the public system. If you'd like to take advantage of the easier access to private health here, and can afford it, go for the insurance.  

If you do want insurance, make sure you're getting a quote for the right thing. You cannot access the same policies as an Australian citizen or permanent resident. You can only take Overseas Health Cover.  There used to be policies which would take into account your reciprocal status, so they were somewhat cheaper. I'm not sure if that's still the case.  

https://www.australianunity.com.au/health-insurance/overseas-visitor-cover/

Edited January 29, 2023 by Marisawright

[teejaybee]

Many thanks to Quoll and Marisa for your comments,greatly appreciated.

Your experiences are invaluable especially in respect of serious matters like Healthcare.

Any further comments/experiences welcome.

[Marisawright]

4 minutes ago, teejaybee said:

Many thanks to Quoll and Marisa for your comments,greatly appreciated.

You're welcome, @teejaybee, but I realise I missed a VERY important element from my post.  

As Quoll rightly points out, the official wording of the Reciprocal Agreement says that if treatment is not essential or urgent, you must go back to your home country to have it done.  That's reasonable, because the reciprocal agreement was intended for use by short-term visitors, not people who'd be spending the rest of their lives here. 

The problem for you, is that you can't go back to the UK to have elective surgery.  The NHS won't treat you, because you're no longer a legal resident (being a UK citizen makes no difference).  So in theory, you'll be in big trouble.  In practice, however, the story is different.  Over the years, we've heard of many bridging visa holders who've had hip replacements and other elective surgery under Medicare without any problems.  It seems that hospitals and doctors aren't sufficiently aware of the rules!   So you could take a gamble and trust that the same will apply in your case.  

However, it would be wise to assume you will need to take out private health insurance at some point, and budget accordingly.  Years ago, you could have flown back to the UK and the NHS would have treated you without question, in spite of the rules about residency.  In recent years, realising the expense of visitors accessing healthcare, the NHS has tightened up, and are applying the rules strictly.    I'd say it's very likely Medicare will eventually realise the same thing, and start making sure the rules are applied.

[Marisawright]

@teejaybee, sorry for the multiple posts, but I thought of something else.  Have you considered the cost of prescriptions?    As a bridging visa holder, you will not be eligible for pensioner concessions or safety-net provisions, so you will pay the same for your prescriptions as a working adult.   A single item can cost up to $40.  For instance, my blood pressure tablets are $20 per packet of 30, and my asthma inhaler (which lasts one month) is $34.   You can look up your own medications on the PBS (if you google the name of the medication and PBS Australia, you should find it). 

[rammygirl]

Or you can “self insure” we made the decision not to pay monthly for private health care but to have a slush fund to use where Medicare could not offer what we needed. We did the same in the UK. It can be a gamble but we are many thousands up on the deal so far.

Even Medicare isn’t totally free so you may pay a gap fee to see a gp.  You can and should shop around for treatment and prescriptions though, never be afraid to ask how much.  Also your gp may well automatically refer you to a private clinic but you can ask for public and discuss costs.  
 

Chemist Warehouse is a big pharmacy chain that is cheaper for most prescriptions, there isn’t one near us but local chemists will price match - but only if you ask! It can make quite a difference. My neighbour was paying $35 for her regular prescription and now pays $19 it all adds up, she was embarrassed to ask so I went with her. Honestly it really annoys me as the people who need the cheaper prices simply do not realise or are afraid to question. 

[Quoll]

1 hour ago, rammygirl said:

Chemist Warehouse is a big pharmacy chain that is cheaper for most prescriptions, there isn’t one near us but local chemists will price match - but only if you ask! It can make quite a difference. My neighbour was paying $35 for her regular prescription and now pays $19 it all adds up, she was embarrassed to ask so I went with her. Honestly it really annoys me as the people who need the cheaper prices simply do not realise or are afraid to question. 

Oh yes, I discovered these only fairly recently - I had been supporting my local pharmacy for years but when I found the discount chemist and I was paying less than half I would at the local pharmacy I am afraid I changed allegiance and it is only a few metres further from home.  I didnt think to ask the local one to price match

We considered self insuring and, honestly, we could but we had the lowest age loading, having had it for decades (because we were over the threshold) so thought we would continue with the lower level premiums.  For us it was a toss up and I am OK with it.  Given the appalling elective surgery options around here I wasnt going to risk the public system - significantly worse than the NHS in this neck of the woods I reckon.

[rammygirl]

Exactly I really don’t mind paying a bit extra for local convenience and to support local, but when they charge SO much more for exactly the same thing…………….then are happy to lower the price if challenged it makes me mad.  

[ramot]

4 hours ago, teejaybee said:

Many thanks to Quoll and Marisa for your comments,greatly appreciated.

Your experiences are invaluable especially in respect of serious matters like Healthcare.

Any further comments/experiences welcome.

We had overseas health cover with Medibank for 15 years while on the, now no longer, old  long term retirement visa, until we finally got PR almost 5 years ago, it’s very expensive, by my experience double the cost,  of regular health cover for PR and citizens, but on our visa we weren’t entitled to Medicare. From memory we last paid $10 or $11,000 a year then, but we were very well covered for almost everything, eg no gap to pay the GP or specialist on our policy, claim for prescriptions.

We knew quite a few people on the 804 visa, again going back 20 years, when the wait for the visa was  processed  much quicker, and they didn’t bother with private health cover, just used reciprocal Medicare . Quite a few had fairly serious health problems, and all were treated here with no problems, but as everyone we know now have PR, I don’t know if it’s still the same, as the wait is so much longer, and more and more elderly parents in the long long queue, things might have tightened up, due to the increased the cost to the government .

Edited January 30, 2023 by ramot

[Marisawright]

10 hours ago, rammygirl said:

Or you can “self insure” we made the decision not to pay monthly for private health care but to have a slush fund to use where Medicare could not offer what we needed. We did the same in the UK. It can be a gamble but we are many thousands up on the deal so far.

My husband has always self-insured.  He works in the insurance industry and his view is, IF you start self-insuring while you're still young and healthy, it's the best solution.  And by young, he means under 50. 

However, if you are already in your 60s, he feels it's probably too late to start self-insuring.  For self-insurance to work, you need a "buffer" of several years where you don't need to use much, if any, of your slush fund.  By age 60, there's a high risk that you won't have enough years before you need to start drawing substantially on the fund, and then it will quickly go negative. 

[Parley]

3 hours ago, Marisawright said:

My husband has always self-insured.  He works in the insurance industry and his view is, IF you start self-insuring while you're still young and healthy, it's the best solution.  And by young, he means under 50. 

However, if you are already in your 60s, he feels it's probably too late to start self-insuring.  For self-insurance to work, you need a "buffer" of several years where you don't need to use much, if any, of your slush fund.  By age 60, there's a high risk that you won't have enough years before you need to start drawing substantially on the fund, and then it will quickly go negative. 

You don't have to privately fund everything. You pick and choose what you go public for and what you go private for.

I did this too. Got sick of paying Medibank overt $3K a year and never needing to use it so started putting into a separate saving account. I now have over $50K in that account but now consider it my emergency fund not necessarily just for medical needs.

A well funded emergency fund is a great safety net for life's unexpected emergencies.

PS. I think if you can afford to emigrate then $30 a month for prescriptions is unlikely to put anyone off.

Edited January 30, 2023 by Parley

[Marisawright]

9 hours ago, Parley said:

You don't have to privately fund everything. You pick and choose what you go public for and what you go private for.

However in the OP's case, they won't be able to pick and choose because officially, they're not eligible to have elective surgery on Medicare.  That's why the fund would exhaust faster, especially if they're at an age (like me) where elective surgeries become far more likely.

[teejaybee]

My thanks to all for your comments and advice.

I have been researching further and found this useful piece of information, albeit dated 2014 but assuming this may still relavent today.

 

[Marisawright]

16 minutes ago, teejaybee said:

My thanks to all for your comments and advice.

I have been researching further and found this useful piece of information, albeit dated 2014 but assuming this may still relavent today.

 

Yes, that confirms what I said:  "Anecdotally, we have been advised....there are no Medicare restrictions attaching to this card".   That is still correct. However bearing in mind that you're going to be in Australia on the bridging visa till you die, and the Government is very concerned about what aged parents are costing the taxpayer, it may not remain true for the whole of your stay in Australia, so you should be prepared for that possibility.