What does Medicare Cover?

[Scarby]

Hi, forgive me for being daft but can't seem to get my head around what medicare covers, is it like the NHS or do you need to have private health care? I am currently in the process of getting a small hole in the heart fixed before we emigrate in October and will need to see a consultant on an annual basis, would this be covered my medicare or would I have to pay for a consultant?

Thanks

Celia

[Quoll]

Medicare covers out of hospital medical care. It is meant to be a co-pay system where each visit to the doctor costs you a bit out of pocket unless you find a bulk billing doctor (that seems to be a passion for new migrants). Specialists are usually co pay and you can pay over $100 for a first visit with some refunded through medicare. Sometimes you can access a specialist through the public system but you probably dont want to wait that long.

 

Private health only covers hospital treatments and added extras like dental and optical, it doesnt cover specialists in their rooms.

[Fred & Wilma]

I have lived here 3 years & we have used medicare & private. Basically I think medicare is very much like the NHS, you can get services but you have to wait longer for appointments & use the local public hospital. My daughter needs a nose operation & we were told she can have it done through medicare or through our private healthcare , whichever we choose to use. I took my daughters to the Drs last week, the visits were free on medicare, the prescriptions can be expensive though, we paid $40 for a nasal spray. If you earn above a certain threshold then you have to have private healthcare, otherwise they whack you with a tax to cover it. I'm sure you will get a better answer from someone with more knowledge than me. I work in disability & my clients receive regular consultants check ups etc through medicare. After 3 years here, I'm still a bit confused to be honest. Oh & you can also get eye tests through medicare.

[fish.01]

Medicare covers free public hospitals and free public hospital specialists like the NHS. You may have long wait times for public specialists like you do on the NHS. Sometimes they are fine though, depends on your location and whether there is a shortage of specialists in the field you require.

 

It also pays some money towards services rendered by out of hospital private providers like GP's, pathology, private specialists, x-rays, eye tests etc. Some of these private practices provide their service for free (aka bulk bill) as they do not charge you anything on top of the amount the government pays them. eg. Approx 70% of GP's australia wide fit into this category. You are not tied to GP's or other doctors in your area so it is expected that you doctor shop to find doctors that meet your budget or other needs (where available). Regional areas often have significantly worse access to healthcare given Australia's low population density outside large cities.

 

Finally there is subsidised medicine under the medicare funded PBS with a maximum charge of $34.20 for most PBS medicines or $5.60 if you have a concession card.

 

There are also safety nets under general medicare and the PBS that reduce your costs if you spend a lot on medical/drugs.

[Guest NeilEB]

How much are prescriptions in OZ, or does it depend on the medicine?

 

I have a chronic condition (asthma, not too serious but I require regular medicine), how much can I expect to pay?

[2tigers]

Whenever I had a prescription I was always offered a generic version (cheaper than the one prescribed), its the same drug/medication, different name and cheaper. I wasn't able to claim any money back for the prescriptions and remember they could get pricey.

 

I had no faults with medicare and saw no need to go private. I needed specialist help with regards to depression and the psychiatrist help I received was a quick referral and brilliant. I claimed majority of the sessions on medicare and I think I was $10 out of pocket after each session. I also gave birth under public hospital, no worries at all, excellent care.

 

Sorry I cant be any more specific for you, but for me I didn't see the need in private cover (no income for me so no tax penalisation either)

[calNgary]

I have a condition that requires me to see a specialist every 6 months, i also have to have scans and blood tests every 6 months to. All of this is covered by Medicare and doesnt cost me a cent. It did take a while to be ''appointed' to a specilaist (approx 9 months from Dr referring me) but since i got one the treatment i have had is second to none.

 

When you see a GP at first i found that unless you state you want to go public they will refer you to a private Dr.

 

Cal x

[Quoll]

How much are prescriptions in OZ, or does it depend on the medicine?

 

I have a chronic condition (asthma, not too serious but I require regular medicine), how much can I expect to pay?

 

Up to $34.20 per script which is the max for PBS drugs. Sometimes you can get generic ones which are cheaper. But it wont be more than that and, yes, depends on the drug.

[an1ta]

Hi I live in Nsw and the medicare is great, my daugther had to have tonsils out and we waited 2 months.

When my son broke his hand I didnt pay a penny everything was covered by medicare again. I was rushed into hospital at 3am was seen right away and ended up staying in for 3 days with a blood clot in my stomach all medication was free, I had to go back for blood test and loads of scans every week and there was no charge.

The one thing I would get is ambulance cover it is so expensive to call one out, I have to call them twice through sport, it also covers me and the kids for dentist, eye test and glasses, physio and a few other things. I pay $48 a month and its worth it.

Hope this helps

Anita

[PontePom]

Hi, forgive me for being daft but can't seem to get my head around what medicare covers, is it like the NHS or do you need to have private health care? I am currently in the process of getting a small hole in the heart fixed before we emigrate in October and will need to see a consultant on an annual basis, would this be covered my medicare or would I have to pay for a consultant?

Thanks

Celia

I had a hole in my heart closed about 3 years ago and had seen the specialist to check it was closed properly which was 1 year after the operation before we came to Australia and got a letter from him to bring with me.

I'm waiting to see a specialist for my elbow but not going private because of the costs. The public system will do for me.

Good luck with the op

 

Howard

[Guest siamsusie]

I have nothing to say about Medicare other than "excellent" !

 

I am seen weekly by my Hepatologist in his rooms, pathology.. the hospital , always over supply me with free meds.. GP ....... all bulk billed.

 

It is seldom I use my Medibank card.

[inception]

Do I have to fill an enrolment application form in order to use Medicare? Am I allowed to use both Medicare and a private insurance provider at the same time or do I have to choose one or the other? I am really not sure how the healh insurance system works.

[Guest siamsusie]

Do I have to fill an enrolment application form in order to use Medicare? Am I allowed to use both Medicare and a private insurance provider at the same time or do I have to choose one or the other? I am really not sure how the healh insurance system works.

 

You must register with Medicare

 

http://www.immi.gov.au/living-in-australia/settle-in-australia/to-do-first/register-medicare.htm

 

You can choose who you use. Your GP will be under the medicare scheme, who will then recommend a private specialist if needs be.

 

I use both, the latter more for optical, podiatry and dental.

[Guest roaminnomore]

Our local Medical Centre bulk bills the children so no money exchanges hands for an appointment. It charges 62.50 Auz dollars for an apointment for adults. Basically, you book your appointment, see the doctor, after your appointment return to reception and pay. You are given a receipt which you then take to a Medicare Centre and they refund two thirds in cash there and then. (Example - 50.00 paid at the doctors, 34.50 returned by medicare).

 

My husband recently required a full CT Scan, the cost was 708.80, we paid 220.00. It sounds alot but when you think how much pressure is taken off the system and my husband has be dealt with within three weeks you understand. On saying that however, I am looking into Ambulance, Optical and Dentistry cover.

 

Ley x

[Scarby]

Thanks so much everyone for all your really helpful replies.

Celia

[leemg]

Like the NHS in the UK, it also depends where you are, I had to wait four months for physiotherapy in Central Sydney but was told if I went to another hospital in the suburbs it could be about 6 to 8 weeks. Most of what we get here seems to be covered, although the payment / refund system can get very confusing

[Scarby]

Ok, starting to get my head around this,thanks.

 

So how do you work out which doctors bulk bill?

 

Celia

[Guest siamsusie]

Ok, starting to get my head around this,thanks.

 

So how do you work out which doctors bulk bill?

 

Celia

 

For us our GP appears to bulk bill everyone. I guess you can phone around Scarby.

 

Susie

[Guest NeilEB]

What is Bulk Billing? Heard lots of people mentioning it, and it's something poms like but Aussies 'frown upon'?

[tisme]

Bulk Billing is where a doctor bills the government direct for seeing a patient, they will only charge them the schedule amount. If a doctor bills the patient they will charge them over the schedule amount so when the patient goes into Medicare to get this rebated they will be out of pocket the difference between what the doctor charged and what Medicare rebates, ie the schedule amount.

 

EG. If you doctor charged you $65 for a consultation and the schedule amount Medicare pay is $35 then you are out of pocket $30, this is called your out of pocket expense.

 

this link explains what is and what isn't covered.

http://www.medicareaustralia.gov.au/public/claims/what-cover.jsp

[newjez]

I assume pre existing conditions would affect the cost of private insurance?

 

I can't get private in the UK because of the cost. I imagine it would be the same in Oz. When I lived in Oz, I always had the basic cover for optical and dental. If you wear glasses it's a no brainer really.

 

I did have a private op when I was under my parents private cover. They had no single rooms so they put me in a share with a guy with hemarroids, (not pleasant for him or me). They had lovely food on the menu but I was nil by mouth. It still cost me $1000 even with private cover. I should have waited and had it done under medicare.

 

I also had a strange experience when my father was getting a hernia done in St John of God (lovely hospital), and my mother was taken to Charlie Gardener as an emergency at the same time. A&E cases are usually covered under medicare anyway, as few private hospitals have A&E facilities. The two hospitals were like comparing a B&B to a five star hotel, but the quality of care seemed to be the same.

[fish.01]

I assume pre existing conditions would affect the cost of private insurance?......

 

No, it's illegal in australia to base your premium on your health. The insurance companies can't change the premium based on your age or pre-existing conditions.

[tisme]

You usually have to wait 12 months to be able to claim on pre-existing ailments.

 

You are penalised according to the age you join the fund after you turn 31. You have to join prior to 1st July after your 31st birthday or you get charged a loading, an additional 2% for each year over 31, up to 70%, this applies to the hospital component of the cover only. It is removed after 10 continuous years of cover. I do believe new migrants who take up Private health insurance within a specified time of arriving, (I think it's 3 months) are exempt from the loading.

[fish.01]

You usually have to wait 12 months to be able to claim on pre-existing ailments.

 

You are penalised according to the age you join the fund after you turn 31. You have to join prior to 1st July after your 31st birthday or you get charged a loading, an additional 2% for each year over 31, up to 70%, this applies to the hospital component of the cover only. It is removed after 10 continuous years of cover. I do believe new migrants who take up Private health insurance within a specified time of arriving, (I think it's 3 months) are exempt from the loading.

 

Not that it matters to the final cost but just a note that this is a government devised scheme to reduce the govt subsidy they will give you to push more people ino private insuance rather than the insurers changing your premium based on you being a higher risk due to your age.