OZ medical care and insurance explained

[LaraBond]

Last weekend I bumped into a couple from Liverpool who have been here in Brisbane for 6 weeks. After a short chat they said that they are going back at Christmas time. It turned out that even though they very much like it here in Brisbane, the cost of medical care for their young daughter, who suffers from arthritis, is prohibitive. All their possessions are arriving shortly but luckily, they said, they have not sold the house and they can get their jobs back when they return. However, they will suffer relocation costs back and forth.

This sad story has prompted me to reveal the facts that are not talked about in any relocation shows, magazines, books or agents – medical costs in Australia.

RECIPROCAL HEALTH AGREEMENT

First of all, the good news is that private health insurance is not compulsory for British citizens as we have a reciprocal health agreement between UK and OZ. You will only pay 1.5% medical levy from your salary for a state provider Medicare. You can apply for a Medicare card at a Medicare office on arrival, you just need to show your passport with a visa and provide your address. This will entitle you to all state health care same as residents including hospital treatments but not ambulance. See about Medicare here: http://www.medicareaustralia.gov.au/ . Your employer, however, might provide you with or insist you get a private health insurance initially until you register for Medicare. After that it is your choice to have it or not.

PRIVATE HEALTH INSURANCE

However, if your salary exceeds $77,000 per single or $154,000 per family (plus $1,500 per additional child after the first child), you will be either charged an additional 1% medical levy surcharge or you have to take out a private medical insurance. As a PR, you can choose any health provider and opt for any level of cover, which depends on amount of contribution, not on your medical history. If you are a temporary resident on, say, business visa, you are restricted to major providers with specific (and more expensive) covers for overseas visitors, such as Medibank, MBF, AHM, BUPA, HIF.

You can choose to have hospital cover only but many people take out additional extras cover for dental, optical and various alternative treatments which are not available on Medicare. Those who do not need a private medical cover can take out extras cover only – especially for dentists (read more about this one later). Extras Cover is the same for residents and visitors.

There is age loading for hospital cover – that is, the older you are the more it will cost if you are over the age of 31 and you have not taken it within the first year of registering for Medicare. The loading increases 2% a year to a maximum of 70% and once attracted will apply for 10 consecutive years. Read more about this here: http://www.privatehealth.gov.au/healthinsurance/incentivessurcharges/lifetimehealthcover.htm'>http://www.privatehealth.gov.au/healthinsurance/incentivessurcharges/lifetimehealthcover.htm Those eligible for Medicare are entitled to Federal Government Rebate of 30% of the cost of health insurance.

Please note that there are annual cost limits for treatments and there is an excess to pay each time depending on the level of the cover chosen. As well as waiting times for cover of major treatments. More about private health insurance here: http://www.privatehealth.gov.au/ .

STATE HEALTH INSURANCE

Despite what some members say about bulk-billing (free) GPs and doctors, they are like gold dust. There are certainly none in the city with some very rare exceptions for under 16-s, pensioners and those on benefits. There are some in underprivileged or rural areas but not in the cities. Everybody I have spoken to here – locals or foreigners – all pay for their GPs. It is very difficult to find a bulk-billing GP and even then you may not qualify.

GPs charge about $65 per visit, double that at the weekend. You get about a half of it back with your Medicare card. You also pay for tests, x-rays and routine treatments including materials and medications. Specialist doctors that you might be referred to also charge $150-200 per consultation with additional fees for tests and treatments, which will cost about the same again. You will get about half of it back through Medicare but there will almost always be a gap payment. This may not sound too bad for those fortunate ones who hardly ever visit a doctor but for those who are older or with chronic conditions this soon adds up! Also, you need to visit a doctor for repeat prescriptions (and pay for a visit), they do not take it over the counter or over the phone.

There are PBS (subsidised) and private prescriptions. Cost of PBS subscription vary from about $10 to $34.20. A lot of prescriptions are not on PBS though, even some regular drugs. Private prescriptions can be very expensive. Once you have spent over $1317.20 per year you pay only $5.60 for prescriptions. More about this here: http://www.medicareaustralia.gov.au/provider/pbs/index.jsp .

If your medical expenses exceed $2,000 per year you can claim 20% tax rebate on most medical expenses over that amount. This includes gap payments and prescriptions.

AMBULANCE AND EMERGENCY

Medicare does not cover ambulance services. You have to pay for an Ambulance Cover, which is variable (about $100 per year or so). In Queensland it is added to your electricity bill, so you don’t have to take it out separately. If you don’t have it you might find yourself paying nearly a thousand for a call out.

If you go to the A&E department yourself, their services are free for Medicare card holders.

DENTISTS

Now the bad news. There are no state funded dentists in Australia, they are all private, even for children and their prices appear to be unregulated. Their charges are extortionate and on average 3-4 times more than private dentists’ in the UK. See average dental prices here: http://www.privatehealth.gov.au/healthinsurance/whatiscovered/averagedental.htm . An endodontist consultation can cost $300 and a specialist root canal treatment for one tooth $3,000 – and this is not including $1,500 for a crown that you will need afterwards. There is no separate dental insurance, it is included in Extras Cover of your private health insurance along with other items. As with hospital cover, in the majority of cases there is a gap payment for every treatment depending on the level of cover and whether you use a dentist approved by your insurance provider or not. Again, there are annual spending limits for every type of treatment and waiting periods for major dental work like crowns, bridges, root canals, braces etc.

I hope I have covered the majority of information about medical care for British immigrants and temporary residents. You can find more details following the links provided. I know this topic will cause a lot of controversy and arguments, so if you are young, healthy and childless, not in OZ or have lived in OZ for a while, please leave this thread, it is not for you as you either will not or have not experienced the full impact of mounting bills of a chronic patient or you have had a free doctor for years – an option not available to a regular average new immigrant any longer. However, additional information and clarifications are welcome.

[RockDr]

You're a little confused about the reciprocal health care agreement.

 

Permanent Residents get full medicare cover (green card).

 

People who have applied onshore for a PR visa get interim medicare cover (blue card). This entitles them to everything the green card does, but it needs renewing every year.

 

Temporary residents (e.g. 457 visa) and visitors from certain countries including the UK are entitled to reciprocal healthcare (yellow card). This entitles them to any treatment that is absolutely necessary prior to the end of their visa. If treatment isn't essential and/or urgent, it won't be covered.

[LaraBond]

We have reciprocal health cover, have been to the doctors, consultants and A&E with non-urgent problems and were never denied treatment on the grounds of non-urgency or being non-essential. How much medical care is not essential anyway? We are not talking about cosmetic operations here.

[rikyuu]

Good post, very useful.

 

"Despite what some members say about bulk-billing (free) GPs and doctors, they are like gold dust. There are certainly none in the city with some very rare exceptions for under 16-s, pensioners and those on benefits. There are some in underprivileged or rural areas but not in the cities. Everybody I have spoken to here – locals or foreigners – all pay for their GPs. It is very difficult to find a bulk-billing GP and even then you may not qualify."

 

not sure about other areas, but where we live in the west, we are registered with 2 doctors, both bulk bill, one is 5mins walk, the other 5mins drive.

 

Also, I've phone during the day and got an appointment that evening, even late or weekends. Something I could never do in the UK. The number of times we had to take our children to emergency at the hospital and wait for 8 hours, because we could not book an appointment at the doctors for 2 weeks or more was unreal. In fact, once the government targets came in to get an appointment within x days, it got worse, because if they didn't have an appointment within the target time frame, they simply didn't give you one. Target met as no appointment outside the target time frame was given. There was no target for actually giving an appointment.

[RockDr]

I'm not talking about cosmetic surgery, I'm talking about elective surgery. "Elective surgery is surgery that a doctor believes to be necessary but which can be delayed for at least 24 hours."

One of my friends has a knee problem, which needs surgery, he's had to wait for his PR to come through before he could have it done. Just because you haven't had a health problem that's not been covered doesn't mean others haven't. It is incorrect to state that reciprocal health is fully equivalent to full medicare cover.

[LaraBond]

Thank you for your clarifications. In a joint effort we should get a complete picture of this very complicated system.

[Guest The Pom Queen]

Lara you really do seem to have a bee in your bonnet about the health system over here. Personally I can talk from experience, I don't want to go in to personal details but I have been fighting the big C for a number of years now and have had to go in and out of hospital for treatment and check ups.

The only time I have had to pay is when my Dr has decided I need to be seen asap and sent me private (but that was my option as well I could have gone in under medicare and not paid a cent.)

I am not sure where you live but, wherever I have lived we have always had bulk billing dr's close by and I don't take to being classed as living in an underprivileged area.

My longest stay in hospital was for 2 weeks which I didn't pay anything for.

Also you say you have to pay for tests, xrays etc, a lot of these services are bulk billed.

I understand Australia isn't for everyone but for a family to say they are going home because medical treatment is too expensive seems a little strange and I am sure there must be more going on.

A lot of things you say are correct but not everything, I have found my treatment here to be second to none, and when I have had to go to A & E I have been seen within 20-30 minutes not 3-4 hours like in the UK.

A PIO member wrote this on another forum and kindly gave me permission to reproduce it here:

Public Hospital

 

NHS = Free

Medicare = Free

 

Public Specialists

 

NHS = Free (some long waits, some not)

Medicare = Free (some long waits, some not)

 

GP's

 

NHS = Free

Medicare = 80% of visits Australia-wide free - if you get a paying one it will cost you a gap fee of about $35 average - note, smaller towns have worse access to free GP's. Pensioners, children often free even at GP's where you pay. Medicare Safety Net if you pay too much over the year.

 

Medicines

 

NHS Script = Approx $16 , free repeats

Medicare Script = Max $32.90, pay for repeats - PBS safety net if you spend too much in year

 

Dental

 

NHS = free (access getting harder and quality sometimes questionable)

Medicare - free only for surgical procedures or people prepared to wait forever and then be accidently killed by a drill. Almost everyone uses private dentists.

 

Average Life expectancy

 

NHS = 79.3 years

Medicare = 81.3 years

 

That's where the little bit of extra money goes

[Skani]

Some clarifications I would make:

 

Bulk billing is certainly available in some cities - I know it is here in Hobart.

 

I have never been charged extra for a weekend or public holiday appointment.

 

I have been given a repeat prescription over the phone at no extra expense. However that may depend on a long relationship with your doctor.

 

Ambulance services vary from state to state so whether/how much cover one needs depends on where you live. Ambulance service is free in Tasmania - but I don't know whether this applies to any other state.

 

There are no state funded dentists in Australia, they are all private, even for children

 

Tasmania has a state funded dental service for both adults and children. Some other states may also have one.

 

Free medical care can be accessed at public hospitals but priority is given to accidents, emergencies and critical care. Elective (non life threatening) surgery such as a hip or knee replacement is low on the waiting list so, although it can really upset the quality of life, it may mean you have to wait a long time.

[Guest The Pom Queen]

I have just found the 2009 stats for bulk billing Dr's (sorry can't find anything newer)

So you say you live in Brisbane, in 2009 78.3% of Dr's visits were bulk billed.

 

 

• NSW unchanged at 84.8 per cent
  
• Victoria up 0.3 of a percentage point to 78.0 per cent
  
• Queensland up 0.8 of a percentage point to 78.3 per cent
  
• South Australia up 0.5 of a percentage point to 80.2 per cent
  
• Western Australia up 0.9 of a percentage point to 73.2 per cent
  
• Tasmania up 0.4 of a percentage point to 73.8 per cent
  
• Northern Territory up 1.0 percentage point to 63.5 per cent
  
• ACT up 0.3 of a percentage point to 52.2 per cent.
  

 

[LaraBond]

Seems we have a raw deal in Brisbane as nothing seems free here and everything I have stated I have experienced personally. Does it vary in different areas/states? Can anyone from Brisbane itself comment on this?

[boganbear]

Lara you really do seem to have a bee in your bonnet about the health system over here. Personally I can talk from experience, I don't want to go in to personal details but I have been fighting the big C for a number of years now and have had to go in and out of hospital for treatment and check ups.

The only time I have had to pay is when my Dr has decided I need to be seen asap and sent me private (but that was my option as well I could have gone in under medicare and not paid a cent.)

 

 

Sorry to hear about your illness. It certainly is one of my worries as I get older as there is a family history of Cancer in its various forms so I am pleased to hear that you have not had to pay for treatment. Despite my mum losing the battle against cancer I can't fault the treatment on the NHS and they never had to pay a penny for anythign except car park charges. It's sad they didn't get to it in time But I do worry when I see programmes on TV like "Today Tonight" (I know I shouldn't watch them as they are trash) when they have stories on some poor kid who has to go to America or the family are raising funds for treatment so you have put my mind at rest somewhat.

 

On a more positive note, I haven't been to the dentist in nearly 3 years since we came. My teeth are very good anyway but I've been gettign quotes for fees and was pleasantly surprised to hear that check ups are about $60 and clean/scrub $100. Its still a lot of money but not as much as I thought it would be so Look after your teeth!

 

A friedn of mine had a serious ear operation recently and didn't pay for a thing. She said the quality of care and the facilities, food etc was much better than in the UK .

[LaraBond]

I have spoken to a few local ozzies and they said their GPs used to bulk bill but no longer. I have rang lots of GPs and no one said they bulk bill. Also, could it be the case that those who have been with their GPs for years, can still get bulk billed but not new patients?

[Guest The Pom Queen]

Seems we have a raw deal in Brisbane as nothing seems free here and everything I have stated I have experienced personally. Does it vary in different areas/states? Can anyone from Brisbane itself comment on this?

 

I must be losing the plot today as I thought I had posted this but can't see it, try this list of Bulk Billing GP's

http://www.doctors-4u.com/brisbane/b_bill.htm

[LaraBond]

I have seen this list before, it is mainly consultants and very few GPs - all well out of city and most say they are for concession card holders and under 16's.

[RockDr]

On a more positive note, I haven't been to the dentist in nearly 3 years since we came. My teeth are very good anyway but I've been gettign quotes for fees and was pleasantly surprised to hear that check ups are about $60 and clean/scrub $100. Its still a lot of money but not as much as I thought it would be so Look after your teeth!

 

 

 

If you've not been for a while, they'll probably take an x-ray too, which will be extra cost.

[Guest The Pom Queen]

I have seen this list before, it is mainly consultants and very few GPs - all well out of city and most say they are for concession card holders and under 16's.

So where in Brisbane are you and we can tell you what Dr's Bulk Bill in your area.

[LaraBond]

I have just had another look at the list you mentioned - most of these clinics are skin cancer clinics which are free anyway or other specialist clinics. If you look closely a lot of the state that they Bulk Bill only pensioners, health care card holders and children 16years and under. I have found only one single GP clinic (with some bulk-billing GPs) within 15 km radius from where I live, and that is 12 km east from CBD.

[Jurls]

I have just had another look at the list you mentioned - most of these clinics are skin cancer clinics which are free anyway or other specialist clinics. If you look closely a lot of the state that they Bulk Bill only pensioners, health care card holders and children 16years and under. I have found only one single GP clinic (with some bulk-billing GPs) within 15 km radius from where I live, and that is 12 km east from CBD.

 

Isn't this how it's supposed to work though? I mean, Medicare isn't set up to be a free system like the NHS, it's subsidised not free. So yes, if you have a chronic condition and you're not a child/pensioner or health card holder, chances are it's going to cost some money. But that's where the Medicare safety net comes into play I think.

[LaraBond]

On a more positive note, I haven't been to the dentist in nearly 3 years since we came. My teeth are very good anyway but I've been gettign quotes for fees and was pleasantly surprised to hear that check ups are about $60 and clean/scrub $100. Its still a lot of money but not as much as I thought it would be so Look after your teeth!

 

Our neighbour is 65 and she never needs to go to the dentist and has been to a GP once in many years. For her health care is very cheap too!!! Cancer treatment is free and short waiting times too I heard. But it does not mean the same for others. Even though they might really look after their teeth and health in general. Some people have bad genes etc - remember Linda McCartney?

[Skani]

though they very much like it here in Brisbane, the cost of medical care for their young daughter, who suffers from arthritis, is prohibitive.

 

Surely they can access free medical care through the Paediatrics or Rheumatology Clinics at the public hospital? All the children I know who have chronic medical conditions are able to do this.

[LaraBond]

Obviously not otherwise their GP would have told them about this?

[rikyuu]

I think the UK NHS dentist was subsidized, but not free. Seem to remember paying about 20 pounds for a check up and 60-80 pounds for a filling.

 

I had a wisdom tooth extracted once, but it was done in a hospital. Would that be free here in the same circumstances?

[rikyuu]

I have spoken to a few local ozzies and they said their GPs used to bulk bill but no longer. I have rang lots of GPs and no one said they bulk bill. Also, could it be the case that those who have been with their GPs for years, can still get bulk billed but not new patients?

 

I joined one bulk billing doctor 10 months ago and the other about 5 months ago.

[LaraBond]

Surely they can access free medical care through the Paediatrics or Rheumatology Clinics at the public hospital? All the children I know who have chronic medical conditions are able to do this.

 

I don't think so because yet another child - of our colleague also has arthritis and they spend thousands every year - I think with private health insurance.

[LaraBond]

I think the UK NHS dentist was subsidized, but not free. Seem to remember paying about 20 pounds for a check up and 60-80 pounds for a filling.

 

I had a wisdom tooth extracted once, but it was done in a hospital. Would that be free here in the same circumstances?

 

No it would not be free as I just had an enquiry myself regarding this. My dentist said he would have a go but if the tooth does not come out I woould have to do it in hospital but it will cost much more he said.

 

With regards to GPs it seems situation in Melbourne is much better than in Brisbane.