OZ medical care and insurance explained

[Guest The Pom Queen]

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.

I'm in Queensland now and have never had any of the problems you have.

[LaraBond]

You obviously know your way around here. Have you been here long? Did you know someone here before you came who pointed you in the right direction? Because this could make a big difference. We have spoken to many work colleagues who came 2-4 years ago and they all are in the same situation. If it was that easy surely they would have found free doctors and treatments by now?

[Guest The Pom Queen]

You obviously know your way around here. Have you been here long? Did you know someone here before you came who pointed you in the right direction? Because this could make a big difference. We have spoken to many work colleagues who came 2-4 years ago and they all are in the same situation. If it was that easy surely they would have found free doctors and treatments by now?

 

I am not sure how that has anything to do with it, yes I've been here 8 years, no I didn't know anyone when I arrived. I've lived in Melbourne and Queensland and never had any of the problems you have. There isn't a week goes by when I haven't been in and out of hospital or the Dr's/Specialists.

[Guest The Pom Queen]

What about the Medicare Safety Net?

 

The Medicare Safety Net provides families and individuals with financial assistance for high out-of-pocket costs for out-of-hospital Medicare Benefits Schedule (MBS) services. Once you meet a Medicare Safety Net threshold, you may be eligible for additional Medicare benefits for out-of-hospital MBS services for the rest of the calendar year. Also available is the PBS Safety Net if you and your family need a lot of medicines in any year.

Medicare Safety Net thresholds as at 1 January 2011

 

Threshold amount Who it is for How it is calculated What the benefit is Original $399.60† All Medicare cardholders Based on gap amount 100% of schedule fee for out-of-hospital services Extended concession and FTB(A) $578.60† Concession cardholders and families eligible for FTB(A) Out-of-pocket costs 80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services Extended general $1157.50† All Medicare cardholders Out-of-pocket costs 80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services Out-of-pocket costs—the difference between the Medicare benefit and what your doctor charges you.

Schedule fee—a fee for service set by the Australian Government.

Gap amount—the difference between the Medicare benefit and the schedule fee.

What is an Extended Medicare Safety Net (EMSN) benefit cap?

 

An EMSN benefit cap is an upper limit on the amount of Medicare Safety Net benefit payable for an out-of-hospital MBS service. Not all Medicare items have an EMSN cap.

For more information about the EMSN benefit cap go to the Extended Medicare Safety Net fact sheet on the Department of Health and Ageing's MBS Online website.

What are the benefits for me?

 

Once you reach a Medicare Safety Net threshold visiting a doctor or having tests may cost you less.

For example: if you reach a threshold and then visit your doctor who charges you $65.00 for a standard consultation, you will receive your Medicare benefit of $34.30. You will also receive 80 per cent of your out-of-pocket costs (($65.00 - $34.30) x 80 per cent), giving you an extra $24.60. So in this example it will only cost you $6.10 to visit your doctor. An out-of-pocket cost is the difference between the Medicare benefit and what your doctor charges you.

What services are covered?

 

The Medicare Safety Net covers a range of doctor visits and tests covered by the MBS that you receive out-of-hospital. Having surgery, seeing a doctor or having a test when you are in hospital, or medical services not included in the MBS, do not count towards the Medicare Safety Net.

Some examples of services where costs count towards the Medicare Safety Net are:

 

 

• GP and specialist consultations
  
• blood tests
  
• CT scans
  
• pap smears
  
• psychiatry
  
• radiotherapy
  
• tissue biopsies
  
• ultrasounds
  
• x-rays.
  

 

Who needs to register?

 

Individuals—do not need to register for the Medicare Safety Net. Just keep your contact details up-to-date with Medicare Australia.

Couples and families—need to register for the Medicare Safety Net, even if all of your family members are listed on your Medicare card.

 

 

• Each family member needs to be identified so their medical costs can be counted towards your family’s Medicare Safety Net.
  
• You only need to register once.
  
• Registration is free.
  

 

How do I register?

 

 

 

• Fill in the online Medicare Safety Net couples and families registration form
• Call 132 011*
  
• Visit your local Medicare office
  
• Download a Medicare Safety Net couples and families registration and amendment form [PDF, 151Kb]
  

 

What happens next?

 

If you pay your doctor in full and then claim your Medicare benefit we will:

 

 

• automatically keep a tally of your medical expenses for you
  
• write to you when you are nearing a threshold
  
• if you claim from Medicare Australia before paying
  your doctor:
  
  • we will send you a cheque payable to the doctor, which you take to your doctor along with any outstanding balance you owe
    
  • take your receipts to Medicare Australia as proof of payment (that is your receipt and Medicare Statement) and we will keep a tally of your expenses for you
    

   

   

  [*]contact you when you are nearing a threshold and may ask you to substantiate any unpaid claims

  [*]once you reach a threshold, all further out-of-hospital claims you make for that calendar year may automatically attract a higher benefit.

   

 

Note: if you and your partner and/or children are registered for the Medicare Safety Net we will ask you to confirm in writing who is in your Medicare Safety Net family each year before any higher benefits can be paid.

Remember: you need to give Medicare Australia all of your receipts for doctors’ accounts to ensure you get all the benefits that you are entitled to.

What is a Medicare Safety Net family?

 

For Medicare Safety Net purposes a family consists of:

 

 

• a couple legally married and not separated or a couple in a de facto relationship with or without dependant children
  
• a single person with dependant children.
  

 

Note: a dependant child is someone under 16 years of age or a full-time student under 25 years of age attending school, college or university, whom you financially support.

What if my child is a member of two registered families?

 

If your child is a member of two registered families, for reasons such as separation or divorce, the family that pays the cost of the medical service receives the benefit. Any out-of-pocket costs will count towards that family’s Medicare Safety Net. This is determined by the Medicare card used to claim the benefit.

What is the Medicare Safety Net original threshold?

 

Threshold amount Who it is for How it is calculated What the benefit is Original $399.60† All Medicare cardholders Based on gap amount 100% of schedule fee for out-of-hospital services For every service that can be claimed from Medicare Australia, the Australian Government has set a fee for the service—this is called the schedule fee. This is not the doctor’s fee.

The Medicare benefit that is paid when you visit a doctor is usually 85 per cent of the schedule fee, other than your General Practitioner (GP) consultation which is 100 per cent of the schedule fee.

The gap amount is the difference between the schedule fee and Medicare benefit.

How do I reach the Medicare Safety Net original threshold?

 

Medicare Australia calculates all of the gap amounts you have paid during the calendar year.

Once your gap amount reaches the Medicare Safety Net original threshold of $399.60† and you have confirmed in writing who is in your Medicare Safety Net family, you may be entitled to higher Medicare benefits. We will provide you with the details for you to confirm who is in your Medicare Safety Net family.

What is the EMSN concession threshold?

 

Threshold amount Who it is for How it is calculated What the benefit is Extended concession $578.60† Concession

cardholders Concession cardholders Out-of-pocket cost 80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services The EMSN concession threshold is for concession cardholders. Medicare Australia will pay 80 per cent of the out-of-pocket costs or the EMSN benefit cap for MBS services provided out-of-hospital after a threshold of $578.60† per family or individual per calendar year is reached. Eligible concession cards are those issued by Centrelink or the Department of Veterans’ Affairs, including:

 

 

• Commonwealth seniors' health cards
  
• Health care cards
  
• Pensioner cards.
  

 

Who is considered a concessional family?

 

If you are a concession cardholder at any time during a calendar year, you are eligible for the EMSN concession threshold for the remainder of that year starting from your eligibility date.

What is the EMSN Family Tax Benefit (Part A) threshold?

 

Threshold amount Who it is for How it is calculated What the benefit is Extended FTB (A) $578.60† Families eligible for FTB(A) Out-of-pocket costs 80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services Family Tax Benefit (Part A) (FTB (A)) is an annual tax benefit to help families with the cost of raising children. Medicare Australia will pay 80 per cent of the out-of-pocket costs or the EMSN benefit cap for MBS services provided out-of-hospital after a threshold of $578.60† per family per calendar year is reached. You may get FTB(A) if you:

 

 

• have a dependant child under 21 years of age (including a foster child), in your care for at least 35 per cent of the time, or
  
• have a dependant full-time student 21 to 24 years of age in your care for at least 35 per cent of the time, and
  
• have income under a certain amount and permanently live in Australia, and
  
• you are an Australian citizen, a New Zealand citizen, the holder of a permanent visa or the holder of certain temporary visas.
  

 

Eligibility for FTB(A)

 

Who is considered an FTB(A) family?

 

If you are eligible for an FTB(A) payment, you and your family are eligible for the EMSN FTB(A) threshold.

How can I claim an FTB(A) payment?

 

There are two ways families can claim an FTB(A) payment—as a fortnightly instalment or as a lump sum payment.

Fortnightly instalment examples:

 

 

• If you claim FTB(A) as a fortnightly instalment through the Family Assistance Office, your EMSN FTB(A) threshold eligibility will start on the date of payment in that calendar year.
  
• If you claim FTB(A) by deferring your fortnightly instalment payments through the Family Assistance Office, your EMSN FTB(A) threshold eligibility will start on the date of deferment in that calendar year.
  
• If you claim FTB(A) by deferring your fortnightly instalment payments through Centrelink, your EMSN FTB(A) threshold eligibility will start on the date of deferment in that calendar year.
  

 

Lump sum example:

 

 

• If you claim FTB(A) as a lump sum payment for a past period, for example the previous financial year, your EMSN FTB(A) threshold eligibility will start the following calendar year.
  

 

Note:

 

 

• Lump sum payments must be received before 31 December to be eligible for the next entire calendar year. If the payment is made after 31 December, eligibility will start from the date of payment in the eligible calendar year in which it is received.
  
• A person who has shared care of a child between 14 per cent and 35 per cent will be considered eligible for the Medicare FTB(A) Safety Net threshold.
  

 

Disclaimer: how you choose to receive your FTB(A) payment/s determines your eligibility for the EMSN FTB(A) threshold. It is your responsibility to understand that your choice of FTB(A) payment can affect your Medicare Safety Net FTB(A) eligibility.

What if I receive only one fortnightly FTB(A) payment?

 

If you are eligible for FTB(A) at any time during a calendar year, you are eligible for the EMSN FTB(A) threshold for the remainder of that year starting from your date of payment.

What is the EMSN general threshold?

 

Threshold amount Who it is for How it is calculated What the benefit is Extended general $1157.50† All Medicare cardholders Out-of-pocket costs 80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services The EMSN general threshold pays 80 per cent of the out-of-pocket costs or the EMSN benefit cap for MBS services provided out-of-hospital, after a threshold of $1157.50† per family or individual per calendar year is reached.

When you pay the account in full, you will receive the Medicare benefit plus the additional 80 per cent or the EMSN benefit cap.

When you do not pay the account in full, we will send you a cheque payable to the doctor. To receive the additional 80 per cent benefit or the EMSN benefit cap you must:

 

 

• take the cheque to your doctor along with any outstanding balance you owe
  
• pay the remainder of the account in full and provide proof of payment to Medicare Australia.
  

 

How do I know when I’ve reached a threshold?

 

We will contact you when you are nearing a threshold.

To check your Medicare Safety Net balance:

 

 

• visit our Online Services. If you’re not already registered for Online Services, register now.
  
• call 132 011*
  
• visit your local Medicare office
  

 

Why do I need to confirm?

 

We want to make sure your family gets the highest benefits possible. If you are approaching a Medicare Safety Net threshold and you are registered as a couple or family, we will ask you to confirm in writing who is in your Medicare Safety Net family each year. Confirming your details allows us to check your family’s eligibility for higher Medicare benefits.

[Guest The Pom Queen]

DENTAL IN BRISBANE

 

COSTS at UQ School of Dentistry

check-up: from $60 (including some xrays)

clean: $95

restoration (filling, chipped tooth): from $50

root canal: from $250

 

COSTS at a private dentist in Brisbane city

check-up: $55 (plus xrays $40 each)

clean: $145

restoration (filling, chipped tooth): from $50 -$400

root canal: from $800-$1300

 

WAITING TIMES UQ:

check-up: from 3 days

restoration: two days

emergency: one to three days

 

WAITING TIMES Qld Public Dental Hospital at South Brisbane:

For Health Card holders or pensioners only. Free treatment.

check-up: 2 years

restoration: queue up from 7.45am and you may be seen that day

emergency: same day

 

WAITING TIMES Private dentist in Brisbane city:

check-up: next day

restoration: next days

emergency: same or next day

 

 

 

 

[Jurls]

You obviously know your way around here. Have you been here long? Did you know someone here before you came who pointed you in the right direction? Because this could make a big difference. We have spoken to many work colleagues who came 2-4 years ago and they all are in the same situation. If it was that easy surely they would have found free doctors and treatments by now?

 

 

But the point is not for everyone to have free doctors and treatments. If everyone were supposed to have this, then all the doctors would bulk bill for everyone and I imagine everyone's taxes would be higher.

 

I do agree that it's a really complicated system and definitely something that

potential migrants need to research thoroughly before arrival, especially if they have a chronic condition. Medicare is not the NHS after all, it's a foreign system in a foreign country.

[Guest The Pom Queen]

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

 

It may also be worth joining a plan like Noble Dentist

http://www.nobledentist.com.au/

[LaraBond]

What about the Medicare Safety Net?

 

The Medicare Safety Net provides families and individuals with financial assistance for high out-of-pocket costs for out-of-hospital Medicare Benefits Schedule (MBS) services. Once you meet a Medicare Safety Net threshold, you may be eligible for additional Medicare benefits for out-of-hospital MBS services for the rest of the calendar year. Also available is the PBS Safety Net if you and your family need a lot of medicines in any year.

Medicare Safety Net thresholds as at 1 January 2011 .

 

Thank you Moving2Melbourne, this is much more helpful. We shall consider subscribing to this however it is still very complicated which exactly is the threshold we qualify for - we get no concessions and my poor husband is constantly on Warfarin and associated blood tests and checks and cancer observations.

 

With regards to dental treatments by students I won't risk it - my treatments are far more complicated that simple fillings. Perhaps, a trip abroad to a dental clinic would be a better option. Anyone has experience and can advise on this?

[Petals]

Anyone who has a child with a chronic medical condition does not have to worry about it here in Aus.

 

My daughter became a type 1 diabetic as a child and she has had the best of care in fact when we returned for a holiday in the early nineties she had an insulin pen which were not available in the UK at that time. She was taken care of by a whole team of doctors at the hospital special clinic for children with her condition and it did not cost us anything. Her insulin is subsidised in that she gets six month supply of insulin for one prescription fee unlike everyone else who has to pay month by month. I am sure that any other conditions like this are attended to in the same way.

 

She has also been treated for the big C and is still being treated and her treatment is completely free. She does not even have to make her mri appointments or her specialist appointments, the hospital do all that for her and just advise her by mail.

 

I like the fact that we do pay for some of our medical here in Australia because this helps with costs and stops people dropping by at the drop of a hat. Although they seem to like sitting in ed department all night with a cold. Why I never know.

 

The system is not hard and rather than taking others advice why not go to the horses mouth and check it all out on the very informative sites of medicare and the pharmaceutical benefits site. All is revealed there and accurately, not saying what we give is not accurate but there may be nuances we miss and me I always go to the source for my information.

[Skani]

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.

 

I'd have to agree with you m2m. Surely you wouldn't go through all the upheaval of migrating with a chronically ill family member without checking the medical implications...only to return after 3 weeks?

 

Especially as the(public) Royal Children's Hospital in Brisbane has a specialist rheumatology unit.

[landv]

LaraBond,

 

 

With regards to bulk-billing GP-s, people do have to do their research to find them, they're still about, my GP bulk bills, although they have now started to charge for consultations on Saturdays, which is $55.

I had to go recently on a Saturday and payed, but I got $34 back from Medicare, so really I only had to pay $20 and afterall it was a Saturday, many GP surgeries in the UK are not open on Saturdays.

[LaraBond]

I'd have to agree with you m2m. Surely you wouldn't go through all the upheaval of migrating with a chronically ill family member without checking the medical implications...only to return after 3 weeks?

 

I asked the same question and they said they did do research, but you have to understand that people who used NHS all their lives would just assume that if there is a state health system it would be similar to NHS with free consultations and treatments. It is not advertised anywhere otherwise and until recently nothing was mentioned on this forum either. You won't necessarily do research about something you don't even suspect about. Also, for that particular couple, these medical costs in addition to unexpectedly high costs of living was a deal breaker.

 

Information on Medicare site is not that obvious and the health system itself is so complicated that often you don't find out until you get here and go to the doctors. A lot of people are not even aware that they are entitled to Medicare and what is deemed as 'medically necessary' treatment - too vague for most! Also, health provision seem to be different in various states and depending on circumstances people's experiences of health care would be different.

 

This is exactly why I started this thread - to raise people's awareness on the subject so they know what to expect.

[Skani]

until recently nothing was mentioned on this forum either.

 

 

Welll...not exactly. If you enter Medicare in the Search box on PIO it produces 499 separate threads, going back to December 2005.

 

However I just hope the couple you spoke to really do have all the facts correct about their situation. It seems very strange that the Royal Children's Hospital in Brissie has a Rheumatology unit and yet they can't afford the treatment.

[MicheleW]

I am based in Brisbane and have first hand experience with the medical system. I go to a doctor in the city and over the past 2 weeks I have visited them 3 times, had numerous blood tests, a chest x-ray with only a 5 minute wait and the results available by the time I got back to the doctors, a trip in an ambulance, and a day in hospital with a slew of tests.

 

Total cost $21.

[LaraBond]

Sounds great Michele. Which practice do you go to?

[MicheleW]

I go to the Market St medical practice, down near Eagle St. Pier.

[LaraBond]

Thanks Michele. Though I just had a look at their website and it said: 'This practice offers a private billing system. Fees vary depending on the time and skill involved in the consultation. Pensioners, students and health care card holders are billed at concession rates. Current fees are displayed at the reception desk.'

 

How will you explain this?

[Jurls]

Hi Lara,

 

Here's a leaflet with info about the Medicare Safety Net. Hope it is of some help, it breaks the info down.

http://www.medicareaustralia.gov.au/public/services/msn/files/1856-24-how-does-the-medicare-safety-net-work.pdf

 

Cheers

[Jurls]

And here is a leaflet about the PBS and the PBS safety net.

http://www.medicareaustralia.gov.au/provider/pbs/pharmacists/files/2406-pharmaceutical-benefits-scheme-brochure.pdf

[pinkk8]

I signed up to a medical practice in Milton (Brisbane) when I arrived and it bulk bills, haven't had any problems with that. Resent paying for the pill and think dentists are frighteningly expensive but try and visit my dentist at home every time I go.

[MicheleW]

Thanks Michele. Though I just had a look at their website and it said: 'This practice offers a private billing system. Fees vary depending on the time and skill involved in the consultation. Pensioners, students and health care card holders are billed at concession rates. Current fees are displayed at the reception desk.'

 

How will you explain this?

 

I just know what I got charged. I actually collapsed in the doctors surgery last week and left via an Ambulance so didn't get a chance to pay. Yesterday I went back into pay and they told me I had been bulk billed, so maybe I was fortunate.

[Guest The Pom Queen]

I just know what I got charged. I actually collapsed in the doctors surgery last week and left via an Ambulance so didn't get a chance to pay. Yesterday I went back into pay and they told me I had been bulk billed, so maybe I was fortunate.

Hope you are ok Hun :hug::hug:

[MicheleW]

Hope you are ok Hun :hug::hug:

 

Thanks m2m, I seem to be doing a lot better - I have to be as I fly off to Jakarta for 3 weeks on Sunday for work. :smile:

[Guest The Pom Queen]

Thanks m2m, I seem to be doing a lot better - I have to be as I fly off to Jakarta for 3 weeks on Sunday for work. :smile:

 

Well take it easy:hug:

[LaraBond]

I just know what I got charged. I actually collapsed in the doctors surgery last week and left via an Ambulance so didn't get a chance to pay. Yesterday I went back into pay and they told me I had been bulk billed, so maybe I was fortunate.

 

Sorry to hear that Michele. Hope you will get well soon.

It seems after talking to some people that bulk billing is at the doctor's discretion.