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graham834

Medicare - How does it work??

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Hi,

 

Can anyone explain to me how Medicare works - is it similar to the NHS in the UK?

 

I have seen some threads talking about taking our private medical insurance - is this necessary and if so how much does it cost?

 

I have psorsias and see a dermatologist every 3 months here in the UK and I take methatraxate for it also. How will this fare out in OZ when I arrive in June. Do I just need to make an appointment to see a doctor when I arrive who will sort out medication and referral??

 

Any help would be appreciated.

 

Thanks,

 

Amanda

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hi

It will depend what state you move to I think

Most cases are dealt with a doctor that you choose in your area... some come under bulk billing but are like gold dust. (depends on visa) you will get a medicare card at centrelink this is only for pr visa's and aussie citizens a visa like a 457 work visa you will require private med insurance.

 

What is 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 2012

 

[TABLE]

[TR]

[TD][/TD]

[TH]Threshold amount

[/TH]

[TH]Who it is for

[/TH]

[TH]How it is calculated

[/TH]

[TH]What the benefit is

[/TH]

[/TR]

[TR]

[TD]Original

[/TD]

[TD]$413.50

[/TD]

[TD]All Medicare cardholders

[/TD]

[TD]Based on gap amount

[/TD]

[TD]100% of schedule fee for out-of-hospital services

[/TD]

[/TR]

[TR]

[TD]Extended concession and FTB(A)

[/TD]

[TD]$598.80

[/TD]

[TD]Concession cardholders and families eligible for FTB(A)

[/TD]

[TD]Out-of-pocket costs

[/TD]

[TD]80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services

[/TD]

[/TR]

[TR]

[TD]Extended general

[/TD]

[TD]$1198.00

[/TD]

[TD]All Medicare cardholders

[/TD]

[TD]Out-of-pocket costs

[/TD]

[TD]80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services

[/TD]

[/TR]

[/TABLE]

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 sheeticon-external.gif 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 $35.60. You will also receive 80 per cent of your out-of-pocket costs (($65.00 - $35.60) x 80 per cent), giving you an extra $23.55. So in this example it will only cost you $5.85 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.

 


Starting life as an proper Aussie............. 457 to citizen ....5 years

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Medicare is similar to the NHS, it is not essential or compulsory to take out Private health insurance, it is a luxury that many cannot afford so use the public sector, which by the way for the most part is a very good service. 1.5% levy or tax is taken out of everyone's pay towards Medicare. In some cases, dependent on yours or your combined income you may have to pay a surcharge levy (tax) of 1%, (a penalty for earning too much), BUT if you take out Private health insurance this exempts you from the surcharge levy. The whole Medicare and Private Health system is so complicated I don't think even those that work in Medicare fully understand it. :laugh:

 

First you will need to register with Medicare, that's just a case of going into your local Medicare office with your passport and filling in the forms, a card will be sent out to you in the mail.

 

All you will need to do is go to a Doctor for a referral to a specialist. Due to your past medical history I would recommend you bring medical records with you from your Doctors in the UK.

 

Depending which state your going to will determine if you need to take out Ambulance cover, this is essential, a ride in one will cost in excess of $820. It is usually included in Private health cover but can be taken out by itself.

 

All the above info is also dependent on your type of visa too.

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Your medications will cost you each month - usually the max is around $32 per fill unless the med is not on the Pharmaceutical Benefits Scheme in which case they will either find something else which is on the scheme or you pay the market rate (in which case your private health coverage may pay some of the difference, if you have private insurance, that is!). There is a safety net for pharmaceuticals as well and you may get them at a reduced rate once you have spent around $1200 (from memory) in any year.

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Hi Amanda,I'd hope your proriasis isn't that bad once you get to Oz thanks to the sunshine! It can sometimes make it worse but that's not that common. You can get your GP in the UK to give you a long prescription for maybe a few months. I doubt they'd prescribe methotrexate for a whole year for example, maybe though. Nothing to lose by asking. Fingers crossed for ya!SX


Temp Res Visa application sent 24.10.11, Permanent Resident Visa approved 24.02.12 :ssign19:

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Guest jkirk

Thanks for that.

 

Great to keep when copy & pasted into a Word doc. Cheers.

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Guest liverpoolollie

hello all.

 

so ,correct me if i have misunderstood but,if i and my family come out on a 176 pr ,i would not need to pay for private insurance ,but just get ambulance insurance?

both me and my daughter (2) get monthly inhalers for asthma here in uk ,so what is that likely to cost in perth ?

 

thankyou so much in advance .

 

lee

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Guest Guest31881

Ambulance cover depends on what state you are going to, Queensland the Ambulance is free and i think Tasmania it is as well, Visiting the doctor will normally cost you per visit but you will be given repeat prescriptions for most medication. Ventolin (salbutamol) Inhalers are available over the counter from the chemists, no prescription needed with cost varying from $5 to $15 depending on the chemist.

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Very few people actually understand how health services work here and the system almost looks as though it was designed to make sure nobody could ever get to grips with it. Mostly we just learn on a case by case basis as we need to get treatment but we never know in advance how much it will cost or whether we will get reimbursed. I had a simple day procedure carried out a year ago and I got about half a dozen different bills, some of which were reimbursed and some were not.


Feb 2010 Prospective Marriage Visa | Nov 2010 Temporary Partner Visa | Nov 2012 Permanent Partner Visa | Jan 2015 Australian Citizenship

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hello all.

 

so ,correct me if i have misunderstood but,if i and my family come out on a 176 pr ,i would not need to pay for private insurance ,but just get ambulance insurance?

both me and my daughter (2) get monthly inhalers for asthma here in uk ,so what is that likely to cost in perth ?

 

thankyou so much in advance .

 

lee

 

Yes ,I would advise you to take out Ambulance cover. It's only about $100 a year so well worth it.

Private health cover is optional. You could take out an 'extra's cover' only, it will cover you for glasses, the eye test is free anyway, also covered is dental to a specified limit depending on the level of cover you take out. It is all very confusing trying to get prices from different insurers, they all have different sorts of cover so it's like comparing apples to pears.

I think it's time someone just bit the bullet and simplified the whole system.

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Does anyone know how likely it is to be covered by a works policy for you and your family? Also does anyone know if this is the norm or an exception?Sx


Temp Res Visa application sent 24.10.11, Permanent Resident Visa approved 24.02.12 :ssign19:

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Totally agree on that one... people don't realise that even a 200m trip down the road by ambo can cost $856 without cover.... $ 100 a year well worth it.......before there is a wise crack about you would walk it.... you could just be the lucky one to pass out or be knocked out lol.....

Yes ,I would advise you to take out Ambulance cover. It's only about $100 a year so well worth it.

Private health cover is optional. You could take out an 'extra's cover' only, it will cover you for glasses, the eye test is free anyway, also covered is dental to a specified limit depending on the level of cover you take out. It is all very confusing trying to get prices from different insurers, they all have different sorts of cover so it's like comparing apples to pears.

I think it's time someone just bit the bullet and simplified the whole system.

Edited by realitynotincluded

Starting life as an proper Aussie............. 457 to citizen ....5 years

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We are in WA on a 457 visa and we had to take out family private medical insurance covering much more than just Ambulance cover as a visa requirement. This is normal. Went you look on private medical insurance websites you have to look at the overseas visitor/international visitor section. The cover is designed to meet the 457 requirements.


Wherever you are, make the most of it.

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We are in WA on a 457 visa and we had to take out family private medical insurance covering much more than just Ambulance cover as a visa requirement. This is normal. Went you look on private medical insurance websites you have to look at the overseas visitor/international visitor section. The cover is designed to meet the 457 requirements.

 

If you were a British resident I believe they now accept the reciprocal medicare as meeting the requirement for medical cover so private insurance is no longer necessary.

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When I phoned 2 companies last week they both said that I needed the private cover to meet requirement something-or-other of the visa even with the reciprocal that I have on medicare. They said that I could only have the reduced cost non-international one once I had permanent residency. I think I'll have to ring them again because it's not clear. Or maybe I'll ring the visa people. The private insurance people have given me incorrect or conflicting information in the past which makes understanding it all even harder! :confused:


Wherever you are, make the most of it.

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When I phoned 2 companies last week they both said that I needed the private cover to meet requirement something-or-other of the visa even with the reciprocal that I have on medicare. They said that I could only have the reduced cost non-international one once I had permanent residency. I think I'll have to ring them again because it's not clear. Or maybe I'll ring the visa people. The private insurance people have given me incorrect or conflicting information in the past which makes understanding it all even harder! :confused:

 

Definitely worth checking as I have seen plenty of posts from this and another site where British immigrants have said the rules have changed and they have personally just used the reciprocal with the consent of immi dept.

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I'm sorry to butt in with another question. Somebody mentioned that with 176 visa I don't have to take a private insurance. But will I be covered by Medicare only after I start a job or even during looking for one? Shouldn't I pay something "voluntarily" during my unemployed period?

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We had to have private health cover to get the 457 visa but this was only until we registered with medicare for reciprical care which we have now done. All we needed was a 21 day emigration policy to get the visa approved.

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