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An Introduction to Medicare - The Australian Public Health System

    The Australian Government funded Medical health care system is called Medicare, and is similar in some ways, to the UK National Health system.

    • Some Doctors are Free, (called Bulk Billing).
    • Public Hospitals make no charges to Medicare Card Holders for in-patient, emergency and out-patient services.
    • Some Doctors will charge per consultation, and you claim part back from Medicare.
    • Private Hospitals charge for everything, but you can claim some of it back from Medicare. Private Health Insurance is considered a must for using Private Hospitals, unless your finances are sufficient to cover large bills.


    The Australian Government has agreed values for doctors payments for specified procedures and consultations, and will normally pay 85% of this figure either directly to the doctor, or to the patient.

    Many Doctors actually only charge 85% of the quoted figure, and therefore the patient pays nothing, other Doctors charge higher, and then the patient has to contribute.

    With the doctors where you pay nothing, you often have to wait to see a doctor, as they tend to be more popular. In my experience this can be 20 minutes to 2 hours, or even the next day, however, in some areas this can be longer.

    The current Doctors rates in 2008, in my area, are about $50 for a standard visit. The Medicare Rebate is $31.45, meaning that your NET cost would be $18.15. Note: Some doctors charge more than $50 and some charge less.

    When a Doctor "Bulk Bills", it means they accept a consultation charge of $31.45 only, and they get paid direct from Medicare, so the patient has nothing to pay.

    Bulk Billing doctors are more common in the less affluent areas, but can be rare in the better off areas.

    There are "safety net thresholds" so that patients do not pay too much over the year, even if they have many visits to the Doctor.

    Public Hospital services are available free of charge to eligible persons who choose to be treated as public patients.

     

Registering for Medicare

    After you have arrived in Australia the Department of Immigration and Multicultural Affairs will notify Medicare of your visa details, normally within the first week. You can then register at a local Medicare Office.

    This is a quotation from the Eligibility and enrolment section of the Medicare Australia Website

      Who is eligible to register for Medicare in Australia ?

      People who reside in Australia - excluding Norfolk Island - are eligible if they:

      • hold Australian citizenship
      • have been issued with a permanent visa
      • hold New Zealand citizenship
      • have applied for a permanent visa (excludes an application for a parent visa)—other requirements apply. Contact Medicare for further information.

      You will need to provide documents to support your residency in Australia or your severing of ties with the previous country of residence if:

      • you are an Australian citizen returning to Australia to reside after living overseas for more than five years
      • you are a New Zealand citizen requesting enrolment as a permanent resident.

      In some cases both forms of documentation may be needed

    That section of the website also has a link to the enrolment form that you will need to complete.


Migrants and Travellers, who is eligible for Medicare in Australia ?:

    This is a question asked many times, and the answer can be different depending on your circumstances. A good document to read is a PDF file provided by the Private Health Insurance Administration Council (PHIAC), an independent, Australian Government body within the health system, called "Insure? Not Sure?"


What Does Medicare Cover ?

Medicare provides benefits for:

  • consultation fees for doctors, including specialists, but not always 100% of what you are charged.
  • tests and examinations by doctors needed to treat illnesses, including X-rays and pathology tests
  • eye tests performed by optometrists
  • most surgical and other therapeutic procedures performed by doctors
  • some surgical procedures performed by approved dentists
  • specified items under the Cleft Lip and Palate Scheme
  • specified items for allied health services as part of the Enhanced Primary Care (EPC) program—contact Medicare on 132 011 for more information

Medicare does not cover such things as:

  • dental examinations and treatment (except specified items introduced for allied health services as part of the Enhanced Primary Care (EPC) program)—contact Medicare for more information
  • ambulance services
  • home nursing
  • physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology
  • acupuncture (unless part of a doctor's consultation)
  • glasses and contact lenses
  • hearing aids and other appliances
  • the cost of prostheses
  • medicines (except for the subsidy on medicines covered by the Pharmaceutical Benefits Scheme)
  • medical and hospital costs incurred overseas
  • medical costs for which someone else is responsible (for example a compensation insurer, an employer, a government or government authority)
  • medical services which are not clinically necessary
  • surgery solely for cosmetic reasons
  • examinations for life insurance, superannuation or membership of a friendly society


Medical Levy Surcharge (MLS) Source: www.health.gov.au

    If you are a single person, earning more than $70,000 per year, or a family earning more than $140,000 per year combined, then a correctly chosen Private Medical Insurance Policy will save you from paying the extra 1% Medical Levy Surcharge (MLS).

    Individuals and families on these higher incomes, who do not have private patient hospital cover (including their dependants and their spouse if they have one), may be liable to pay the extra 1% MLS for any period that they did not have this cover.

    The aim of the Medicare Levy Surcharge is to encourage high-income earners to take out private hospital cover and, where possible, to use the private system to reduce the demand on the public system.
     

Bulk Billing : Dental : Ambulance : Tax Offset : Skin Cancer : Eyes : Safety Nets

Pharmaceutical Benefits Safety Net

The maximum price for a standard prescription, as at 1st Jan 2008, is $31.30 for general patients.

However, for those who need regular prescriptions, there is a safety net in place so that once they have spent a certain figure in the year, all future prescriptions are at a substantially lower price.

The general patient safety net threshold for 2008 is $1,141.80
When patients and/or their families have spent that amount, they can apply for a Safety Net Concession Card and pay only $5.00 per prescription for the rest of that calendar year.

Medicare Safety Net

    If you need to see doctors or have tests regularly you could end up with high medical costs—the Medicare Safety Net is designed to help you when you need it most.
    It means that once you reach a safety net threshold, visits to your doctor or having tests should end up costing you much less.

    The basic benefit is that once you reach the threshold, any further qualifying medical expenses are reduced by Medicare covering 80% of the extra payments you need to make.


    Medicare Safety Net Thresholds from Jan 1st 2008

    • General $1,058.70
    • Concession & FTB(A) $529.30
    • Gap $365.70


Tax Offset  for medical expenses over a specified limit

    There is a medical expenses tax offset that may be available if you have out of pocket medical expenses over a specified limit in an income year. The 2007-2008 year threshold is $1,500, and any medical costs exceeding this can be claimed against, and a Tax Offset of 20% of the excess is claimable.
    This is claimed on your end of year tax return through the ATO.

Bulk Billing : Dental : Ambulance : Tax Offset : Skin Cancer : Eyes : Safety Nets


Ambulance Cover

    The cost of getting an ambulance can be quite substantial, so it is very important to have insurance cover where required.

 


Skin Cancer

Bulk Billing : Dental : Ambulance : Tax Offset : Skin Cancer : Eyes : Safety Nets

Optical

    • Eye Examinations are available at many Opticians, and the cost of this examination is covered by Medicare for one FULL examination every two years.


LINKS

Medicare

  • Medicare Explained for Migrants "PDF Document" link
  • Medicare Australian Public Health Service


Government Health Departments


Private Health Organisations

  • iSelect.com - iSelect compares private Health Insurance policies from participating health funds
  • MBF - Private Health Care
  • HBA - A BUPA member
  • HCF - Private Health Care
  • NIB - Private Health Care
  • Manchester Unity - Private Health Care
  • Medibank - Australia's largest private health insurer


Online Medication Links (to get ideas of costs etc)


 

 

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