In an emergency, and if you can't get to a Doctor, then go to the local
Hospitals Accident & Emergency department.
The Australian Government funded Medical health care system is called Medicare, and is
similar 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 $30.85 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.
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 $100,000 per year, or a family earning more than $150,000 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.
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Dental
Ambulance
Tax Offset
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Eyes
Safety Nets
Pharmaceutical Benefits Safety Net
Information from:
http://www.medicareaustralia.gov.au/.../pbs.shtml
A standard prescription cost from 1st Jan 2008 is $31.30 for general patients.
This should be the Maximum figure you pay for a standard Pharmaceutical Benefits
Scheme (PBS) prescription. Sometimes the figure will be lower; in April
2008 I paid $31.30 for one and $27.80 for another.
There are two safety net thresholds - one for general patients and the other for
Concession Card patients.
The general patient safety net threshold for 2008 is $1,141.80 (2006 was $932.10
& 2005 was $874.90). 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.
The concession card holders safety net threshold for 2008 is $290.00 (2005 was $239.20)
(this also applies to gold, white and orange card-holders under the RPBS).
Once patients and/or their families reach this amount, they can apply for a Safety Net Entitlement Card
and receive items free of charge for the rest of the calendar year.
During 2006, the payment
for subsidised drugs was $29.50 for general patients, and $4.70 for
concession patients.
Brand premiums, therapeutic group premiums and special patient contributions do not count towards the safety net thresholds.
The thresholds may be adjusted on 1 January each year in line with inflation.
Medicare Safety Net
Details at:
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 may end up costing you less.
All families and couples need to register. Even if all your family members are listed on your Medicare card you still need to register for the safety net.
- Each family member needs to be identified so their medical costs can be counted toward your family’s safety net.
- You only need to register your family once.
- Registering is free.
Some examples of services where costs count towards the Medicare safety net are:
- GP and specialists consultations
- ultrasounds
- pap smear
- blood tests
- CT scans
- x-rays
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.
eg: Once you have reached the threshold, and
you see a doctor who may charge you $45, from which you receive $25.70 the normal
Medicare rebate (for 2004), you will also get a further $15.44 rebate, being 80% of the gap
payment that you would have made. ie: ($45.00-$25.70 = $19.30 then 80% of
$19.30 = $15.44.
So, before the threshold that visit would have cost you $19.30 ($45.00-$25.70 = $19.30),
but after the threshold it will cost you $3.86 ($45.00-$25.70-$15.44 = $3.86)
(Medicare Rebate in 2005 is $30.85, up from the $25.50 in 2004)
Obviously if your Doctor bulk bills you, then this may not apply in your case, except for specialists consultations etc.
Medicare Safety
Net Thresholds from Jan 1st 2008
- General $1,058.70
- Concession &FTB(A) $529.30
- Gap $365.70
The 2006 General Threshold was $1,000 (2005 was $716.10) for all Medicare card
holders.
The Concession and FTB(A) threshold for 2006 was $500 (2005 was $306.90) for Commonwealth concession card holders and Families eligible for FTB(A) (ie: People with children)
How does the Medicare safety Net work ?
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
2004-2005 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.
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Safety Nets
Bulk Billing
You will find some areas where most doctors will Bulk Bill, and other areas where few doctors will bulk bill.
In the cheaper areas of Western Sydney, almost all doctors bulk billed, but in the more expensive areas, very few doctors would consider it.
Due to recent legislation, we are now finding that more doctors are bulk billing for
Children and Pensioners, due to financial incentives from the government for the Doctors to do this,
In essence when someone visits a Doctor, Medicare will pay 85% of the Medicare Schedule fee for services
provided by the treating practitioner. Let's say that the "scheduled
fee" is $30.00 (Based on 2004, these figures will now be different, I haven't checked for some time)
If a Doctor fully bulk bills, they will not charge you, but they will get paid
85% of that $30 scheduled fee direct from the Medicare.
Some Doctors wish to charge, say $40.00 or more, so one of two things happens:
1: The doctor will charge you say $40, and YOU claim 85% of the scheduled $30 fee back from the local Medicare
Office ($25.50). Net cost to you = $14.50
2: The doctor collects $14.50 from you, and gets you to sign the Medicare
benefit over to them, and they claim the $25.50 direct from Medicare. Net cost
is the same.
This difference is called "A Gap"
More very recent legislation is putting a limit on the maximum "Gap" that you have to pay each year. ie: Once you have paid a certain figure, Medicare will step in again, and repay more of the doctors bill to you. I don't have full details to hand.
Public Hospitals don't charge anything for Medicare patients, and sometimes even give you free medicine !!
In 2000, over 70% of all services covered by Medicare were bulk billed with
the patient not having to pay anything.
In the December quarter of 2005, 75.1 per cent of all Medicare services were
bulk billed.
In the March quarter of 2008, 73.7% of all Medicare services were bulk
billed. This varied in each State as follows:
84.1% New South Wales
78.7% South Australia
76.4% Victoria
76.2% Queensland
73.3% Tasmania
71.8% Western Australia
62.9% Northern Territory
52.2% Australian Capital Territory
Medicare Rebate is now $31.45 (Jan 2008), up from the $30.85 in 2006.
Extract from:
http://www.aph.gov.au/.../05bd058.htm
For example, a standard consultation with a GP
lasting 15-20 minutes (item 23 on the MBS) has a schedule fee of $30.85.(2)
The 85 per cent Medicare rebate for this service is $26.25. The amendments to
the Health Insurance Act proposed by this Bill will increase the
rebate for this service by $4.60 to $30.85. This means that, for a
standard GP consultation:
-
where the doctor bulk bills (that is, where the doctor accepts the Medicare benefit as full payment for the service, and
bills Medicare directly, thus providing the service free at the point of delivery to the patient),
the doctor will receive an extra $4.60 as payment for the service, and
-
where the doctor does not bulk bill,
the patient will receive an additional $4.60 of Medicare benefit. For
example, under the current arrangements patients receive a Medicare benefit
of $26.25 for a standard GP consultation. Under the new arrangements
proposed by this Bill, patients will receive a rebate of $30.85. This means
that, if a doctor charges $50 for a standard consultation, the patient’s
out-of-pocket costs (the difference between the fee charged upfront and the
Medicare benefit) will be reduced from around $24 to around $19.
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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
Australia, having a high incidence of skin cancers has speciality cancer checks
available in most areas. One such system is the
Molescan system, which some of the GP's
now have.. Due to the ease and speed at which skin can be
checked, Australia has less deaths from skin cancer than may be expected,
when compared to some other countries. A quote from
www.cancerresearchuk.org makes interesting reading
Although Australia has one third the population of the UK, it has more cases of malignant melanoma.
Yet each year 600 more people die from the disease in Britain than in Australia.
Over 382,000 Australians are diagnosed with skin cancer (over 8,800 are melanoma - the most deadliest form)
and over 1,300 Australians die from melanoma and skin cancer each year.
www.cancer.org.au
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Eyes
Eye Examinations are available at many Opticians, and the cost of this examination
is covered by Medicare for one FULL examination every two years.
Membership of some of the Australian Medical Health Funds can give
discounts on frames, lenses and contact lenses, at some opticians.
Solar ultraviolet light causes cataracts
source and
source(PDF File)
Long term exposure to solar ultra violet radiation is a risk
factor for cataracts, a very common eye disorder that results in loss of
vision. The prevalence of significant cataracts is 25 per cent in people aged
65-74 and over 40 per cent in those aged more than 75 years.
Cataract surgery imposes a very significant annual cost on
the community. Over 120,000 cataract operations are performed in Australia
each year. Australia’s cataract surgery rate is 6,300 per million, which is
higher than the USA and the UK. About 0.3 per cent of the population suffers
from blindness due to cataracts.
Research shows that Australians who spend even moderate time
in the summer sun without appropriate eye protection are twice as likely to
develop dangerous vision complications later in life.
LINKS
Medicare
- Medicare Explained for Migrants "PDF Document"
link
- Medicare
Australian Public Health Service
Government Health Departments
Private Health Organisations
Online Medication Links (to
get ideas of costs etc)
-
ePharmacy - Australia's
online pharmacy
-
Glasses Online -
Prescription Glasses, Online Spectacles & Discount Eyeglasses
