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May 18 2011

Medical: Introduction to Medicare


An Introduction to Medicare

The Australian Public Health System

medicare

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

Medicare provides access to:

  • Free treatment in a public hospital as a Medicare patient
  • Free or subsidised treatment by Doctors, Specialists and Optometrists.

Medicare will normally cover the following:

  • 100% of the Schedule fee for GP services
  • 85% of the Schedule fee for other out-of-hospital services
  • 75% of the Schedule fee for in-hospital serviceswww.medicare.gov.au/
  • 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.
  • You can register with as many or as few Doctors as you wish. Registration is a simple case of showing your Medicare card, and filling in a small form with name and address etc.
  • 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.

A Medicare Card looks like this:

medicare-card

The Australian Government has agreed values for doctors payments for specified procedures and consultations, and will normally pay 100% of this figure either directly to the doctor, or to the patient.

Many Doctors actually only these agreed prescribed values for consultations, 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 2009, in my area, are about $50 for a standard visit. The Medicare Rebate for a level B consulation is $33.55, meaning that your NET cost would be $16.45. Note: Some doctors charge more than $50 and some charge less.

When a Doctor “Bulk Bills“, it means they accept a consultation charge of $33.55 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 ?

    The Australian Government has signed a Reciprocal Health Care Agreement with the United Kingdom which entitles you to limited subsidised health services for medically necessary treatment while visiting Australia.
  • www.medicareaustralia.gov.au/…/visitors/uk.jsp
    Reciprocal Health Care

    The Australian Government has signed Reciprocal Health Care Agreements with various countries INCLUDING the United Kingdom.

    Reciprocal Health Care agreements normally cover treatment that is medically necessary.

    More information can be found at:

    and a PDF document detailing the Exact law on this is:

    This quotes the following information regarding Maternity Services:

    • Maternity Services for Short Stay Visitor (ie: under 9 months)
      • Routine antenatal care is covered
      • Confinements are not covered unless
      • Emergencies or complications arise (eg: premature births)
      • Special cases (eg: where a patients visit to Australia is primarily for her, or her partners work, and the patient has no choice other than to have the baby in Australia)
    • Maternity Services for Long Stay Visitor (ie: over 9 months)
      • Confinements and antenatal care are covered, including routine ultrasound tests such as chromosome sampling where medically indicated (eg: where the mother is in an at risk age group or there is a family history of deformities)
    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) programcontact 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
    Medicare Levy

    Almost all workers pay the standard 1.5% Medicare levy towards funding the cost of the Medicare system in Australia. The only exemptions/reductions to this are for the very low paid, (2008 is about $17,309pa) and this detail can be checked at:

    Medical Levy Surcharge (MLS)

    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). 2008/09

    These thresholds will be increasing to $73,000 and $146,000 for the 2009/10 taxation year.

    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.

    www.health.gov.au

    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 coststhe 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

    The Government has introduced legislation changing eligibility for the net medical expenses tax offset; restricting who can claim and what medical expenses can be claimed.

    To be eligible to claim this offset you must have either:

    1: received this offset in your 2012–13 income tax assessment; or
    2: paid for medical expenses relating to disability aids, attendant care or aged care.

    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 2008-2009 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.

    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

    Deaths from Skin Cancer

      Australia = 1,678 deaths from 380,000 + reported cases

UK = 2,300+ deaths from 72,000 + reported cases

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
Government Health Departments
Private Health Organisations
  • 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)
  • ePharmacy – Australia’s online pharmacy
  • Glasses Online – Prescription Glasses, Online Spectacles & Discount Eyeglasses






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