What is actually covered ......

[Guest Guest6235]

Hi,

 

What is and isn't actually covered on Medicare, we will have a skilled 189 Visa (Permanent) & also what does private medical insurance cover and what is a reasonable amount to be paying monthly for private medical insurance. A friend of ours in Perth pays $80 a month for a family of 4.

 

Is private medical insurance required or does medicare cover all.

 

Thanks

[nikkiwd]

hi keefo, I am no expert so someone may correct me if I am wrong but from what I gather people take out private insurance for ambulance, dental, optical(if required) and maybe other extras. I think that you have to pay a percentage of your wage for medicare levy but if you have private cover you dont pay the medicare levy. like I said someone may be able to offer more info or correct me if I am wrong!

[ali]

http://www.mydr.com.au/first-aid-self-care/australian-health-system-how-it-works

[verystormy]

There are things listed in ali's link though that, although technically covered by medicare, you may find are not or are only partialy covered. For example, it states "tests ordered by your doctor". But i recently had to have a ultra sound. That was $200.

 

Health insurance varies a lot, but $80 is probably only going to get you ambulance cover - ambulances even in an emerganecy are not free. The one time i needed one it came to over $500.

[Guest Guest6235]

There are things listed in ali's link though that, although technically covered by medicare, you may find are not or are only partialy covered. For example, it states "tests ordered by your doctor". But i recently had to have a ultra sound. That was $200.

 

Health insurance varies a lot, but $80 is probably only going to get you ambulance cover - ambulances even in an emerganecy are not free. The one time i needed one it came to over $500.

 

I wouldn't have thought it would be worth paying $80 per month then if that's all it covered you for & for the amount of times you'd actually need one. If you or a family member had a serious illness like cancer or something are you left with a whacking huge bill for care etc

 

Thanks

Keith

Edited April 8, 2014 by Guest6235

[nicolac34]

As far as I know medicare covers you in an emergency situation (although not an ambulance) at A&E - but any follow up treatment may require you to pay if you don't have medicare. When my DH has had to go to hospital (more times than he ever did in England!) all his treatment and x-rays etc was all covered by medicare. He had to go for some radiology scans or something and that was covered up to a point, but then you had to pay.

 

Doctors, if you find one that bulk bills then you don't pay anything for a consultation, otherwise you medicare covers you up to about $35 and you pay the rest. So my doctors is $70 for a consultation so I have to pay the difference. Having medical insurance isn't going to make any difference to this.

 

Dental isn't covered by medicare - you want cover for that you have to have private cover.

 

They incentivise higher earners to get medical insurance, as you pay an extra levy if you earn over a certain amount and don't have it. So in some cases it's actually cheaper to get private health than pay the levy.

 

We have health insurance, and pay quite a princely sum for it ($320 per month for a couple) I wanted this level of cover because when we have children I want to have them in a private hospital. Once we are done having children we'll drop it down again. We use all the extras it offers up - so dental, physio, optical which helps. Means that instead of paying $75 for a remedial massage it costs me $27. Swings and roundabouts really!

[verystormy]

Nicola has pretty much nailed it.

 

Yes, you get full free treatment in an emergency. Though there is one thing to watch for. If you are admitted, then they will ask Medicare or Private. There will be gaps between what the hospital charge and the treatment. Depending on how long you are in hospital and the treatment recieved, this gap can be large - think thousands. So if going down this route, check with the insurer.

 

Also, be aware that other treatment can result in a large bill when private. I recently was refered for a colonoscopy. The wait time was over a year and the doc was concerned as there was a risk i had bowel cancer (i didnt) so she recomended i went private. Which i did and was seen in a few days. But, even having the best and most expensive cover Bupa offer, i still had $500 to pay myself

[Sideshowdeb]

Wow, this seems much more complicated than I had originally thought. Where would you suggest a newbie goes to get advice, other than PP, of course?

Are there insurance brokers, who can talk through all the different products?

What about pre-existing conditions? My OH had cancer almost 18 months ago and the Dr pretty much guaranteed it would come back at some point in the future. It's the most treatable kind, but it would be nice to know what to expect and if so how much to set aside to get him the same level of care, and prompt treatment he received in the UK.

Thanks,

Deb x

[verystormy]

Cancer would be treated under medicare and he would recieve the same level of care. Some of the initial diagnistics may cost, as mine did, but treatment wouldnt.

 

I have never seen a broker as such. You would be better speaking to some of the major suppliers such as Bupa, Medibank, HBF

 

Could also try this

http://www.iselect.com.au/

 

Honestly though, dont panic. It is not a bad system, just different and with some costs, but a very good system.

[Guest Guest6235]

So to my earlier question if you had a serious illness do you get a whacking bill which could basically bankrupt a family?

 

Also is Medicare totally free or does a certain amount come out of your wages like National insurance.

 

Keith

[Sideshowdeb]

Thanks, it was skin cancer, so really simple to assess and treat. Other than that none of us have had any issues. I'll check out that website though, thanks.

[verystormy]

No - you may have some smallish costs during intitial tests - a few hundred. Afrter that the treatment is free - similar to the NHS.

 

Normally medical insurance is to cover for things such as initial tests, glasses, dental, ambulance, some physio, counselling, alternative therapies - my wife has had a couple of massage type treatments. Major health is basically free.

 

GP services can result in a bill - mine charges about $35 on top of medicare that i have to pay for and prescriptions cost the drug price (with some things capped). That can be a plus as some are cheaper than an NHS prescription or a negative. Eg, i have asthma, ventolin is dirt cheap and available over the counter, but my other inhaler costs about $40.

[Sideshowdeb]

Paycalculator.com.au shows what deductions to expect from your gross salary including the medicare levy.

[Rossmoyne]

It isn't just about having health cover... it is about the level of health cover you have. So many policies do not cover some things and it isn't until you need that cover that sometimes you find you don't have it. So my advice would be to carefully look at what policy you take out to ensure you have the cover you need. Also remember that the health insurance companies change their policy cover as often as people change their underwear, and although they are supposed by law to let you know, this is not always what happens.

 

Mostly though it all works well. Health insurance doesn't cover the gap between Medicare and any GP visits or tests that are done as an outpatient, but once you are an admitted patient in a private hospital, it swings into action... but once again depending on your level of cover.

 

You can just have ambulance and ancillary cover (Dentist, Optometrist, Chiropractor etc.....) or you can add various levels of hospital cover onto that.

 

Personally, as a Senior Citizen on a pension, I still pay the high level of medical insurance that I have maintained throughout the 23 years I have lived in Oz. Yes I do have gap payments between my GP and Medicare - but I get to see my chosen specialist privately and quickly and do not have to join the months long queue via Medicare. As I say a personal decision. But then we always had private health insurance in UK so maybe I am conditioned to that level of support.

[odies]

Ross I to will be on pension do you think it worth while to start private insurance, or will it be overly expensive due to our age ?

[Rossmoyne]

Ross I to will be on pension do you think it worth while to start private insurance, or will it be overly expensive due to our age ?

 

Odies I don't know from your perspective and you should start to look at various companies and policies and what they offer. I just know that private has always worked for us and so I factor the costs into my budget.

 

I took out private health insurance long before the extra Medicare payment came into force, it has been worth it for me and I owe my life to it. I have to say that I have had private medical insurance since 1979 in UK and it was a godsend there. Had issues with my son as a small baby that NHS were not dealing with.... sorted within days on private.... I had health issues following his birth and couldn't see anyone on NHS for 4 months.... sorted in days on private. Since we came to Oz have had so many similar issues. I know there are gap payments between Medicare and Private, but I am prepared to pay those to get the immediate attention for me and my family. One example... I had constant ear infections for many many months that antibiotics were not touching, and it was affecting my sense of balance and affecting my ability to be the sole breadwinner of our family. After a 6 month wait I finally got to see an ENT specialist through Medicare at Sir Charles Gardner Hospital who told me that I needed an op but there was a waiting list of three years. I already had basic private health cover and increased it to the top level that day. I went back to my GP who referred me to an ENT specialist who was private only... I was in surgery within days.... he removed a cancerous tumour from my inner ear that was growing into my skull.... hallo!!!! next stop brain!. Yes I am now totally deaf on my left side... but I am alive... which I probably wouldn't have been if I had left my health to the Medicare system. The total cost in 2002 was well over $15,000... I paid a mere $120... the rest was covered by Health Insurance. When it comes to health, in my view, you do what you need to. Medicare is great for simple stuff, but when it gets difficult.... well move into the private sector and things happen amazingly quick. And bugger the cost!

[verystormy]

I agree with Ross on this. The system here is any many ways similar to the NHS in that it can have long waits for things.

 

Odies, although you wont get the advantage of the rebate being on a pension, the reality is that you (and i am not that far behind) are getting to an age where a bit more medical might be needed. So personally i would take it out.

 

For us too, it has more than paid off.

[Guest Guest6235]

Odies I don't know from your perspective and you should start to look at various companies and policies and what they offer. I just know that private has always worked for us and so I factor the costs into my budget.

 

I took out private health insurance long before the extra Medicare payment came into force, it has been worth it for me and I owe my life to it. I have to say that I have had private medical insurance since 1979 in UK and it was a godsend there. Had issues with my son as a small baby that NHS were not dealing with.... sorted within days on private.... I had health issues following his birth and couldn't see anyone on NHS for 4 months.... sorted in days on private. Since we came to Oz have had so many similar issues. I know there are gap payments between Medicare and Private, but I am prepared to pay those to get the immediate attention for me and my family. One example... I had constant ear infections for many many months that antibiotics were not touching, and it was affecting my sense of balance and affecting my ability to be the sole breadwinner of our family. After a 6 month wait I finally got to see an ENT specialist through Medicare at Sir Charles Gardner Hospital who told me that I needed an op but there was a waiting list of three years. I already had basic private health cover and increased it to the top level that day. I went back to my GP who referred me to an ENT specialist who was private only... I was in surgery within days.... he removed a cancerous tumour from my inner ear that was growing into my skull.... hallo!!!! next stop brain!. Yes I am now totally deaf on my left side... but I am alive... which I probably wouldn't have been if I had left my health to the Medicare system. The total cost in 2002 was well over $15,000... I paid a mere $120... the rest was covered by Health Insurance. When it comes to health, in my view, you do what you need to. Medicare is great for simple stuff, but when it gets difficult.... well move into the private sector and things happen amazingly quick. And bugger the cost!

 

Sorry for all these questions but what sort of monthly payment would you be making for medical insurance to get the private care you received for your op? You mention $120 but was that some sort of one off payment on top of your insurance or was that your monthly cost for medical insurance?

 

Also I'm probably being slow here but was is a gap payment between medicare and private?

 

Thanks

Keith

[Guest guest9824]

Sorry for all these questions but what sort of monthly payment would you be making for medical insurance to get the private care you received for your op? You mention $120 but was that some sort of one off payment on top of your insurance or was that your monthly cost for medical insurance?

 

Also I'm probably being slow here but was is a gap payment between medicare and private?

 

Thanks

Keith

 

hi Keith, our monthly payment for private health is $230.00, that covers all of us, a family of four for pretty much everything, dental, orthodontist, glasses, ambulance, operations, physio, it's quite a list and a very good insurance cover. The gap is what you pay that is not covered by your insurance, so say you go to the physio and his bill is $150 the insurance company may pay $100 you then pay the gap which would be $50.00, there are some polices out there that are called 'no gap' which does what it says....with certain providers...

 

hope that helps..

 

pea

[colinmacl]

Basically medicare is the same as NHS. no one is refused treatment you just may have to wait. That is where the similarities end. In Australia if you earn over $160k as a family you pay extra tax so in that case it may cost around the same as your premiums of say $300pm. If you have private health insurance in oz it does not cover 100% unlike the UK so you will always be paying gap payments. Personally i think it is a total rip off, would you accept car or home insurance that pays 60%?. I would say save the $300 pm and if you ever need an op you can pay for it from savings. If you have a heat attack in the street the ambulance takes you to a public hospital so again its pointless. I have it for dental and ambulance as they can be expensive but most people just accept it as the norm here as they don't know better.

[odies]

I will look further into this, in the uk my RA can not be covered as it is pre existing , use to have bupa then stopped as everything seemed related to RA and was never covered. Will this be the same in oz ?

[colinmacl]

I will look further into this, in the uk my RA can not be covered as it is pre existing , use to have bupa then stopped as everything seemed related to RA and was never covered. Will this be the same in oz ?

Yes it will as i said previously they cover far less here for insurance than the UK

[Rossmoyne]

Odies you will find that pre-existing ailments are not covered under most policies, although I understand that some policies will cover pre-existing in some instances but you have a waiting period before you can claim.

 

I understand that some people think private health insurance is a rip off, but in my personal view, health is so important and is worth the expense, so I will always pay the premium.

 

I do have friends who do not have private health insurance and they put the equivalent of the premium into a separate bank account and use this to pay for medical issues privately. A sort of self-insurance really I suppose and I am sure that if you start it when you are young enough and could be strong enough not to touch the money, it could work.

[ali]

Odies you will find that pre-existing ailments are not covered under most policies, although I understand that some policies will cover pre-existing in some instances but you have a waiting period before you can claim.

 

I understand that some people think private health insurance is a rip off, but in my personal view, health is so important and is worth the expense, so I will always pay the premium.

 

I do have friends who do not have private health insurance and they put the equivalent of the premium into a separate bank account and use this to pay for medical issues privately. A sort of self-insurance really I suppose and I am sure that if you start it when you are young enough and could be strong enough not to touch the money, it could work.

 

We have private cover and have been thankful for it.

[Walkabout]

I used the Iselect website VS listed as when we arrived as I was anxious that I needed to get at least ambulance cover sorted and really didnt (and still dont to a large extent) feel that I understood it! They were actually really helpful at talking through what I thought I wanted and what policies could cover it at prices that I was happy with. we are paying $160 a month for a family of 5 with hospitals and extras cover which I dont think is too bad, we will need to up the dental cover over time as there is every chance that at least one of the kids will need braces, but we can do that in time. We were also told that there is a 1 year wait on pre-existing conditions but after that time we will be able to claim, so we were happy with that. I think you have to work out what is right for you and your family as what works for 1 is not right for another, its a bit of a mine field (and not one that I am sure I have sucefully navigated yet!) but for me having something was important and then we can adjust it over time once we understand it better and know more what we will need.