Medicare
Feb 27th 2008, 8:54 pm
#1
Forum Regular
Thread Starter
Joined: Sep 2005
Posts: 146
Medicare
I've been reading about it and I've noticed in some instances it will say you may need to pay out of pocket...but other readings it will say 100% of this or that. How exactly does it work?
Feb 27th 2008, 11:56 pm
#2
BE Forum Addict
Joined: Jun 2007
Location: Peregian Springs, Sunshine Coast
Posts: 1,872
Re: Medicare
It depends on your nationality and visa route. What is yours?
Feb 28th 2008, 1:49 am
#3
Crazy Cat Lady
Joined: Apr 2004
Posts: 65,493
Re: Medicare
It depends on whether you find a bulk billing doctor or not. If you do find one that bulk bills (very thin on the ground) they bill Medicare direct and you don't pay a cent to see the Doctor. If you go to one that doesn't bulk bill, you pay the $50 bill, then head round to the Medicare office and get about $30 back so in effect you are out of pocket $20. Many doctors will bulk bill for children, elderly and concession holders, ie those on very low incomes etc but it's quite rare to find one that does 'normal' adults and even if you do, you will probably find that their lists are full and won't take you on.
Feb 28th 2008, 2:55 am
#4
Lost in BE Cyberspace
Joined: Mar 2003
Posts: 9,397
Re: Medicare
Many here will say otherwise, having never had to be admitted to hospital or have major investigations done but the way the refund and charging "system" (my quotes <g>) is run defies all logic.
If you just roll up to the doctors there is a chance that he will "bulk bill" - charge Medicare directly. Most times he will charge you, the patient: it could be anything from $32 to $100 or more. You can then take the receipt along to Medicare and get a refund of the "Medicare Determined Fee" - about $32. Anything above this, you pay yourself.
If the doctor requires tests the path lab might bulk bill, or charge you and the same procedure applies. Sometimes the doctor might "ask" the non-bulkbilling lab to bulk bill and they might or might not.
If a prescription is written, you will pay the pharmacy. Say the drug is $40 at the chemist, you will get a sticker to put in your scrapbook saying that the Medicare cost was, for example, $30. You will not get anything refunded. If your family have spent more than the PBS safety net in the year (based on the *Medicare* charges, not what you've actually paid), remaining scripts during that year ae discounted. At the end of the *financial* year you get a tax relief on your medical expenditure over and above a certain figure.
If you go into hospital, everything might be covered by Medicare. However, even if you arrive at the emergency door, if you are in any private fund you will eventually be charged for every little item from an aspirin to a heart operation.
With me so far?
Now it gets more complicated! Medicare will, in many cases, pay a percentage of the Medicare standard fee. Say an anaethetist charges $1000 for a procedure: Medicare fee might be only $200 and the Medicare refund 80% of that, or $160. *You* pay the man $1000, Medicare refund you $160 and your private health fund - which you wrongly imagine is going to make up any shortfall - pays the "gap" - the difference between what Medicare have determined is the "correct" fee and what they have refunded to you ($40). You are $800 out of pocket, despite being in Medicare and a private health fund!
After an operation, bills keep drifting in for months from all sorts of agencies: path lab work, dressings, ward doctors, you name it. Most of the invoices give you no idea who is charging or for what. Medicare may pay a bit of some of them, as above, or may in some instances not pay anything: it seems sometimes completely random.
I could go on but you get the gist. I have had several admissions this last year which have cost me tens of thousands of $$ despite being privately insured - The whole thing is a gigantic bureaucratic dog's breakfast and if anyone can explain it fully please put me in contact with him!
Feb 28th 2008, 3:02 am
#5
Crazy Cat Lady
Joined: Apr 2004
Posts: 65,493
Re: Medicare
On the other hand the treatment my daughter has had with two emergency admissions has been nothing short of brilliant from my financial aspect. Things I think I should probably have paid for (we don't have private) have been waived. Now whilst I have no idea how it all works
at the moment we are more than happy with the way Medicare works and the treatment received. I can fully understand your situation Wol and hope I never see your side of it. You're right though, it doesn't make sense when you try and work it all out.
at the moment we are more than happy with the way Medicare works and the treatment received. I can fully understand your situation Wol and hope I never see your side of it. You're right though, it doesn't make sense when you try and work it all out.
Feb 28th 2008, 3:12 am
#6
Banned
Joined: Feb 2008
Posts: 421
Re: Medicare
It is, frankly, the most appalling mess!
Many here will say otherwise, having never had to be admitted to hospital or have major investigations done but the way the refund and charging "system" (my quotes <g>) is run defies all logic.
If you just roll up to the doctors there is a chance that he will "bulk bill" - charge Medicare directly. Most times he will charge you, the patient: it could be anything from $32 to $100 or more. You can then take the receipt along to Medicare and get a refund of the "Medicare Determined Fee" - about $32. Anything above this, you pay yourself.
If the doctor requires tests the path lab might bulk bill, or charge you and the same procedure applies. Sometimes the doctor might "ask" the non-bulkbilling lab to bulk bill and they might or might not.
If a prescription is written, you will pay the pharmacy. Say the drug is $40 at the chemist, you will get a sticker to put in your scrapbook saying that the Medicare cost was, for example, $30. You will not get anything refunded. If your family have spent more than the PBS safety net in the year (based on the *Medicare* charges, not what you've actually paid), remaining scripts during that year ae discounted. At the end of the *financial* year you get a tax relief on your medical expenditure over and above a certain figure.
If you go into hospital, everything might be covered by Medicare. However, even if you arrive at the emergency door, if you are in any private fund you will eventually be charged for every little item from an aspirin to a heart operation.
With me so far?
Now it gets more complicated! Medicare will, in many cases, pay a percentage of the Medicare standard fee. Say an anaethetist charges $1000 for a procedure: Medicare fee might be only $200 and the Medicare refund 80% of that, or $160. *You* pay the man $1000, Medicare refund you $160 and your private health fund - which you wrongly imagine is going to make up any shortfall - pays the "gap" - the difference between what Medicare have determined is the "correct" fee and what they have refunded to you ($40). You are $800 out of pocket, despite being in Medicare and a private health fund!
After an operation, bills keep drifting in for months from all sorts of agencies: path lab work, dressings, ward doctors, you name it. Most of the invoices give you no idea who is charging or for what. Medicare may pay a bit of some of them, as above, or may in some instances not pay anything: it seems sometimes completely random.
I could go on but you get the gist. I have had several admissions this last year which have cost me tens of thousands of $$ despite being privately insured - The whole thing is a gigantic bureaucratic dog's breakfast and if anyone can explain it fully please put me in contact with him!
Many here will say otherwise, having never had to be admitted to hospital or have major investigations done but the way the refund and charging "system" (my quotes <g>) is run defies all logic.
If you just roll up to the doctors there is a chance that he will "bulk bill" - charge Medicare directly. Most times he will charge you, the patient: it could be anything from $32 to $100 or more. You can then take the receipt along to Medicare and get a refund of the "Medicare Determined Fee" - about $32. Anything above this, you pay yourself.
If the doctor requires tests the path lab might bulk bill, or charge you and the same procedure applies. Sometimes the doctor might "ask" the non-bulkbilling lab to bulk bill and they might or might not.
If a prescription is written, you will pay the pharmacy. Say the drug is $40 at the chemist, you will get a sticker to put in your scrapbook saying that the Medicare cost was, for example, $30. You will not get anything refunded. If your family have spent more than the PBS safety net in the year (based on the *Medicare* charges, not what you've actually paid), remaining scripts during that year ae discounted. At the end of the *financial* year you get a tax relief on your medical expenditure over and above a certain figure.
If you go into hospital, everything might be covered by Medicare. However, even if you arrive at the emergency door, if you are in any private fund you will eventually be charged for every little item from an aspirin to a heart operation.
With me so far?
Now it gets more complicated! Medicare will, in many cases, pay a percentage of the Medicare standard fee. Say an anaethetist charges $1000 for a procedure: Medicare fee might be only $200 and the Medicare refund 80% of that, or $160. *You* pay the man $1000, Medicare refund you $160 and your private health fund - which you wrongly imagine is going to make up any shortfall - pays the "gap" - the difference between what Medicare have determined is the "correct" fee and what they have refunded to you ($40). You are $800 out of pocket, despite being in Medicare and a private health fund!
After an operation, bills keep drifting in for months from all sorts of agencies: path lab work, dressings, ward doctors, you name it. Most of the invoices give you no idea who is charging or for what. Medicare may pay a bit of some of them, as above, or may in some instances not pay anything: it seems sometimes completely random.
I could go on but you get the gist. I have had several admissions this last year which have cost me tens of thousands of $$ despite being privately insured - The whole thing is a gigantic bureaucratic dog's breakfast and if anyone can explain it fully please put me in contact with him!
Would you say it leans towards the NHS or the US system?
Feb 28th 2008, 3:28 am
#7
Lost in BE Cyberspace
Joined: Mar 2003
Posts: 9,397
Re: Medicare
I always thought that the UK NHS should not be free at the point of sale, to discourage trivial treatments but the Australian "system" ( I just can't help putting in the quotes!) is a complete mishmash of conflicting and illogical rules which often seem to be made up on the spot depending on who you see at the desk.
The US system is more straightforward in that if you have treatment your fund pays all or most of the charges depending on the excess.
What really bugs me is that people argue about private versus public ad infinitum, in every country. In the States you would think that "public healthcare" is a swearword; the opposite here. Whereas in fact healthcare is getting to be so expensive that NO country can really afford to fully care for the population properly regardless of the source of funding.
I don't know what the other Australian states are like, but the NSW health "system" (There are the quotes again <g>) is in complete meltdown. Every day brings new revelations of doctors maiming patients, staff refusing to operate in unhygeinic wards and theatres, beds being taken out of service because the funds aren't there, brand new hospitals being closed because of shoddy work and design etc etc.
Memo: don't under any circumstances get sick in NSW!
Last edited by Wol; Feb 28th 2008 at 3:42 am.
Feb 28th 2008, 4:01 am
#8
BE Enthusiast
Joined: Dec 2007
Location: Michelago
Posts: 545
Re: Medicare
We have private health cover but a couple of years ago, I had to have an operation on my knee, I was out of pocket by nearly $3,000. My private health paid a staggering $200. Why bother but if you and your partner earn over $100,000 combined income, if you dont have private health, they slug you 3% extra medicare levi at tax time. Rock and a hard place is the term I would use.
Recently my wife was bitten by my dog and had to go to emergency. She did not declare she had private health and went in as a medicare patient. She did not pay one cent for the 5 day hospitalisation. (She had a bad infection in her hand).
Needless to say, I was in big trouble with my wife as it was my dog that bit her. (thats my boy).
A work collegue went into hospital but refused to be treated as a private patient and demanded to be treated as a medicare patient. This did not go down well with the hospital Nazi admin officer but in the end, it was agreed that he would be treated as a private patient but only if they guarenteed no out of pocket expenses. This they did. He never received a bill for his stay.
Barney
Recently my wife was bitten by my dog and had to go to emergency. She did not declare she had private health and went in as a medicare patient. She did not pay one cent for the 5 day hospitalisation. (She had a bad infection in her hand).
Needless to say, I was in big trouble with my wife as it was my dog that bit her. (thats my boy).
A work collegue went into hospital but refused to be treated as a private patient and demanded to be treated as a medicare patient. This did not go down well with the hospital Nazi admin officer but in the end, it was agreed that he would be treated as a private patient but only if they guarenteed no out of pocket expenses. This they did. He never received a bill for his stay.
Barney
Feb 28th 2008, 5:09 am
#9
Forum Regular
Joined: Feb 2008
Location: UK heading to WA
Posts: 35
Re: Medicare
This is very confusing and worrying. Is there a policy for private medical insurance that will pay for everything, are there any unbiased web sites that compare cover?
When we move to WA we were looking at the private health insurance part of Medicare.
Also, correct me if I’m wrong, but we have one year from registering with Medicare to take up the life time health cover option, is this worth while?
Thanks
When we move to WA we were looking at the private health insurance part of Medicare.
Also, correct me if I’m wrong, but we have one year from registering with Medicare to take up the life time health cover option, is this worth while?
Thanks
Feb 28th 2008, 5:35 am
#10
(It's not my real name)
Joined: Sep 2002
Location: Ilukapool. WA
Posts: 12,467
Re: Medicare
The secret is to make sure you have the extras cover - for dentists opticians etc... that's worth it.
If you have hospital cover the other BIG secret is if you have to go to hospital in an emergency then DON'T TELL THEM you have private medical insurance, they will ask, just deny it or the bills will be coming in for months just like they did for us when my daughter was sick. We were thousands out of pocket.
Reserve your hospital cover for non urgent surgery that you would otherwise have to wait years for on Medicare.
Feb 28th 2008, 5:52 am
#11
BE Forum Addict
Joined: Aug 2006
Location: WA but NOT Perth!!!!!
Posts: 3,318
Re: Medicare
I had to go into hospy for a procedure and they asked if i wanted to go privatae. when i asked what the difference was it was just that you got the consultant, rather than the registrar, and you got a private room. i went public just cos i wanted it done, didnt bother me who did it. in the end i got the consultant anyway!!
Had i gone private all i would have paid was the $100 excess but as it was public didnt cost a bean
As for bulkbilling GPs, we had one of those, he made you come in for everything, even test results, whereas our current one who doesnt bulkbill gives you results over the phone. Our current GP also has it set up so that medicare pay srtaight into your bank account a couple of days later so no need to bother going to their office and queuing forever and a day.
Had i gone private all i would have paid was the $100 excess but as it was public didnt cost a bean
As for bulkbilling GPs, we had one of those, he made you come in for everything, even test results, whereas our current one who doesnt bulkbill gives you results over the phone. Our current GP also has it set up so that medicare pay srtaight into your bank account a couple of days later so no need to bother going to their office and queuing forever and a day.
Feb 28th 2008, 6:24 am
#12
Banned
Joined: Feb 2008
Posts: 421
Re: Medicare
Neither!
I always thought that the UK NHS should not be free at the point of sale, to discourage trivial treatments but the Australian "system" ( I just can't help putting in the quotes!) is a complete mishmash of conflicting and illogical rules which often seem to be made up on the spot depending on who you see at the desk.
The US system is more straightforward in that if you have treatment your fund pays all or most of the charges depending on the excess.
What really bugs me is that people argue about private versus public ad infinitum, in every country. In the States you would think that "public healthcare" is a swearword; the opposite here. Whereas in fact healthcare is getting to be so expensive that NO country can really afford to fully care for the population properly regardless of the source of funding.
I don't know what the other Australian states are like, but the NSW health "system" (There are the quotes again <g>) is in complete meltdown. Every day brings new revelations of doctors maiming patients, staff refusing to operate in unhygeinic wards and theatres, beds being taken out of service because the funds aren't there, brand new hospitals being closed because of shoddy work and design etc etc.
Memo: don't under any circumstances get sick in NSW!
I always thought that the UK NHS should not be free at the point of sale, to discourage trivial treatments but the Australian "system" ( I just can't help putting in the quotes!) is a complete mishmash of conflicting and illogical rules which often seem to be made up on the spot depending on who you see at the desk.
The US system is more straightforward in that if you have treatment your fund pays all or most of the charges depending on the excess.
What really bugs me is that people argue about private versus public ad infinitum, in every country. In the States you would think that "public healthcare" is a swearword; the opposite here. Whereas in fact healthcare is getting to be so expensive that NO country can really afford to fully care for the population properly regardless of the source of funding.
I don't know what the other Australian states are like, but the NSW health "system" (There are the quotes again <g>) is in complete meltdown. Every day brings new revelations of doctors maiming patients, staff refusing to operate in unhygeinic wards and theatres, beds being taken out of service because the funds aren't there, brand new hospitals being closed because of shoddy work and design etc etc.
Memo: don't under any circumstances get sick in NSW!
http://www.imdb.com/title/tt0386032/
Is it really that bad?
Feb 28th 2008, 6:33 am
#14
Account Closed
Joined: Dec 2005
Posts: 546
Re: Medicare
It is, frankly, the most appalling mess!
Many here will say otherwise, having never had to be admitted to hospital or have major investigations done but the way the refund and charging "system" (my quotes <g>) is run defies all logic.
If you just roll up to the doctors there is a chance that he will "bulk bill" - charge Medicare directly. Most times he will charge you, the patient: it could be anything from $32 to $100 or more. You can then take the receipt along to Medicare and get a refund of the "Medicare Determined Fee" - about $32. Anything above this, you pay yourself.
If the doctor requires tests the path lab might bulk bill, or charge you and the same procedure applies. Sometimes the doctor might "ask" the non-bulkbilling lab to bulk bill and they might or might not.
If a prescription is written, you will pay the pharmacy. Say the drug is $40 at the chemist, you will get a sticker to put in your scrapbook saying that the Medicare cost was, for example, $30. You will not get anything refunded. If your family have spent more than the PBS safety net in the year (based on the *Medicare* charges, not what you've actually paid), remaining scripts during that year ae discounted. At the end of the *financial* year you get a tax relief on your medical expenditure over and above a certain figure.
If you go into hospital, everything might be covered by Medicare. However, even if you arrive at the emergency door, if you are in any private fund you will eventually be charged for every little item from an aspirin to a heart operation.
With me so far?
Now it gets more complicated! Medicare will, in many cases, pay a percentage of the Medicare standard fee. Say an anaethetist charges $1000 for a procedure: Medicare fee might be only $200 and the Medicare refund 80% of that, or $160. *You* pay the man $1000, Medicare refund you $160 and your private health fund - which you wrongly imagine is going to make up any shortfall - pays the "gap" - the difference between what Medicare have determined is the "correct" fee and what they have refunded to you ($40). You are $800 out of pocket, despite being in Medicare and a private health fund!
After an operation, bills keep drifting in for months from all sorts of agencies: path lab work, dressings, ward doctors, you name it. Most of the invoices give you no idea who is charging or for what. Medicare may pay a bit of some of them, as above, or may in some instances not pay anything: it seems sometimes completely random.
I could go on but you get the gist. I have had several admissions this last year which have cost me tens of thousands of $$ despite being privately insured - The whole thing is a gigantic bureaucratic dog's breakfast and if anyone can explain it fully please put me in contact with him!
Many here will say otherwise, having never had to be admitted to hospital or have major investigations done but the way the refund and charging "system" (my quotes <g>) is run defies all logic.
If you just roll up to the doctors there is a chance that he will "bulk bill" - charge Medicare directly. Most times he will charge you, the patient: it could be anything from $32 to $100 or more. You can then take the receipt along to Medicare and get a refund of the "Medicare Determined Fee" - about $32. Anything above this, you pay yourself.
If the doctor requires tests the path lab might bulk bill, or charge you and the same procedure applies. Sometimes the doctor might "ask" the non-bulkbilling lab to bulk bill and they might or might not.
If a prescription is written, you will pay the pharmacy. Say the drug is $40 at the chemist, you will get a sticker to put in your scrapbook saying that the Medicare cost was, for example, $30. You will not get anything refunded. If your family have spent more than the PBS safety net in the year (based on the *Medicare* charges, not what you've actually paid), remaining scripts during that year ae discounted. At the end of the *financial* year you get a tax relief on your medical expenditure over and above a certain figure.
If you go into hospital, everything might be covered by Medicare. However, even if you arrive at the emergency door, if you are in any private fund you will eventually be charged for every little item from an aspirin to a heart operation.
With me so far?
Now it gets more complicated! Medicare will, in many cases, pay a percentage of the Medicare standard fee. Say an anaethetist charges $1000 for a procedure: Medicare fee might be only $200 and the Medicare refund 80% of that, or $160. *You* pay the man $1000, Medicare refund you $160 and your private health fund - which you wrongly imagine is going to make up any shortfall - pays the "gap" - the difference between what Medicare have determined is the "correct" fee and what they have refunded to you ($40). You are $800 out of pocket, despite being in Medicare and a private health fund!
After an operation, bills keep drifting in for months from all sorts of agencies: path lab work, dressings, ward doctors, you name it. Most of the invoices give you no idea who is charging or for what. Medicare may pay a bit of some of them, as above, or may in some instances not pay anything: it seems sometimes completely random.
I could go on but you get the gist. I have had several admissions this last year which have cost me tens of thousands of $$ despite being privately insured - The whole thing is a gigantic bureaucratic dog's breakfast and if anyone can explain it fully please put me in contact with him!
Feb 28th 2008, 7:01 am
#15
(It's not my real name)
Joined: Sep 2002
Location: Ilukapool. WA
Posts: 12,467
Re: Medicare
Anything urgent then go Medicare everytime or you will be well out of pocket.
The whole system is a dogs breakfast.