Medicare
Nov 24th 2008, 9:52 am
#1
Forum Regular
Thread Starter
Joined: Jun 2008
Location: Glasgow, UK
Posts: 30
Medicare
Hi,
Can anyone tell me how the Medicare system works? Is it similar to the NHS in the UK?
And also, if I have my PR visa (175), am I entitled to use the Medicare system, or do I need to get private healthcare insurance?
Thanks in advance,
Rowdy.
Can anyone tell me how the Medicare system works? Is it similar to the NHS in the UK?
And also, if I have my PR visa (175), am I entitled to use the Medicare system, or do I need to get private healthcare insurance?
Thanks in advance,
Rowdy.
Nov 24th 2008, 9:56 am
#2
mmmmmm duff
Joined: May 2006
Location: Maudsland, Gold Coast, QLD
Posts: 1,629
Re: Medicare
No its not like the NHS - Here you can either pick a specialist Doc for certain problems or go to a bulk billing doc for general stuff. Then you can claim a certain amount back from medicare.
Yes you can claim on a PR visa, but we saw a specialist doc at $300/hr and could only claim $21 back from medicare.
Others will know more, we have only been here 7 weeks.
Yes you can claim on a PR visa, but we saw a specialist doc at $300/hr and could only claim $21 back from medicare.
Others will know more, we have only been here 7 weeks.
Nov 24th 2008, 10:39 am
#3
BE Forum Addict
Joined: Jun 2003
Location: Sydney beachside
Posts: 3,505
Re: Medicare
No its not like the NHS - Here you can either pick a specialist Doc for certain problems or go to a bulk billing doc for general stuff. Then you can claim a certain amount back from medicare.
Yes you can claim on a PR visa, but we saw a specialist doc at $300/hr and could only claim $21 back from medicare.
Others will know more, we have only been here 7 weeks.
Yes you can claim on a PR visa, but we saw a specialist doc at $300/hr and could only claim $21 back from medicare.
Others will know more, we have only been here 7 weeks.
There are some private specialist-type clinics (plastic surgeons, skin cancer clinics and the like) that you can see without a referral but usually this is because there is no Medicare rebate for the service anyway (like plastic surgery) or because they have an in-house GP that do the referrals.
The main difference between the NHS and Medicare is that you can choose any GP you wish and can go to 10 different ones if you want to, all at the same time. You also have to pay to see a doctor if they don't offer bulk-billing. Medicare will refund you 85% of the scheduled fee for the service you have. Note that this does not mean you will get a refund of 85% of what you pay as most doctors charge you much more than the scheduled fee.
Nov 24th 2008, 11:17 am
#4
mmmmmm duff
Joined: May 2006
Location: Maudsland, Gold Coast, QLD
Posts: 1,629
The doc came recommended and was a million times better than the NHS had to offer.
Nov 24th 2008, 11:52 am
#5
Lost in BE Cyberspace
Joined: Sep 2007
Location: Canberra
Posts: 8,378
Re: Medicare
Bear in mind also that most Australians pay the co-payment for seeing a GP - I dont know why there is so much emphasis on expat boards for seeking out a bulk billing doctor. The concept of bulk billing was to ensure that low income earners werent disadvantaged when it came to seeking medical support - the expectation is that if you can afford to pay then you will go to a GP and pay your $20 or whatever it turns out to be.
Anyway, the principle of Medicare is sort of half way to the NHS - you pay 1.5% of your taxable income in Medicare fees then you (generally) pay part of the GP visit. Treatment in public hospitals is free but if you need elective surgery then private treatment is going to be much quicker. If you have a life threatening condition then it wont matter if you are private or not as you willl get priority for public treatment.
Anyway, the principle of Medicare is sort of half way to the NHS - you pay 1.5% of your taxable income in Medicare fees then you (generally) pay part of the GP visit. Treatment in public hospitals is free but if you need elective surgery then private treatment is going to be much quicker. If you have a life threatening condition then it wont matter if you are private or not as you willl get priority for public treatment.
Nov 25th 2008, 12:25 am
#6
Guest
Posts: n/a
Re: Medicare
In my view, Medicare 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.
An Introduction to Medicare - The Australian Public Health System
Nov 25th 2008, 2:40 am
#7
Lost in BE Cyberspace
Joined: Apr 2004
Posts: 10,375
Re: Medicare
Were seeing a Dermatologist/Skin Cancer specialist tomorrow, for a child, $180.00 
and medicare picks up $65.70, this guy has a huge waiting list for any appointment, as hes the cheapest up here, some charge a lot more than that.
and medicare picks up $65.70, this guy has a huge waiting list for any appointment, as hes the cheapest up here, some charge a lot more than that.
Nov 25th 2008, 3:00 am
#8
Proudly Deplorable
Joined: May 2003
Location: Alloha snack bar
Posts: 24,246
Re: Medicare
As a PR you get full use of Medicare.
In my view, Medicare is similar in some ways, to the UK National Health system.
In my view, Medicare 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 system, which by no means is ideal, of the user paying some of the cost with the 'big ticket' items free, is much more sustainable. Having to pay some of the cost prevents a lot of the abuse that occurs in the UK. There is also a safety net for people on low income/dole bludgers/losers etc.
Nov 25th 2008, 5:20 am
#9
Forum Regular
Joined: Jan 2008
Posts: 131
Re: Medicare
PLUS the insurance companies do a lovely thing called lifetime premium loading, which is where they increase your premium by 2% per year after age 31 if you don't have insurance prior to 31. New PR's have 1 year's grace before the loading is applied to them. (Allegedly they will grant penance once you have had insurance for 10 continuous years.)
If you only ever see a GP you will be OK without insurance, but if there is any possibility of ever needing to see a specialist for non-urgent matters then it is worth being insured (although you may still end up paying a lot to go private, as specialists charge more than the 'Scheduled fee' which comes out of your pocket not the insurance company).
Basically the costs for a GP would be:
Bulk billing= free, the GP bills $33.55 to Medicare
Private billing= whatever the GP charges, you get $33.55 of this back from Medicare
And for a specialist
GP refers via public hospital system= free
Bulk billing= don't really exist
Private billing= whatever the specialist charges, you get 75% of the 'scheduled fee' (which is what Medicare thinks they should charge) back from Medicare, 25% from your insurance company and the rest you pay for yourself.
i.e in jad n rich's example above, the scheduled fee is $87.60, medicare are paying 75% of that which is $65.70, the insurance company pays $21.90 and jad n rich pays the rest.
A complete mess in other words.
Nov 25th 2008, 5:28 am
#10
has lost The Game
Joined: Apr 2005
Location: Chippendale, Sydney
Posts: 8,735
Re: Medicare
Also check out ATO website- if you are a high earner without health insurance you pay a higher Medicare Levy, which may cost more than your insurance premium anyway. There is also a 30% tax rebate on health insurance.
PLUS the insurance companies do a lovely thing called lifetime premium loading, which is where they increase your premium by 2% per year after age 31 if you don't have insurance prior to 31. New PR's have 1 year's grace before the loading is applied to them. (Allegedly they will grant penance once you have had insurance for 10 continuous years.)
If you only ever see a GP you will be OK without insurance, but if there is any possibility of ever needing to see a specialist for non-urgent matters then it is worth being insured (although you may still end up paying a lot to go private, as specialists charge more than the 'Scheduled fee' which comes out of your pocket not the insurance company).
Basically the costs for a GP would be:
Bulk billing= free, the GP bills $33.55 to Medicare
Private billing= whatever the GP charges, you get $33.55 of this back from Medicare
And for a specialist
GP refers via public hospital system= free
Bulk billing= don't really exist
Private billing= whatever the specialist charges, you get 75% of the 'scheduled fee' (which is what Medicare thinks they should charge) back from Medicare, 25% from your insurance company and the rest you pay for yourself.
i.e in jad n rich's example above, the scheduled fee is $87.60, medicare are paying 75% of that which is $65.70, the insurance company pays $21.90 and jad n rich pays the rest.
A complete mess in other words.
PLUS the insurance companies do a lovely thing called lifetime premium loading, which is where they increase your premium by 2% per year after age 31 if you don't have insurance prior to 31. New PR's have 1 year's grace before the loading is applied to them. (Allegedly they will grant penance once you have had insurance for 10 continuous years.)
If you only ever see a GP you will be OK without insurance, but if there is any possibility of ever needing to see a specialist for non-urgent matters then it is worth being insured (although you may still end up paying a lot to go private, as specialists charge more than the 'Scheduled fee' which comes out of your pocket not the insurance company).
Basically the costs for a GP would be:
Bulk billing= free, the GP bills $33.55 to Medicare
Private billing= whatever the GP charges, you get $33.55 of this back from Medicare
And for a specialist
GP refers via public hospital system= free
Bulk billing= don't really exist
Private billing= whatever the specialist charges, you get 75% of the 'scheduled fee' (which is what Medicare thinks they should charge) back from Medicare, 25% from your insurance company and the rest you pay for yourself.
i.e in jad n rich's example above, the scheduled fee is $87.60, medicare are paying 75% of that which is $65.70, the insurance company pays $21.90 and jad n rich pays the rest.
A complete mess in other words.
I think 'complete mess' is a little harsh - I have repeatedly found that despite the funding issues, the hospital system is incredibly quick and it doesn't take anywhere near as long as the UK to get the treatment that you need. I accept that this is dependent upon where you live, but here in Sydney the system seems to work well.
One thing to be aware of is that the private insurance isn't usually worth a great deal - Mine covers me for very little, so I have the cheapest I can find to avoid paying the MLS.
S
Nov 25th 2008, 5:33 am
#11
Lost in BE Cyberspace
Joined: Apr 2004
Posts: 10,375
Re: Medicare
Also check out ATO website- if you are a high earner without health insurance you pay a higher Medicare Levy, which may cost more than your insurance premium anyway. There is also a 30% tax rebate on health insurance.
PLUS the insurance companies do a lovely thing called lifetime premium loading, which is where they increase your premium by 2% per year after age 31 if you don't have insurance prior to 31. New PR's have 1 year's grace before the loading is applied to them. (Allegedly they will grant penance once you have had insurance for 10 continuous years.)
If you only ever see a GP you will be OK without insurance, but if there is any possibility of ever needing to see a specialist for non-urgent matters then it is worth being insured (although you may still end up paying a lot to go private, as specialists charge more than the 'Scheduled fee' which comes out of your pocket not the insurance company).
Basically the costs for a GP would be:
Bulk billing= free, the GP bills $33.55 to Medicare
Private billing= whatever the GP charges, you get $33.55 of this back from Medicare
And for a specialist
GP refers via public hospital system= free
Bulk billing= don't really exist
Private billing= whatever the specialist charges, you get 75% of the 'scheduled fee' (which is what Medicare thinks they should charge) back from Medicare, 25% from your insurance company and the rest you pay for yourself.
i.e in jad n rich's example above, the scheduled fee is $87.60, medicare are paying 75% of that which is $65.70, the insurance company pays $21.90 and jad n rich pays the rest.
A complete mess in other words.
PLUS the insurance companies do a lovely thing called lifetime premium loading, which is where they increase your premium by 2% per year after age 31 if you don't have insurance prior to 31. New PR's have 1 year's grace before the loading is applied to them. (Allegedly they will grant penance once you have had insurance for 10 continuous years.)
If you only ever see a GP you will be OK without insurance, but if there is any possibility of ever needing to see a specialist for non-urgent matters then it is worth being insured (although you may still end up paying a lot to go private, as specialists charge more than the 'Scheduled fee' which comes out of your pocket not the insurance company).
Basically the costs for a GP would be:
Bulk billing= free, the GP bills $33.55 to Medicare
Private billing= whatever the GP charges, you get $33.55 of this back from Medicare
And for a specialist
GP refers via public hospital system= free
Bulk billing= don't really exist
Private billing= whatever the specialist charges, you get 75% of the 'scheduled fee' (which is what Medicare thinks they should charge) back from Medicare, 25% from your insurance company and the rest you pay for yourself.
i.e in jad n rich's example above, the scheduled fee is $87.60, medicare are paying 75% of that which is $65.70, the insurance company pays $21.90 and jad n rich pays the rest.
A complete mess in other words.
Nov 25th 2008, 5:35 am
#12
has lost The Game
Joined: Apr 2005
Location: Chippendale, Sydney
Posts: 8,735
Re: Medicare
Mess alright, I personally like the way after a visit to a Doc/specialist you then gather receipts, take numbers at medicare and medibank offices and line up for bits of rebates. Spend 15 mins in a specialist then need to find a good hour driving round and lining up for a little bits of the bill back
Yeah, that is a shambles. It could so easily be organised so that payments could be made electronically.
Medicare offices almost feel like job creation for the sake of it...
S
Nov 25th 2008, 5:39 am
#13
Forum Regular
Joined: Jan 2008
Posts: 131
Re: Medicare
'Mess' was referring to the billing bureaucracy that has become an art form in this system. I am a GP myself so I am well aware of how overall the system is better for the patients compared to the UK with shorter waiting lists and (apparently genuine) patient choices for treatment.
Nov 25th 2008, 5:43 am
#14
has lost The Game
Joined: Apr 2005
Location: Chippendale, Sydney
Posts: 8,735
Re: Medicare
'Mess' was referring to the billing bureaucracy that has become an art form in this system. I am a GP myself so I am well aware of how overall the system is better for the patients compared to the UK with shorter waiting lists and (apparently genuine) patient choices for treatment.
So with every cloud there is a silver lining... My GF is a doctor at the RPA in Sydney - so I have more than an inkling of the bureaucracy inherent in the system...
S
Nov 25th 2008, 5:46 am
#15
Guest
Posts: n/a
Re: Medicare
Medicare Easyclaim is an easy way for patients and practices to claim their Medicare rebate using the existing EFTPOS network.
Payments to practices are usually made within 24 hours, straight into their nominated bank account.
Patients can also use Medicare Easyclaim to claim their Medicare rebate once they have paid their account – the rebate is then paid into their bank account almost immediately. Our research shows that 84% of patients who pay their doctor want to use this system.
Payments to practices are usually made within 24 hours, straight into their nominated bank account.
Patients can also use Medicare Easyclaim to claim their Medicare rebate once they have paid their account – the rebate is then paid into their bank account almost immediately. Our research shows that 84% of patients who pay their doctor want to use this system.
http://www.commbank.com.au/business/...rvices/health/
It will get to everyone eventually, hopefully...