spondyatwood

Hi
My wife and I have been here for 8 months now and I am a tad confused over Medicare and Health Insurance.
Q. What does Medicare cover and upto what amount ?

Q. What is Medicare loading and how much is it

Q. Do we need to take out any extra Private Health Insurance and what is the approx cost

We are a Family of 3.

I thought that Medicare took care of all health issues.

Please help us to clarify this so I can make sure that my family has adequate Health cover

Thanks
Andrew

Bordy

Also make sure you have Ambulance cover for the family.

ABCDiamond

Medicare covers most of the basic medical needs:

http://www.hic.gov.au/yourhealth/our_services/am.htm

In-hospital services
Public Patient
If you choose to be admitted as a public (Medicare) patient in a public hospital, you will receive treatment by doctors and specialists nominated by the hospital. You will not be charged for care and treatment, or after-care by the treating doctor.

Out-of-hospital services
Medicare provides benefits for:

consultation fees for doctors, including specialists
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



Not all of the "Out-of-hospital services" will be covered in full.
The benefits you receive from Medicare are based on a Schedule of fees set by the Australian Government. Doctors may choose to charge more than the Schedule fee. Others will Bulk Bill you and you then pay nothing:

Bulk Billing by the local GP

You will find some areas where most doctors will Bulk Bill, and other areas where few doctors will bulk bill.

In the "less well off" areas, more doctors seem to bulk bill, but in the more affluent 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 (these figures will 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. so one of two things happens:

1: The doctor will charge you $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. I know this has happened to me once, but I have read recently that it should NOT be done this way.

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 !!

Specialists can be expensive, as they charge much more than schedule fees !


That's a small start

spondyatwood

Thankyou very much for the info and link it has really clarified our position and given us a greater understanding

spondyatwood

Thanks Bordy were aware of ambulance costs and have enrolled the Family $100 per annum not bad at all