Mandyisere

I've been looking at taking out private health insurance to avoid the 1.5% medicare levy surcharge and I keep hearing things about the gap, what exactly is it? How much is it ? And can you avoid paying it?

Also if anyone can recommend good insurance companies i'd be grateful.

Thanks
Mandy

sophia

hiya Mandy

The gap is the difference between what you are charged for something and what medicare pay you back. For example, when I visit the doctors it costs me $40, take the receipt over to medicare and they give me back $27 (I think)...so the gap is the difference (ie: what you end up paying - $13). I think the private health funds try to cover the gap...but don't quote me on that as I've only taken out ancillary cover and not the hospital cover.

Its about as clear as mud really isn't it?? LOL!!

love sophia xx

arkon

Private insurance out here isn't like the UK's. Here it doesn't cover the whole cost. For small things like consultations etc. it doesn't amount to much but my uncle with cancer has paid huge gap fees for example an MRI scan might be $2000 but the insurance only pays maybe $1000 leaving a huge gap. He for one cant stand the system as its cost him a small fortune on top of the insurance premiums and as its a terminal disease he would have got the same treatment on medicare but without leaving a huge debt for his widow my aunt.

sophia

You're right there Arkon. My friend and I were both diagnosed (within an hour of each other) with breast cancer a couple of months back. She went private and I stayed with the public health system who were already looking after me after my first bout of breast cancer. Anyway, I had nothing to pay at all, she has had all sorts of bills coming in, from surgeons bills, the anaethetists bill, theatre charges, x-rays etc etc. She does get some back from Medicare, but as you say there is still a large gap for her to pay out of her own pocket.

Glad I was looked after by the public health system...the private stuff seems WAY too complicated for me...plus as you say, fancy having the stress of dealing with those bills when trying to recover from something really major too!..I know my mate is a bit stressed about finances..when she should be concentrating on her recovery.

love sophia xx

cresta57

"The Gap" is the void you think you must have between your ears when you paid out 2k for medical insurance and the first time you use it the hospital charge you $500 for a $300 dollar procedure because you have insurance and you find out that if you'd had no insurance the procedure would have only been $100 as you could have claimed $200 back from Medicare.
Confused still?
So were the unlucky punters we met in the Hospital that had been told you needed private health care in Australia or you received no treatment. I bet it was an insurance salesman that told them.

elksa

I'm confused

If you take out private health care cover you have to pay "the gap" between what you are charged by the hospital and what your insurance cover will pay for.

However,

If you have no health care cover then you go through medicare (public) whereby you will also pay "the gap" between what medicare subsidize and what the actual cost for the treatment is.

Therefore,

There is no real advantage to having private healthcare insurance except for the fact that you may get seen a bit quicker and get your own hospital room!!!

Why would the hospital charge more for the same operation on a private person than someone who is going through Medicare???

NickyC

If you go to hospital as a Medicare patient, you pay nothing for the actual hospital part. You might have to pay a bit of a gap for any specialist visits prior to going into hospital - but nothing for the hospital stay itself.

If you go to hospital as a private patient someone has to pay for everything -your accommodation, surgeon, anaesthetist, scripts etc. This is where the gap comes in - the Health funds only pay a proportion of the fees. You have to cough up the rest which is the GAP.

The other advantage of having Private hospital cover is to avoid having to pay an extra 1% Medicare levy. Just because you have the private cover doesn't mean you have to use it!

sophia

LOL I told you it was as clear as mud!! I went through the public health system for my breast cancer and have not had to pay for any treatment...no gaps no nothing. The only gap I have had to pay so far in 3 years I've been here is the gap between the fee I pay for a GP's appointment and the rebate you get back from medicare.

I think that you are right with regards to the private health cover, you get your choice of surgeon/hospital etc and a private bed! That appears to be the only benefit...they also appear to charge you like a wounded bull for the privilege!

As for whether the hospital charge more for a private patient over a medicare patient, I really don't know..cos medicare cover the cost. I've never yet found out how much all my treatment would have cost me privately...not sure I want to know either!! :scared: I just thank God for medicare...their health system is very similar to the NHS...oversubscribed and underfunded..I think thats why they try to encourage private health cover to take some of the burden off the system....but it's been very good to me!!

love sophia xx

cresta57

Their medical insurance only covered the basic cost of the procedure, in this case it was a scan average cost $300 they were charged $500 as they had medical insurance. If they'd had no cover the cost would have been $300 and they could have recovered a large proportion close to $200 back from Medicare.
In effect by having medical insurance they paid over the odds for a procedure that would have still been done on Medicare and cost them far less.
Yes I am confused also as I thought that's what you paid insurance for.

elksa

Yes but if I have private health care cover I am paying a premium for that. Surely the 1% Medicare levy (which I assume is 1% of everything I earn) is cheaper than paying private health care premums for my family and I.

Maybe I'm still confused but this 1% Medicare cover is similar to national insurance contributions here in England? except for the fact that if I have private health care cover in Australia I am exempt from this charge whereas here in England I am not regardless of the insurances I have out (OK I know that NI contributions don't fund the NHS but you get my point!!! Even if I pay into a pesion scheme I'm not excempt from NI)

NickyC

The basic Medicare Levy is 1.5% that almost everyone pays. If you are classed as a high-earner (>$50k for singles, >$100k with dependants) you are charged an EXTRA 1%. Depending on what you earn, it might be cheaper to pay for a basic Hospital cover than be charged that extra 1%. It was for us..

Bella Donna

Am I right in thinking that having a private health insurance policy can also give you cover for some alternative therapies like osteopathy? This would also be a benefit if you preferred to use alternative therapies. The extra 1% levy on medicare would not provide such cover.

Sue

NickyC

Yes, some policies do. Not the Basic Hospital cover ones but there are variable add-ons that you can take with your Extras cover, some of which do cover alternate therapies and massage etc.

Some of the things you can claim for are remarkable - gym membership fees are available on some policies and the cost of trainers/runners etc. Some policies will cover literally everything involved in getting and staying fit. Guess it saves them more in the long run!

sophia

Hiya Sue

Sort of right. Most health cover plans have 2 sections, one is your main hospital & associated expenses cover and then a separate Ancillary cover (which covers mainly for dentistry, optical, orthopedics,etc)..it's the ancillary cover that generally covers you for "some" natural therapies. For example I'm with HIF for Ancillary cover only...but I have the premium options which DOES cover me for my homoeopathic and naturopathic appointments, but not all levels of cover pay out for complementary therapies. You need to really look into what you think you will need for your family etc.

love sophia xx

arkon

Not to mention getting pregnant out here, The unluck saps that go private end up paying a fortune. The baby is coming out no mater what and theres no difference between private and public when it comes to the service you get and you don't get a whopping bill either.

Cop for this, we were pressured to have the baby private and the reason was you could choose your obstetrician and where we are it would have made no difference as there is only one and you'd get him private or public.

I should also mention from what I've heard the Australians are leaving the private schemes in droves hence the govenment having the sting of the extra 1.5% it was introduced to try and stop the flow of people from the private schemes. I think if its possible you should go for the cheapest private scheme you can to not have to pay the levy but never use it! Go medicare for everything life threatening and only use the private scheme for elective things. I don't know if this is a posibility though.