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Healthcare in Australia

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Healthcare in Australia

From Wiki

Medicare is the cornerstone of Australia's healthcare system. In principle it is similar to the National Health Service in the United Kingdom.

Medicare offices can be found all over Australia. Many BE members have experienced that the level of training and understanding of the rules on Medicare eligibility is poor among front line staff.


[edit] Entitlement to Medicare

As a general rule, you are entitled to Medicare if you are resident in Australia and you are:

  • an Australian citizen; or
  • an Australian permanent resident; or
  • a New Zealand citizen; or
  • if you hold a temporary visa and:
    • that visa carries the right to work in Australia; and
    • you have applied for a permanent visa (other than a parent visa)

[edit] ATO Medicare levy

  • All persons eligible for Medicare are liable to pay a 1.5% income tax levy administered by the Australian Taxation Office
  • There is an additional 1% levy for those with a "high income" who do not have qualifying health insurance cover
  • The Medicare levy applies to those eligible for "reciprocal Medicare"

[edit] Reciprocal Medicare

  • Limited Medicare coverage is provided to residents of certain countries with which Australia has an agreement. This is known as reciprocal Medicare
  • These countries are:
    • United Kingdom
    • Sweden
    • Finland
    • Norway
    • Netherlands
    • Malta
    • Italy
    • Republic of Ireland
    • New Zealand
  • The agreements with the Republic of Ireland and New Zealand are less comprehensive than with the other states
  • However, in all cases, coverage under reciprocal Medicare is limited to treatment that is "medically necessary during your visit"
  • Holders of the Retirement visa (subclass 410) are excluded from reciprocal Medicare unless they first applied for their visa before 1 December 1998.
  • Student visa holders are generally not covered by Medicare and are required to take out Overseas Student Health Cover.

[edit] Duration of visit

  • In practice, long term temporary residents (such as holders of 457 visas) are considered to be "visitors" even though they may remain in Australia for some years
  • The agreements with Malta and Italy do impose a 6 month limit on one's "visit" to Australia
  • It remains possible that Medicare could "crack down" on this and remove eligibility from those in Australia for long periods on temporary status.

[edit] Eligibility : Citizenship or Residence?

  • Eligibility for reciprocal Medicare is generally based on your country of residence not citizenship.
  • So a British citizen formerly resident in France should in theory not be eligible, while an American citizen formerly resident in the United Kingdom should be.
  • In practice many Medicare staff will award eligibility based on nationality.
  • If you are leaving the U.K. it is strongly recommended to bring evidence of your NHS registration.

[edit] Applicants for permanent residence

  • If you are resident in Australia with a working visa (eg 457 visa) and you apply for permanent resident status (except a parent visa), you are immediately entitled to full Medicare coverage.
  • Medicare staff should give you a full Medicare card (normally valid for one year) upon seeing your application receipt from DIAC
  • However, there have been many reports of Medicare staff not knowing about this rule.

[edit] New Migrants

  • New migrants, ie those arriving with a permanent visa, are immediately eligible for Medicare
  • In practice it takes about 10 days for your details to be transferred from DIAC systems to the Medicare system.
  • There have been reports that some Medicare staff have demanded to see evidence of settlement in Australia. It is a matter of luck whether new migrants get asked this or not. Technically it is needed.
    • You should not register with Medicare if only on a visit to "validate" your visa.
    • It is legally a requirement that in order to be eligible for Medicare, you should actually live in Australia. (also see the notes on Lifetime Health Cover below).

[edit] Returning Australian citizens and permanent residents

  • Australian citizens living outside Australia (which excludes Norfolk Island for this purpose) are not normally covered by Medicare
  • A returning Australian citizen who has been absent for more than 5 years is required to show evidence of settlement in Australia. In other words, evidence that he or she is not just visiting.
  • There have been reports that Medicare staff have demanded evidence that all overseas ties have been severed. This is not necessary provided you can show that you have re-established ties with Australia.
  • This also applies to returning permanent residents who have spent more than a few years overseas
  • It also applies to New Zealand citizens moving to Australia

[edit] Lifetime Health Cover

  • Lifetime Health Cover (LHC) is an Australian government initiative to keep the cost of health insurance manageable for older Australians
  • In order to achieve this, younger people are encouraged to take out health insurance at a younger age in order to improve the overall risk profile
  • The premium you pay for health insurance is based on a standard amount + a "Lifetime Health Cover loading"
  • When the system was introduced in 1999/2000 all Australian citizens and permanent residents were given a chance to take out health cover without paying a loading.

[edit] The loading

  • The premium loading is 2% for every year after age 30 for which you delayed taking out health insurance
  • For example, a person first taking out insurance at age 40 would pay 20% extra

[edit] New migrants

  • New migrants have a grace period of 1 year to take out health insurance, from the date of becoming eligible for Medicare, to take out health insurance without paying a loading.

Since 1 April 2007

  • The rules are contained in Division 34 of the Private Health Insurance Act 2007
  • If you established a Medicare eligibility date under the previous legislation (see below), you may retain it.
  • As a "new arrival" since that date, you must take out provate health insurance by the later of:
    • the 1 July following your 31st birthday; or
    • the first anniversary of the date you are registered for Medicare.
  • Australian citizens and permanent residents who were overseas on 1 July 2000 must take out health insurance within 1 year of first anniversary of return from overseas, or the 1 July following 31st birthday, if later.

Rules prior to 1 April 2007

    • The rules for Lifetime Health Cover were in Schedule 2 to the National Health Act 1953.
    • Clause 5(1)(cc) of Schedule 2 of the Act is the one specifically referring to new migrants arriving now.
    • Subclause (ii) states clearly that the Schedule 2 application date for such an individual is the the first anniversary of the day on which he or she became eligible for Medicare benefits";
    • In order to be eligible for Medicare, you must be an "Australian resident," as defined in section 3 of the Health Insurance Act 1973
    • A variety of criteria in terms of immigration and citizenship status must be met, but the common theme is that all of them require that the individual resides in Australia.
  • Hence, if you validate your migrant visa with a holiday to Australia, you are not eligible for Medicare at that point and the 1 year clock legally should not start ticking. (This has never been officially clarified, however). In order to avoid complications, it is not advisable to not register for Medicare until you return to take up residence.
  • Those aged under 31 have until 31st birthday to enrol without paying an age loading, if that is later than the first anniversary of becoming eligible for Medicare benefits.
  • If you obtained full Medicare as a temporary resident due to a PR application, your grace period to take out health insurance starts at that point.

[edit] Special cases

  • Australian citizens and permanent residents who were overseas in 2000 may opt into the system on return to Australia without paying a loading.
  • Persons born before 1 July 1934 are exempt from paying a loading.

[edit] Australian Healthcare links


Insure or Not ? (pdf guide)

Private Health Insurance Administration Council