Medical

[Donovan83]

In SA, we all have access to the government medical services that they "deliver", but none of us use them because they're so bad. So we all have private medical aid and use private hospitals (although these days are limited with the coming NHI system which will bring everyone down to the lowest common denominator of healthcare - the government hospitals). Also, even as it is now, you don't really get much back for the premiums you pay to private medical aids...

How does it work in Australia? What do you pay, and what comes out of taxes (ie, is paid and covered by the government)? Is there somewhere where I can do some detailed reading on this?

[Fish]

In SA, we all have access to the government medical services that they "deliver", but none of us use them because they're so bad. So we all have private medical aid and use private hospitals (although these days are limited with the coming NHI system which will bring everyone down to the lowest common denominator of healthcare - the government hospitals). Also, even as it is now, you don't really get much back for the premiums you pay to private medical aids...

How does it work in Australia? What do you pay, and what comes out of taxes (ie, is paid and covered by the government)? Is there somewhere where I can do some detailed reading on this?

1.5% of your income is deducted from your pay. It is deducted as part of your income tax (your payroll dept adds it together) so you don't really notice it.

This funds the public medical system calls Medicare, similar to the NHS in the UK.

Some things it covers include:

- Free public hospitals

- Free specialists at public hospital outpatients clinics. (If you want to see a free public specialist ask your GP when they are writing a referral otherwise they will probably send you to a private one by default)

- Subsidised medicine (Capped so max you pay is $32.90 I think...or around $5 if on low income) for all medicines on the PBS list. After you use a lot of prescriptions per year it drops to the lower price.

- Payment towards seeing a private GP (some GP's do not charge a co-payment so are totally free - known as bulk-billing - around 78% of GP services Australia wide are free - country/regional/ACT often have worse access to free GP's).

- Payment towards private specialists. Medicare pays part of the bill to see a private specialist...it varies from around 40-75% roughly. (If you want to see a free public specialist ask your GP when they are writing a referral otherwise they will probably send you to a private one by default)

- Glasses prescription (but not glasses)

- Payment towards pathology, X-ray etc. I get all mine free as I ring around but some charge a copayment.

- School dental bus, teen dental voucher and other programmes.

Once you earn over $80,000 as a single or $160,000 as a couple the govt charge you another 1% for Medicare. This is known as the Medicare Levy Surcharge. If you have private hospital insurance you do not have to pay the Medicare Levy Surcharge even if you are over the limits. Note that the private "extras" insurance is irrelevant to avoiding this surcharge. Note that this levy is usually worked out at tax return time so you will notice it as it will be a single large amount rather than spread through your pay during the year. Of course your tax deductions may offset some of it.

Medicare is up there with the best public health systems but like all of them service can vary depending on your local hospital, luck of the draw, worldwide shortage of a particular speciality or whatever.

Private hospital insurance covers:

- Hospital accommodation and doctors costs in private hospitals or official private day hospitals sometimes located in private specialist centres (in the doctors rooms).

- It covers almost nothing outside of this....so does not cover private specialists or GP's etc. Only exception to this is the special private insurance used by temp visa holders.

- Big copayments can sometimes apply under private insurance. You can ask for a specialist to treat you as a No Gap patient. They are not obliged too but usually will. This means they will accept the private insurance payment as payment in full. The No Gap scheme is for the in-hospital doctors costs only.

Some like to have private hospital insurance to jump the queue if a particular public procedure has a long wait.

Note the private health system in Australia operates on a community rating scheme. This means you cannot be denied insurance or have an increased premium no matter what you health or age. The only thing they can do is apply a waiting period for some pre existing conditions (usually 3 to 12 months).

Private Extras insurance (can be combined with Private Hospital Insurance):

- Covers ancillary services like dentistry (expensive in Australia and not covered in public system except in special circumstances and little bit for children), physio, remedial massage, glasses etc

- Usually only pays part of the bill and you pay rest

- Some people prefer to self insure and put money in the bank to cover.

If you are over 30 and decide you want private health insurance then the govt charges you an additional age loading on your premium of 2% per year that you are over 30. This encourages many into private insurance by the time they are 30. If you are an immigrant you have a set time, 12 months I think, to enter without paying the age loading.

Note that there is a tax rebate on all medical expenses you incur over a certain limit. This includes copayments you make for things that attract a medicare payment + non medicare costs like dentistry, physio, even headache tablets if you bought them at the chemist rather than the supermarket. Keep all medical receipts for tax time.

For further reading see:

- Medicare: http://www.medicareaustralia.gov.au/public/index.jsp

- PBS: http://www.pbs.gov.au/info/about-the-pbs

- Private Health: http://www.privatehealth.gov.au/

[Sibella]

Wow Fish thank you. That is the best explanation I've read so far concerning healthcare in Australia.

I found it really confusing so far but you've made it much clearer.

Thanks!!

[PackingforCanberra]

In SA, we all have access to the government medical services that they "deliver", but none of us use them because they're so bad. So we all have private medical aid and use private hospitals (although these days are limited with the coming NHI system which will bring everyone down to the lowest common denominator of healthcare - the government hospitals). Also, even as it is now, you don't really get much back for the premiums you pay to private medical aids...

How does it work in Australia? What do you pay, and what comes out of taxes (ie, is paid and covered by the government)? Is there somewhere where I can do some detailed reading on this?

Also go check out the web for "centrelink"

[mcbear]

Also go check out the web for "centrelink"

Thanks Fish, that was a really good explanation.

How soon after one arrives (on a PR) should one cancel the private medical aid in South Africa?

[patrice]

We arrived with PR’s and cancelled our SA medical, at the end of the month we arrived – arriving 11/11/08 which gave us a +two week overlap, ensuring we had time to register on Medicare before our SA cover lapsed.

On arrival, I believe one has 6 months grace to join a private medical before you are liable for the Medicare surcharge – we shopped around and took out medi-bank private about 3 months after arriving

[ajayrajh]

Hi I am applying for a 457 visa and apparently i need to take out private health insurance? is this a must?

[21yearsoutofrsa]

Hi I am applying for a 457 visa and apparently i need to take out private health insurance? is this a must?

It's a condition of your visa, unless you are covered by a reciprocal arrangement. There are no reciprocal arrangements with South Africa.

[Short&Tall]

I understand you have 1 years grace, as an immigrant, to get the private hospital insurance before they start adding the surcharge for being over 30.

We got a letter from Medicare confirming the date we signed up that we could give to an insurance company when we signed up. Really must get around to doing that I've been looking at the different options with different companies but find it rather difficult to choose.