Medicare in Australia

[mcbear]

I wonder if anyone can help me.

We've had our 175 visas since June 2009, and are in our 5 year window. We are still in SA, just waiting for the job market to improve in Australia before we make the move.

This year we have had some medical problems with our daughter (3 years old) and she probably has petit mal (epilepsy), but we are still in the process of tests and endless doctor appointments to figure out what is wrong. In the meantime she is having therapy sessions three times a week (physio, speech therapy and occupational therapy). Probably she will be put on anti-epileptic medication in the new year.

Does anyone know how this affects us when we arrive and try to join medicare over there? Are they going to make us pay for her medication, or will she be accepted for full cover? We knew nothing of this condition until a few months ago.

Thanks

Jacquie

[Avatar]

There should be no problem with medicare, as you sign up when you arrive permanently, and you aren't asked about any conditions, I assume because this was covered in the medicals, and you are eligible for full benefits from when you arrive to stay permanently.

One only has a duty to inform DIAC of any change in circumstance, especially health and character issues, before one validates the visa, but not afterwards.

Good luck. Hope your daughter is going to be okay.

[LeeInOz]

There will always be some cost alocated to you even if Medicare do cover the cost. When you come I would advise getting a few months or more medication and then see a doctor here to get a script. The biggest factor in the cost is if the medication is on Public Benefits list

http://www.pbs.gov.au/html/home. Thes are drugs that Australian medical practice deem should subsidised by government. This makes a HUGE difference.

I am on a medication (not for epilepsy) that was not on PBS and paid $120 a month or so. Then after about 2 years it went onto the list and now costs about $10 a month. Other similar ones on PBS are about $30 a month. I always allow them to suppy generic

http://www.pbs.gov.au/publications/2009/20...al-schedule.pdf

As to Doctors you will still need to either go to a Dr that bulk bills or pay the normal charge. I would check the medicare website as well

Hope this helps.

[21yearsoutofrsa]

You will be covered by Medicare, to whatever the limits of Medicare are. The limits are more about type of procedure (e.g. Medicare does not cover dental and if you decide to go to a non bulk provider (i.e. private supplier) you will pay for the excess, over the Medicare rate)

Medicare is designed as the "catch all" medical system and will cover everything (Huge simplification of a huge Act and philosophy in one sentence, please accept it as such)

If you decide to take out private medical insurance on top of the state provided Medicare (for what ever reasons you decide (e.g. dental cover)) they will make their own assessment and decide on any exclusions before making an offer on premiums/what's covered etc.

www.medicareaustralia.gov.au/ may help with your questions.

[Bob]

From my understanding:

You've all had Permanent 175 Visas for Australia since june 2009.

I believe you need to "activate" any sort of visa within 12 months of its issue, and it seems you've done so.

If your daughter with the medical problems was with you, or turned up at a later date, and got her PR visa activated, then she is a permanent resident of Australia and will be "on the books" as such for the next 5 years.

If all this is right, then she is entitled to full Medicare treatment whenever she's in Australia.

http://www.medicareaustralia.gov.au/

Only Medicare covers Australians for visits to GPs and specialist doctors. There is no such thing anymore, since Feb 1984, as "Medical" insurance to cover you against the cost of seeing a GP or specialist. It is against Australian law for any insurance company to cover an Australian for that.

An Australian can only privately insure him/herself against costs involved with getting treatment privately in a public hospital or at a private hospital.

Medicare covers 75% of the scheduled fee of a doctor or specialist in a private hospital and you can get "Hospital" insurance to cover you for the "gap" - the remaining 25% of the scheduled fee (cost) and for staying in a private hospital or as a private patient in a public hospital.

Also, prescriptions are affordable for all Australians and permanent residents on the Pharmaceutical Benefits Scheme list.

http://www.medicareaustralia.gov.au/provider/pbs/index.jsp

If your prescriptions in any calendar come to over $300 (I think!) then all prescriptions afterwards, for the rest of the year, are free.

If the prescriptions in any year for the whole family (mum, dad and all the kids) come to more than $750, then all are free after that amount.

You shouldn't have to sell one of your kids into slavery to access health care or buy prescription drugs for personal use in Australia.

All private health premiums are the same for everyone, no matter if they are fully sound or grossly ill. You should be able to privately insure your daughter with a private health fund without any excess premiums, as long as you declare any pre-existing conditions that you or your family have.

The private health funds are not obliged to insure you for up to one year for any pre-existing ailment.

[mcbear]

Thanks guys, you've all been a huge help, I appreciate it.

Looks like we will be okay, they won't kick us out as soon as we get there (I hope)!

It looks like the availability of specialists is better in SA than in Australia from what I hear?? Although there aren't a whole lot to choose from in SA either!

Does anyone know, we are currently on Discovery Health medical aid here, which is covering our expenses pretty comprehensively. If we immediately took out private cover in Australia, would they still not cover us for pre-existing conditions?

[quinswan]

we arrived just over 3 months ago.

As we are not PR yet. we have to get private medical insurance.

the two ig ones are Medibank and Mutual Community.

They both have "waiting periods"

2 months for general stuff

6 months for stuff like glasses etc.

and 12 months for pre existing conditions.

We opted for medibank, because when you go to any of their branches (don't join online) and you insist that you have a friend who they waived the waiting periods for then (you can mentione me if you like) then they waive it.

Except for the 12 months items. I was taught this trick by my south american friends.

The reason is that they are very much in competition with mutual community and would rather waive the 2 and 6 moths periods than lose a new client.

I am not sure about the chronic condition though, but rest asssured that unlike south african medical aids, even that will be unrestricted after 12 months.

I do not believe that people struggle to find specialists here, it probably only because that someone did not yet get the system.

After all, south africa's doctors are all here.

Medibank is quite good and comprehensive, altough the payment system is totally alien to south africans on discovery. here you give the bill to medibank, then they give you the cheques to give to the doctors. it's quite weird i know, but just different. they also cover a lot more stuff than discovery like natural treatments etc.

As far as doctors are concerned, i went to a an ex south african, out of loyalty and was dissapointed.

What i did find a bit irritating, was that doctors here are very scared of malpractice suits, and would rather do a million tests than come to an early diagnosis. you almost sense indecision.

But i suppose that's complaining with the white loaf of bread under the armpit, at least they are thorough.

Any case that is the modern way

[Avatar]

Hi mcbear,

In Australia public hospitals are apparently better than private to cover many conditions, e.g. cancer, so investigate whether or not you do need private cover.

We signed up with mbf, and were told if you sign up within 3 months of leaving an Australian recognised South African medical aid you will not have any waiting periods (Discovery was a medical aid they said was recognised). You need to prove you are within the 3 month period by providing a clearance certificate showing when your cover ended.

I've also read it's best to bring along specialist reports or letters from doctors about pre-existing conditions, so you don't have to start from scratch again, or be uncertain about anything. You will need to see a GP here first, and they will refer you to the relevant specialist if needed.

Good luck!

[Riekie]

Don't underestimate the expertise, skills and facilities of the public hospital system - you just have to watch a few episodes of RPA to know this. Our daughter was referred to a few specialists in two public hospitals by her GP and we never paid a cent: EEG's, MRI's, the best specialists in their fields, the works!

[mcbear]

Thanks so much everybody for your input, it has really helped. I think I am more informed now. It looks like we will be fine, and perhaps now need to get ourselves over there asap!

[Avatar]

Hi mcbear,

Hope you do make it over safely and soon! I just wanted to add it's best you check waiting periods, and whether or not you qualify for this to be waived, with the applicable private health insurance company you plan to sign up to. Each individual's situation might be different, dependent on employer and collective agreements. MBF's website states: "If you already have health insurance with another provider, your waiting period with MBF may be reduced for some services. Call us on 131 137 for more details." (https://www.mbf.com.au/HealthInsurance/Commonquestions/Nutsandbolts/Claimsandwaitingperiods#5)

Good luck!