Health cover decisions

[1982]

Hi there everyone

I was wondering if I could get some advice from a few forumites regarding the necessity of private medical cover. I have gone through most of the related topics on this forum and am still undecided. My husband and I have been here for 8 months now and am aware that we need to make this decision within 12 months.

We are in our early thirties and considering starting a family soon. We are still settling in and trying to get by financially which is why this is a tough decision to make right now

What would you suggest (for our situation) between:

1. Staying on regular Medicare

2. Getting a basic hospital cover

3. Getting a basic hospital cover plus extras eg. Dental

Would you say that the majority of people are on a private medical cover? My aunt and uncle have been here for 14 years and have used Medicare and been very happy.

Who is on a basic cover and what are you roughly paying if you don't me asking?

Appreicate anyone's input.

Thanking you in advance

X

[monsta]

For those of you don't know, there is a thing here called "life time loading" or similar. If you don't take out healthcare while you are young, then it will cost more as you get older. Migrants have a 12 month deadline to get inaurance or be loaded.

Private healthcare isn't always a luxury item. Remember that medicare doesn't cover dental. Another example is a lot of physio isn't covered. Add to that most specialists don't charge medicare rates. So, to go and see an ENT in my area would cost you.

Government hospitals are very good here. Unfortunately, to avoid loading you have to take out hospital cover

I would consider AHM as the adverts make it seem a lot like a South African medical savings scheme.

So, with Medicare you will have to pay for treatment at some point. Saving ahead isn't a bad idea.

[Rhyss]

Hi 1982,

The thing to remember is that private health cover is not the same as medical aid which most Saffas are familiar with. Medicare, the governments national health system is very good, especially for young to middle age families. Just remember that Medicare does not cover dental, that comes under private insurance.

[Mara]

Also remember that under Medicare, if you need anything done, which is not an emergency, you go on a waiting list. We are with HCF, 100% hospitalisation only, no extras. For hubby and I we pay $298 per month and this includes our ambulance cover.

[Fish]

..Add to that most specialists don't charge medicare rates. So, to go and see an ENT in my area would cost you....

Note this is private specialists monsta is talking about...public specialists are totally free but have may or may not have an acceptable waiting time depending on speciality and particular hospital.

[Tiermelk]

Also remember there is a Medicare surcharge if you earn over a certain ammount. Go to http://www.paycalculator.com.au/ and enter your salary to get an idea.

As an example if you are on $100k you would have to pay a surcharge (extra tax) of $1000 annually if you do not have a private fund. The $1000 could cover the cost of the cheaper plans.

^{Form the site "1} You have a Medicare levy of $2,000.00. In addition, if you do not have a private health fund you will be liable for an additional Medicare surcharge of $1,000.00 . The calculation on the Medicare levy assumes you are single with no dependents."

[Fish]

Also remember there is a Medicare surcharge if you earn over a certain ammount. Go to http://www.paycalculator.com.au/ and enter your salary to get an idea.

As an example if you are on $100k you would have to pay a surcharge (extra tax) of $1000 annually if you do not have a private fund. The $1000 could cover the cost of the cheaper plans.

^{Form the site "1} You have a Medicare levy of $2,000.00. In addition, if you do not have a private health fund you will be liable for an additional Medicare surcharge of $1,000.00 . The calculation on the Medicare levy assumes you are single with no dependents."

Further to this, the salary when the surcharge kicks in is $88,000 for singles and $176,000 for families. See: https://www.ato.gov.au/Individuals/Medicare-levy/Medicare-levy-surcharge/

Edited May 12, 2015 by Fish

[1982]

Thanks everyone for your input and advice x

[monsta]

I think you might get the jist by now. Start with a cheaper plan and see how it goes. If you find that you are constantly paying amounts your health fund doesn't cover, then think about a more expensive option..

Edited May 13, 2015 by monsta

[Laurenc]

I understood it as all migrants having to have private health cover before they turn 31 years old, otherwise the government will tax you 1% of your total income after your 1st year, then 2% and then 4% etc.

You also need to think about whether you want to have kids? Private medical aids do not work the same as they do back in S.A. Here in Oz, there is no customer loyalty. You can chop and change private medical aids on a daily basis depending on whichever one offers you the best rate. Great, you might think...but just hold on a second! This means that if you would like to have a baby in the near the future, then you can't contact a private medical aid and sign up a month before your due date. You have to belong to a medical aid for a period of 1 year before they will pay for any births or birth related expenses (miscarriage etc.). Most operations require a 3-6 month waiting period, before the private medical aid company will pay for it. You also need to make sure that you are on the correct plan for your needs. Pregnancy cover is usually one of the more expensive plans.

All permanent residents qualify and have Medicare, the govt healthcare. You can choose to access the government healthcare. So yes, you can give birth in a government hospital free of charge if you wish. BUT if you are not a permanent resident and fall pregnant, then you can still give birth in a govt hospital for about $15 000!!!!! (My sister is a prime example of this. She and her hubby struggled for a year to fall pregnant with baby no. 1 and were on all sort of fertility treatments while living in S.A. They then decided to try for baby no.2, after their regional sponsored visa was issued, thinking that it will take another year, but fell pregnant immediately. They had to come over to Oz as they couldn't put off their visa any longer. She went to a public hospital where c-sections were billed at $ 550 - $1100, compared to the private hospital where I went which would have cost them $ 3500. Her hospital day rate was $ 1200 per night! She only spent 2 nights in hospital after having a difficult c-section.)

We are with Health.com.au. I recently gave birth to a little girl, in a private hospital and only had to pay an excess of $250 with them. I had my own private room with private bathroom. It really was so much better than Medi-clinic back home. Remember that no Gynae appointments or ultra-sounds are covered in full by private medical aid. In fact almost none of your ultra-sounds are covered and you only get a rebate on some of the Gynae's fees from the govt. (Medicare). So I would advise you to shop around for your hospital and your Gynae, as some of these can be horrifically expensive even with private medical aid. (If you decide to rather give birth in a govt or public hospital, remember to bear in mind that every public hospital has a certain catchment area. So although you might prefer one public hospital over another, you home address will determine where you will give birth.

Hope all of the baby advice has been useful.

[Fish]

I understood it as all migrants having to have private health cover before they turn 31 years old, otherwise the government will tax you 1% of your total income after your 1st year, then 2% and then 4% etc.

Just note you incur this extra charge if and when you subsequently take out private hospital insurance. So say you wait until you are 45 and then decide you need it, it is only then that you will pay this extra charge on your private insurance premium. If you never take out private insurance you will never pay the extra charge.

There is a different tax penalty for not holding private insurance if you earn over a certain income but that is not age based.

You also need to think about whether you want to have kids? Private medical aids do not work the same as they do back in S.A. Here in Oz, there is no customer loyalty. You can chop and change private medical aids on a daily basis depending on whichever one offers you the best rate. Great, you might think...but just hold on a second! This means that if you would like to have a baby in the near the future, then you can't contact a private medical aid and sign up a month before your due date. You have to belong to a medical aid for a period of 1 year before they will pay for any births or birth related expenses (miscarriage etc.). Most operations require a 3-6 month waiting period, before the private medical aid company will pay for it. You also need to make sure that you are on the correct plan for your needs. Pregnancy cover is usually one of the more expensive plans.

And for people not sure the waiting period for births on private insurance is the due date, not the date of conception. So you have to hold the insurance roughly 3 months before getting pregnant.

Also note that when you chop and change policies they usually waive waiting periods if you are moving from an insurer where you held the same level of policy. It is only upping your coverage with new items that incurs a waiting period again.

We are with Health.com.au. I recently gave birth to a little girl, in a private hospital and only had to pay an excess of $250 with them. I had my own private room with private bathroom. It really was so much better than Medi-clinic back home. Remember that no Gynae appointments or ultra-sounds are covered in full by private medical aid. In fact almost none of your ultra-sounds are covered and you only get a rebate on some of the Gynae's fees from the govt. (Medicare).

That's right, private hospital insurance only covers in-hospital treatment so no medical treatment outside a hospital/day hospital is covered at all. So seeing a private specialists in their rooms is out of your own pocket though govt medicare does give a (usually smallish) rebate to private costs.

The biggest cost of having a baby in the private system is a once off insurance mgt fee the ob's charge which is usually thousands out of your pocket + all the visits to their rooms during pregnancy. Many are very happy with the public system so that is definitely an option.

[1982]

Hubby and I are both 33, no kids and been here for 8 months now. We thinking about getting a basic hospital and extras cover (which won't include pregnancy) and then having a baby through Medicare? I would want to take a simple plan out to avoid the loading later. We wouldn't be able to afford a top tier plan which includes pregnancy although I love the idea of a private room ? .

Any thoughts?

[miran]

Just make sure you have ambulance cover! Medicare doesn't cover it at all, and I've heard horror stories of ambulances costing $1000's! We are with Australian Unity specifically for dental and eyes, you need additional cover for medicines. I agree: start with a cheap option asap and modify it as your needs change.

edit: Also with ambulance, I recently found out I'm only partially covered. They will take me to a hospital, but if I'm transferred to another hospital, they don't cover that! Worth making sure you're 100% covered.

Edited May 22, 2015 by miran

[monsta]

I agree with Miran 100%

Be VERY caredull about private health care. In RSA the private hospitals assume that if your medical aid won't pay, then you won't either. Here they just send you a bill. Its up to you to know whether your health fund will cover you or not. I, like most Aussies, have a very merky understanding of what I am covered for.

It can get complicated. Health funds may even refuse to pay if the doctor performed the surgery a particular way. Or they may pay less because od way the doctor broke down the line items on the invoice.

That's why I use my health fund for what I can't get from medicare. As with Miran, thats dental and ambulance. And possibly a private patient in a public hospital.

Ai, I am jot saying don't have health cover. But if you do go into a private hospital, find out exactly what is covered and what isn't.

I have seen other customers at my health fund get really angry when they get told that due to a technicality they have to pay in hundreds of dollars. The staff at my health fund have the shopping centers security on speed dial.

Edited May 22, 2015 by monsta

[Mara]

Well then I have a good story to add to this discussion. I have 100% hospital cover only, with HCF. Three years ago I was in a private hospital, private single en suite room, for around five weeks, including open heart surgery, intensive care, high care, and rehabilitation. Two ambulance rides and many specialists, ct scans, x-rays, blood tests, blood transfusions later, I left with a bill totalling $75, 000 which HCF paid in full!

[SuzanneT]

Hi 1982,

We are similar age and I've had 2 babies in the last 3.5 years here in Aus. For both my pregnancies I had private health with pregnancy cover.

I saw a GP/OBS doctor for al my antenatal check-ups and was really happy to have her and would not do it any differently. Having a baby can be a pretty daunting experience - especially your first! Her fees and consultations and all the tests and ultrasounds were paid out of our own pocket and with some payback from Medicare. Private health cover do not pay any of this. My doctor was way more affordable than a private obstetrician would have been, but I still got the best of care - my pregnancies were both normal with no complications.

For the birth itself I booked in to a public hospital but as a private patient. The births and the hospital stay didn't cost us a cent, even when I ended up having an emergency caesarean with the first baby and an elective caesarean with the second baby. I'm really glad I had my doctor there with me in hospital with both births.

My personal opinion is that it is good to have your own doctor with your first baby - be it a GP/OBS or OBS. I was dead set on having a natural birth with my first one, but nature intervened.

I would cancel the extras cover from your private medical and put the pregnancy cover on for now. Then later you can remove the pregnancy cover and put extras back on. Just a suggestion!