Medicare good enough?

[Riekie]

I tore my meniscus, saw a specialist on the Wednesday and had my surgery the following Monday.  If I was not on private health, I could have waited up to a year. That's the benefit of private hospital cover. 

[NoahWi]

On 10/26/2016 at 3:31 AM, Riekie said:

I tore my meniscus, saw a specialist on the Wednesday and had my surgery the following Monday.  If I was not on private health, I could have waited up to a year. That's the benefit of private hospital cover. 

 

Private health is great and excellent thing to have. 

[Peterthe1]

It depends on how much money you want to spend. I rely on Medicare only. I've had two non life threatening procedures this year, both on Medicare. From being referred by the GP to the actual procedure never took longer than 2 months. I haven't had to pay anything on both occasions. Life threatening or urgent procedures are normally done within a very short time (normally a matter of a few days), according to the hospital when I enquired.

I do put money aside regularly for any emergency where I may need to throw out some money. I'd  rather have the money in my account than someone elses

[Mara]

@Peterthe1 I am happy for you, and the decision you have made to only have Medicare cover. I have to say, you remind me of someone else I know, with the attitude "I am healthy, young, it cannot happen to me"!

 

A person can easily develop something catastrophic, which you had not planned for, and it is at that time that you appreciate the fact that you have private medical. In our case, hubby and I have been members for around 17 years, but in one swoop, with open heart surgery, 5,5 weeks in hospital, at a total charge of $72,000, I collected all those monthly payments back. I will stay on it as long as I can afford it.

[Peterthe1]

10 minutes ago, Mara said:

@Peterthe1 I am happy for you, and the decision you have made to only have Medicare cover. I have to say, you remind me of someone else I know, with the attitude "I am healthy, young, it cannot happen to me"!

 

Thank you for the compliment, but moving in on sixty at a fast and furious rate I wouldn't quite go for the "young and healthy" bit. A few years back maybe.?

On a serious note though, if you had put 17 years worth of contributions into your own account you could probably have paid the bill yourself. This is why I put money aside for any unforeseen circumstances. 

If you have children, having medical aid probably makes sense.

Having medical cover is a personal choice.  I don't believe it is everything it is cut out to be and luckily we live in a 1st world country with a good health care system and you wouldn't be left in the street to die.Here you go to the same hospital whether you're a private customer or on Medicare

In SA on the other hand it is probably advisable to have it. Although private hospitals in SA are also not great. My brother died last year due to being misdiagnosed in a private clinic.

 

[Mara]

@Peterthe1 At the time I had my surgery, I had only been a member for 12 years, and I was in a private hospital. If it is regarded as elective surgery, you will not be taken up in a government hospital, until they actually call to tell you there is a place for you. Their idea of elective and your idea of elective, are two hugely different things.

 

As for the 12 years contributions being able to pay for it.... definitely not, that would equate to $500 per month and we paid less than half that.

 

I am sure you comprehensively insure your motor vehicle... why? Is your car more important than your body? (Sorry this is very tongue in the cheek!)

[RYLC]

We also have private and would not be without it.  Both knee and hip replacements are considered elective on Medicare and the wait can be 12 months or more. I choose not to live with that sort of pain. So its not so much the money but how soon you are seen. If you have private cover you won't have to wait long.

[TakeItOnTheChin]

It all depends on the risk that you are willing to take. I don't think anyone could put away money for every eventuality. We opted for private medical, actually we had no choice being on a regional visa first up. When we switch to PR we will maintain it. My wife is due for hip surgery and therefore it seems we made the right choice.

[greggle]

Just a couple of tips for those looking for private medical cover ... do a comparison of the fund exclusions before signing up here: http://www.privatehealth.gov.au/ - Go to "compare policies".

They produce a number of standard information statements (for example this one: http://www.privatehealth.gov.au/dynamic/download.ashx?id=BUP/I28/NEIK10) that make it really easy to compare apples with apples. 

 

I was considering jumping to Qantas Assure Private Health when they dangled their Qantas Points carrot in front of me. But when I did a comparison of their exclusions compared to my existing BUPA, I found that even though the premium was much the same, the cover was quite significantly inferior.

 

Also, if you use your provider's network, then you can save a bit more (e.g. using a BUPA dentist or optometrist).

[TamTam]

The Netherlands has it's own version of Medicare and whilst the service is acceptable (good in some areas, terrible in others) it has made me 100% certain I want to take up Private Health Care once we move over. I say this especially because when you have children you want to be able to see a specialist asap.  

 

As for living with something that's not threatening whilst you wait on a list - how does that affect your quality of life and what is the risk of getting sicker whilst you wait. I think if you can afford private health care it's well well worth it!

[Karools]

There is a flaw in the "I'll just save a bit every month and not have private health" reasoning.

 

Sure, if nothing happens to you for the next 20 years you would have "wasted" a lot of money on private health premiums. And sure, you could possibly have saved enough money to actually pay for a serious accident. 

 

However, if I take out private health today and TOMORROW I am in an accudent in which me, my wife and kids are all badly hurt, we will be covered. From day 1. 

 

As I am not planning on having my family bubble-wrapped for the next 20 years (until I finally have enough of these damn expensive dollars) I will be taking out private health asap. (still covered by Discovery for the next couple of months if something major does happen)

 

 

[Riekie]

Got the shock of my life!  I need to get a CT guided injection and was quoted $992!  Medicare covers about $300 of that and because medicare pays some of it, the health fund pays NADA!  ZERO! ZILTCH! It's times like these that I wonder why we even bother with private health as my premium for one month is almost the amount of my out of pocket for just this one procedure! Private health funds are smiling all the way to the bank...

 

Will I cancel my private health?  Probably not but dang it, I'm not happy today Jan!

[ChrisH]

I've had some of the locals say that you should basically get the cheapest cheapest plan you can get your hands on, basically to avoid the medicare levy.

[new2forum]

 to be honest, maybe its my perception it seems that both medicare and private health seem to be inadequate compared to what medical aids of SA had to offer in the days of yore. Medicare is the bare minimum, if you're literally dying then medicare is for you. It seems emergencies are just for medicare and you get treated by medicare theres no private emergencies in the majority of suburbs .You pay $500 odd for an ambulance which is also scary. thats where private health supposedly comes in. when anathetesists and specialists have their own fees and you've been paying for over 10 years then you wonder why you paid $50K in premiums over the years with nothing to show for it, makes me wonder what the hell I was paying for.
i guess if an electrician and mechanic in australia gets paid $150+/hr, then medical specialists have to charge a very special rate!

[Riekie]

We were on the top cover of Discovery Health and between Medicare and the top cover we now have in Australia, it does not even come close to what we had with Discovery Health. So yes, as far as medical expenses go, you'll definitely be out of pocket quite a bit more in Australia, regardless of whether you have private health insurance or not.

[new2forum]

Well said. Medical aids in sa used to cover orthodontics and a myriad of other things that will be classified as extras. 

 

 

Oh well. That's what happens in a society with a free labour market. From paying $1500+ Per annum to keep a vehicle on the road ( registration, comprehensive insurance, ctp: aprox 300+600+500), the plumber and electrician charging $150 per hour, then of course medical services will be through the roof, not to mention that a medical or dental degree costa over $100k here.  You then add that to your cost of living and the margin that these insurance companies make, then you have one expensive society. 

[TamLovesRic]

Hi  Can I kind of turn the direction of this topic to find out....what DOES medicare cover? I am  very   kind of naive...

For example - If i need to see a GP for antibiotics? My yearly papsmear? Pre and post natal care? Kids vaccinations? If I break my leg and need xrays? My (future) kid get's bitten by one of those snakes I hear so much about? Oncology? Boob jobs (lol kidding)

 

 

...I think this will help me to make a better informed decision...

 

 

Edited March 14, 2018 by TamLovesRic

[RedPanda]

I'll tell you what I can, from our limited experience. Medicare covers the Bulk Billing price of a GP visit, so if you go to a clinic with Bulk Billing doctors medicare covers the whole cost. If you have a private local GP then medicare still rebates you their price, and you have to make up the difference (in our case it's about $60 to see the GP, medicare rebates about $30, roughly rounded). If you need blood tests or urine tests done and they can send it to bulk billing pathologists, it costs you nothing. If you get an IUD at a clinic you need to pay for the device itself, which you can buy from a pharmacy, I think you need a script? But the appointment costs you nothing. If you need to see a specialist, you can either wait for the 'free option' or pay to see a private specialist asap. To my understanding broken bones and snakebite will be covered by medicare, boob job not so much  If you need medicine it depends on the type, sometimes medicare rebates you, in our experience mostly you need to buy it yourself.

I'll let other people fill in the rest or add on. Like I said, we haven't done too much here yet.

[Sunnyskies]

It can be tricky to work out what is Medicare, what is private health and what is out your own pocket.

 

- if you go to the GP Medicare covers a portion of the bill, unless the GP bulk bills.  The rest of the bill comes out of your pocket - no private health top up because it is covered by medicare.

- if you go to a specialist then the same applies as for a GP, but you probably have to pay more out of your own pocket.  Also you have to go to a GP to get a referral to a specialist.

- if you have a medical emergency and go to a public hospital then you are covered by Medicare and you don't pay.  They may ask for your private health card and there is a bit of a debate as to whether you should hand it over.  It won't cost you anything, but effectively private health is called on to make a payment to the public system and so your private health fees are being used for a public service which you are already paying for with your Medicare levy - haven't worked out what my position is, I have handed over the private health card but have to question in my head if that is right.

- if you need treatment for something that is not an emergency, then on the public system you will probably land up on a waiting list.  But when treated you won't pay.

- if you need treatment for something that is not an emergency and have private health cover, then you can be treated immediately but you will have to make a co-payment and you need to be very careful that you understand what will be an out of pocket expense, as private only covers so much of anything.

- if you need an x-ray, CT Scan or MRI, it is more likely than not that Medicare will pay and you pay nothing - you will need a referral letter from your GP.  If you need an x-ray out of normal hours and go to a private facility, you land up making a co-payment and your health fund may fund a portion of the cost.

- if you need medicine and the medicine is on the PBS, then it depends, if it is one of a specified number of life saving drugs there is no co-payment, if it is a listed drug on the PBS you make a co-payment, if it not listed you have to pay for it yourself but can perhaps make a claim against your private health cover to be reimbursed - I still find this one a bit weird and a bit hit and miss as to what I will get back from private health cover if anything - you have to make the payment as the pharmacies will not make a claim against your private health cover for you.

- if you need optical, then medicare will pay for the eye exam, private will make a payment towards the cost of frames and lenses and you pay the balance.  What you have to pay in is very dependent on the level of cover you have from your private health fund.

- if you need dental, then there is only medicare for certain children and for certain dental.  Generally medicare doesn't cover dental at all, but private health will, but you will need to make a co-payment.

- if you need contraception, you pay for the device (like medicine at the pharmacy - you also have to get the device from the pharmacy) and the visit to the doctor is treated like any other visit to the doctor.

- if you need a psychologist, then I think it depends on whether you qualify for mental health from the state as to whether you have to pay or whether medicare will cover - I think that most people have to pay themselves and may get a contribution from their private health.

- physio - no medicare, private health will make a payment if you have the right level of cover and you will have to pay the balance.  Private health will be capped for the year.

- naturopath - no medicare, level of cover from private health depends on your level of cover and they don't pay for vitamins etc.

- boob jobs, tummy tucks, face lifts, botox, fillers - all out of your own pocket - no assistance from anyone.

 

 

[tcmiller]

Some medication is not covered by medicare because it is simply too cheap. Last year I had some anti inflammatory prescribed by doctor and had to cough up the $10 out of pocket because it wasn't covered by Medicare. Granted $10 isn't going to bankrupt anyone but it is the principle.

[new2forum]

medicare is a far cry from medical aid in sa. thats the biggest difference