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Health Insurance and the Medicare Benefits Schedule

March 15th, 2012 0 comments
Health Insurance Australia

Medicare is Australia’s public health system which provides affordable medical services for citizens and permanent residents. The 1.5% Medicare Levy you pay as part of your taxes financially supports the whole scheme. The program fully subsidizes treatment in a public hospital. It can also cover part of doctors’ fees and medical tests.

The Medicare Benefits Schedule (MBS) is the public document that outlines all these points and their accompanying costs. This document is also often used as a basis for most types of private health insurance coverage.

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Benefits of Medicare

The MBS presents the hospital and medical benefits that can be received through Medicare. The Pharmaceutical Benefits Scheme (PBS) is actually a separate and older health care policy. But it has been integrated with Medicare and forms the third set of benefits.

Under Medicare, you are treated as a public patient. As such it is the public hospital that assigns your doctor. You may not also have a say on when you’ll be scheduled for admission. While these conditions may be limiting, the major advantage here is that your hospital treatment will be free of charge.

Medicare can actually cover 100% of a general practitioner’s consultation fees and 85% of those of a specialist. Take note however that this only pertains to what is set in the MBS. It is entirely possible that a doctor may actually charge a higher rate. Besides this, tests such as x-rays or a complete blood count are among the program’s medical benefits. Also included are specified surgical procedures done by doctors and dentists.

Prescription medicine is also partly subsidized by Medicare. It is the PBS that outlines which percentages of the costs are covered. Usually this would depend on the type of medicine. Just like in the MBS, there is an upper limit to what the PBS can cover.

Private health insurance and Medicare

The other half of the country’s health care system is private health insurance. This is provided in Australia by various private health funds. You’ll notice as you compare health insurance products that the coverage extends further than what the Medicare Benefits Schedule covers.

There are, for example, gap coverage schemes for out of hospital treatments. As mentioned earlier, doctors may charge higher than the fees set in the MBS. The gap in this case is the difference between the actual charge and the maximum limit that Medicare provides on the MBS. Private health insurance may help to cover that difference.

General treatment cover is where private health effectively supplements Medicare. This set of coverage types is sometimes called extras cover because they handle some of the Medicare exclusions. Psychiatric treatment is one example. Ambulance cover is another service that private health insurance can provide which is not part of the MBS.

Some people choose to rely solely on the Medicare program. Others who can afford it go with private health funds. It is not uncommon for people to actually combine both health schemes. The important thing to consider here is that coverage can overlap. Thus it is highly recommended that you check the latest version of the MBS first when you do a private health insurance comparison.

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