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Healthcare 101: What’s Covered and What’s Not

July 18th, 2011 0 comments

Healthcare in Australia is a fairly complex system and is provided by both the private sector and government institutions.  Medicare is a health insurance system setup throughout the country and is funded through income taxes.  In addition to Medicare, most citizens choose to take out a private policy as well to cover what Medicare does not.  The first step in understanding coverage is to differentiate what is covered by the government and by private financing.

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In 1984 the Government introduced a comprehensive health care system called Medicare.  Medicare Australia is available to all citizens and permanent residents of Australia.  Listed below is an overview of what Medicare covers

  • No charge for treatment as a public patient in a public hospital
  • Free or subsidized treatment as a patient by general practice doctors
  • Other subsidies on some treatments by certain specialists, dentists, optometrists, etc…

Medicare ensures that any resident can walk into a hospital and be treated without bias by specialists and doctors nominated by Medicare.  If you are a private patient in a public or private hospital you may choose your own doctor, however Medicare will only cover 75 percent of the charges.  As far as seeing a general practitioner, some will bill the entire visit to Medicare where others may charge more than what Medicare covers, this is called the “Medicare Gap”.  In these instances you will be required to pay the balance. However low-income families may be able to recover some or all of these gap payments.  Medicare will also not cover the full charge of any medicines prescribed by your general practitioner.

Medicare is set up to cover emergencies, however the Australian government urges and even provides incentives for citizens to get additional private coverage.  The private health system operates in a unique system, where premiums do not change due to your current health, medical history or age.  To counteract this, waiting periods are put into place, specifically for pre-existing conditions.  Essentially you must wait a predetermined amount of time before you can file a claim. This time frame can be up to 12 months.  Some private insurance companies are run for profit while others are non-profit.  There are two basic types of private care, which are Ancillary Coverage and Hospital Coverage.

Ancillary Coverage

This policy is also referred to as “essentials” or “extras” and covers some treatments that are not covered by Medicare which include dental, podiatry, optical, etc…  Like any other insurance, these plans offer different levels of coverage at different prices depending on what meets your needs.  It should be noted that with an ancillary plan there are maximum levels of coverage as well and annual claim limits.

Hospital Coverage

Private hospital coverage gives you more freedom and allows you to decide when procedures are performed, which hospital you go to, and even what doctor to have.  You should not assume that you will be 100 percent covered even if you have a private plan.  As mentioned before with the “Medicare Gap”, if your hospital or doctor charges more than the scheduled fee you will be stuck with the balance which is referred to as the “Hospital Gap”.  Some plans will provide additional gap coverage so it is important to find out if this applies to you beforehand.

Australia enjoys a top quality health care system that has been ranked as one of the best in the world.  The balance between Medicare and private insurance has allowed for more options but have also made the system much more complex.  You should contact several care providers before making a decision.  If you are still overwhelmed or do not want to spend a long time comparing different policies you can always hire a healthcare advisor to assist in finding the best option for you.

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