Medicare

 

The Australian Government’s funding contributions include a universal public health insurance scheme, Medicare. Medicare was introduced in 1984 to provide free or subsidised treatment by health professionals such as doctors, specialists and optometrists (Department of Human Services 2013b).

 

The Medicare system has 3 parts: hospital, medical and pharmaceutical.

 

The major elements of Medicare include free treatment for public patients in public hospitals, the payment of benefits or rebates for professional health services listed on the Medicare Benefits Schedule, and subsidisation of the costs of a wide range of prescription medicines under the Pharmaceutical Benefits Scheme (Department of Human Services 2013b).

A person can have Medicare cover only, or a combination of Medicare and private health insurance coverage.

The government-funded schemes and arrangements aim to give all Australians access to adequate, affordable health care, irrespective of their personal circumstances. The schemes are supplemented by social welfare arrangements, such as smaller out-of-pocket costs and more generous safety nets for those who receive certain income-support payments.

Your Medicare card holds your Medicare number, which is required to claim from Medicare and receive Pharmaceutical Benefits Scheme medicines.

 

Eligibility

People who reside in Australia are eligible to enrol in Medicare if they:

  • Hold Australian citizenship
  • Have been issued with a permanent visa to live in Australia
  • Hold New Zealand citizenship
  • Have applied for a permanent visa

How to Apply

You first need to Complete a Medicare Enrolment Application form online

Supporting documents

To enrol for Medicare, you will need to show us an original or a certified copy of your birth certificate or passport to confirm your identity. As a migrant.  Additionally, you need to show your visa status to prove your eligibility.

Submit your form

Submit your completed form and supporting documents at a service centre.  

Enrolment outcome

Once your application has been submitted and processed:

  • you’ll be issued a Medicare number which you can use straight away
  • you can register for a Medicare online account through myGovand use the Express Plus Medicare app to get a digital copy of your Medicare card
  • your physical Medicare card will generally be issued within 3-4 weeks

For more details visit: Australian Department of Human Services

 

S​ydney – A Migrant’s Essential City Guide

Check out latest book, packed with content aimed to help migrant’s make the move to Sydney and settle down with ease

Medicare and hospital treatment

Medicare offers free treatment and accommodation as a public patient in a public hospital, by a doctor appointed by the hospital

It usually covers:

  • free or subsidised treatment by health professionals such as doctors, specialists, optometrists and in specific circumstances dentists and other allied health practitioners and accommodation as a public patient in a public hospital
  • 75 percent of the Medicare Schedule fee for services and procedures if you are a private patient in a public or private hospital (does not include hospital accommodation and items such as theatre fees and medicines)
  • some health-care services in certain countries (Department of Human Services 2014).
  • A public patient cannot choose their own doctor and may not have a choice about when they are admitted to hospital for elective procedures.

Medicare benefits are based on a schedule of fees (the Medicare Benefits Schedule, or MBS), which are set by the Australian Government after discussion with the medical profession. Practitioners are not required to adhere to the schedule (except for optometry) and can charge more than the scheduled fee. In these instances the patient is required to pay the extra amount, often called a ‘gap‘ payment (ABS 2013; Queensland Government 2013).

Medicare does not cover:

  • medical and hospital services which are not clinically necessary, or surgery solely for cosmetic reasons
  • ambulance services.

Medicare and medical services

When a person visits a doctor outside a hospital, Medicare will reimburse 100% of the MBS fee for a general practitioner and 85% of the MBS fee for a specialist. If the doctor bills Medicare directly (bulk-billing), the patient will not have to pay anything . If the doctor charges more than the MBS fee, the patient has to pay the difference.

Medical costs that Medicare does not cover include:

  • ambulance service
  • most dental examinations and treatment
  • most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry and psychology services
  • acupuncture (unless part of a doctor’s consultation)
  • glasses and contact lenses
  • hearing aids and other appliances
  • home nursing
  • Medicare and prescription pharmaceuticals

Medicare also subsidises a wide range of prescription pharmaceuticals under the Pharmaceutical Benefits Scheme (PBS). Under the PBS, Australians pay only part of the cost of most prescription medicines bought at pharmacies. The rest of the cost is covered by the PBS. The amount paid by the patient varies, up to a maximum of $36.10 for general patients and $5.90 for those with a concession card (Department of Health 2013d).

If a medicine is not listed under the PBS schedule, the consumer has to pay the full price as a private prescription. Non-PBS medicines are not subsidised by the Australian Government (Department of Health 2013b). However, pharmaceuticals provided in public hospitals are generally provided to public patients for free, with the cost covered by state and territory governments.

Private health insurance

Private health insurance is available for those who wish to fully or partly cover the costs of being admitted to hospital as a private patient and/or the costs of other ancillary health services (Private Healthcare Australia 2013). Part of the cost of being admitted as a private patient is also covered by the Australian Government through the MBS and PBS.

Private health insurance is not compulsory, and people who opt to buy private health insurance can mix and match the levels and type of cover to suit their individual circumstances. Private insurance also offers cover for some or all of the costs of a range of other items or services not covered by Medicare, such as ambulance services, dental services, prescription glasses, and physiotherapy. Private patients have more control in choosing their treating doctor in Private health insurance is available for those who wish to fully or partly cover the costs of being admitted to hospital as a private patient and/or the costs of other ancillary health services.

Part of the cost of being admitted as a private patient is also covered by the Australian Government through the MBS and PBS. Private health insurance is not compulsory, and people who opt to buy private health insurance can mix and match the levels and type of cover to suit their individual circumstances. Private insurance also offers cover for some or all of the costs of a range of other items or services not covered by Medicare, such as ambulance services, dental services, prescription glasses, and physiotherapy. Private patients have more control in choosing their treating doctor in

Private patients have more control in choosing their treating doctor in hospital and may be able to reduce their waiting time for elective surgery by having treatment in a private hospital. A person can choose to be treated as a public patient in a public hospital, even if they have private health insurance.

According to the Private Health Insurance Administration Council, at June 2013, 10.8 million Australians (47% of the population) had some form of private hospital cover and 12.7 million (55%) had some form of general treatment cover (Private Health Insurance Administration Council 2013).

 

Do you want to see your name here? Did you have an article you would like to share? If you would like to submit an article for use on this website, please click the button below.

0 Comments

Submit a Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.