(Note: This post was originally published at The Sydney Life, an expat blog by Samantha Binding.)
I’m not going to lie, the medical system in Australia has reduced me to tears on a couple of occasions. Coming from the UK, where everything is free at point of care, it’s been a shock to the system to have to pay-as-you-use, and I now need the emotional support of a (large) bar of chocolate to browse insurance sites and book appointments. I started to write the following glossary to help me navigate the system, then realised that I couldn’t find anything similar online, with all the new concepts and terminology listed in one place.
Disclaimer: Firstly, I have no qualifications to be offering advice, and you should always make your own decision based on your personal circumstances. Secondly, I’m maritally single with no dependants, from the UK, hold a skilled worker 457 visa, and it is February 2016 when I write this. So while citizens of other countries are eligible for Reciprocal Medicare Cards, the following is all based on my experience as a Brit from Jun 2015 – Feb 2016. I don’t know whether your nationality affects what’s covered.
The main thing to get your head around: Australian healthcare isn’t free; you will have to pay for some things, and they can be really expensive. The Medicare system subsidises some services (eg appointments, tests), but not all treatments and medicines are covered, and you may not get 100% of the covered rate back.
First things first
Being a British expat makes you eligible to apply for a Reciprocal Medicare Card. With one of these you’ll have access to emergency medical treatment at public hospitals as a public patient, and the cost will be covered by the government. Their system is called Medicare, and as far as money goes, it’s very different to the NHS. If you go to a public or private hospital as a private patient, you’re eligible to apply for a refund of the Medicare rate, but you need to pay for the remainder yourself. Likewise, it doesn’t cover all treatments, so make sure you check whether yours is covered. Many people take out health insurance to cover the difference, which I’ll discuss in a later post.
Apply for a Medicare card asap, and when it arrives, set up your online account at https://my.gov.au and register your bank account details. This will make claiming at a later date much easier.
The following is taken from the http://humanservices.gov.au website:
As a resident of one of these countries, the United Kingdom, Sweden, the Netherlands, Finland, Belgium, Norway, Slovenia, Malta and Italy, you are entitled to the following health or injury treatments while you are in Australia:
- free treatment as a public in-patient or out-patient in a public hospital
- subsidised medicine under the Pharmaceutical Benefits Scheme (PBS)
- Medicare benefits for out-of-hospital treatment provided by a doctor
Residents of the Republic of Ireland and New Zealand are entitled to:
- services as a public patient in a public hospital (including outpatient services) for medically necessary treatment medicines available on prescription which are subsidised under the Pharmaceutical Benefits Scheme (PBS), at the general rate
Medicare Benefits Schedule (MBS) – a list of services that are subsidised by Medicare. Each service on the list (register) is given an item number, and has an associated amount – called the MBS rate. Usually you will be reimbursed 85% of the MBS rate for outpatient services (eg doctors, consultation with specialist, blood tests), and 75% for inpatient services (admitted to a public hospital for treatment as a public patient).
Gap amount – this is sometimes used to refer to the difference between what you pay to the doctor and what you get reimbursed by Medicare. These are your “out-of-pocket” expenses (once you’ve claimed back the MBS rate for your treatments) if you have no insurance. The annual gap amount you pay for out-of-hospital services listed on the MBS schedule is capped by the Medicare Safety Net scheme.
Bulk billing – this is the term for doctors’ appointments and treatments where the fee charged is equal to that listed on the Medicare Benefits Schedule. If a doctor bulk bills, you won’t be out-of-pocket at all for a first consultation. If you are bulk billed, your healthcare provider will usually contact Medicare directly and claim this amount on your behalf. If they don’t do this or you are not bulk billed, you pay for your treatment at the MBS rate or higher, and then claim back the MBS cost of the treatment using the Medicare app or at a Medicare centre.
To find local bulk billing practices, search online, then ring and check. This has been surprisingly tricky. The best website I’ve found for searching for clinics is www.healthengine.com.au, which also lets you book online. Note that some places may offer bulk billing for Medicare Card holders, but charge more for Reciprocal Medicare Card holders, so if it’s not stated explicitly then call and ask before booking!
Mixed billing (or some variation) – Private doctors and hospitals charge more than the MBS rate. Ask when booking.
In my experience on the Lower North Shore in Sydney, bulk billing appointments are available at most places for children and concession card holders (available to people on low income, or senior citizens), but adults will usually have to pay more than the MBS rate for an appointment.
Medicare Safety Net – The Medicare safety net caps the amount you pay over and above the MBS rate each year, so that if you need to see the doctor lots, or have many tests, your costs won’t sky-rocket. Your safety net is calculated based on your personal circumstances, and can be viewed when you log into your myGov Medicare account.
Pharmaceutical Benefits Statement (PBS) rate – some medicines are subsidised by the government, with the price varying depending on the drug and brand. Not all medicines are covered, you can check which ones are by searching the PBS database, which is available online and can be searched by the medical condition, brand name of the drug, or name of the active ingredients. If you present your Reciprocal Medicare card at a pharmacy when you buy a prescription, you should be offered the reduced PBS rate, which is money you have to part with. If not, you can claim back the excess you paid (above the PBS rate) at a Medicare centre. You will need an official pharmacy receipt to do this, so ask for one at the time of purchase.
Some health insurance providers cover prescription medicines. Check whether they only cover PBS medicines up to the PBS rate or, whether they cover the part or full cost of non-PBS medicines too.
Medicare Levy – Australian residents pay 2% of their taxable income to fund the Medicare program.
Medicare Levy exemption – if you are a low earner, you may be eligible for an exemption from the levy or a reduction in the amount you pay.
Medicare Levy surcharge – if you are a high earner and don’t have private health insurance, you may have to pay an additional surcharge. The surcharge varies between 1-1.5% of your taxable income on top of the 2% that everyone pays. If you take out private health insurance, it needs to meet certain requirements to make you eligible to avoid the levy. Note that some types of insurance including Overseas Visitor Cover (which you’ll have if you came over with a 457 Visa), do not count.
Private Health Insurance rebate – If you take out private health insurance in Australia, you can claim a rebate from the government to partially cover the cost of your premiums. The amount you can claim varies with how much you earn, and how old you are. Note that this rebate can’t be claimed for Overseas Visitor Cover.
Out of pocket expenses
To cover the rest of the cost of treatment, you may want to take out private health insurance. There are insurance policies such as Overseas Visitor Cover for foreigners – this might be part of your visa requirements – or there are policies designed for residents. There are many providers, and iSelect is meant to be an unbiased comparison agency who will call you back to discuss your individual circumstances over the phone if you like.
Private health insurance can cover different items at different rates though, and if you don’t know the jargon you might get caught out like I was, so make sure you check exactly what they’re covering!
For example, “up to the MBS rate” – Medicare doesn’t always pay you the MBS rate, you might only get 85% or 75% of the listed rate. An insurance company might top this up to the MBS advertised rate, so you still have to pay for anything above that.
“50%, 80%, 100% of the cost” – this is commonly seen for add-ons such as dental treatment or glasses, which aren’t covered by Medicare. The insurance company may offer to partially cover the cost of some things.
I hope that helps a little, as I said, I have no qualifications to offer advice and that’s all knowledge that’s been gained in dribs and drabs over the last year, then read up on for this article. Even then I was finding new things. Good luck!
More about the author Samantha and why she moved to Sydney.
“Last May, I moved to Sydney from Oxford in the UK after (finally) finishing 7 and a half years of university. I was following my ideal job, taking up a role as a Postdoctoral Researcher in the new chemistry lab at a university where I work on improving the recyclability of molecular catalysts for important reactions. (Niche, but that’s my thing.) I’d been searching for something pretty spectacular to make up for the fact I was having to leave behind such a beautiful, incredible city and the friends there, and so far Sydney has certainly lived up to my expectations!”
Be sure to check out Samantha’s blog, The Sydney Life.