Health

Medicare

WHAT IS MEDICARE ?

Leaving the familiar and moving to a new country represents a very stressful event in most people’s lives, which can often result in illness. Understanding how the Australian Health System functions can help you to take better care of your and your family’s health.

Australia’s national health care system, called MEDICARE is considered one of the best in the world. Medicare is administered by the Health Insurance Commission and takes care of the health care needs of all Australian residents.

ARE YOU ELIGIBLE?

You are eligible for Medicare if:

• You reside in Australia
• Are an Australian or New Zealand citizen, or
• Are a permanent resident of Australia
• Have already applied for certain permanent resident visas and you:
  • Have been granted a valid visa and have permission to live and work in Australia
  • Have been granted a valid visa and your spouse, child or parent is an Australian citizen
  • Have been granted a valid visa and your spouse, child or parent is a permanent resident of Australia

When do you not qualify:

• If you hold a temporary residents visa and have not yet applied for permanent residence.
• If you hold a temporary prospective marriage visa (fiancée subclass 300) you are not eligible for Medicare until you become a permanent resident.
• If you have a current parent visa being considered you may not be eligible for Medicare.

WHAT IS COVERED BY MEDICARE ?

Hospital Services

Should you require hospitalisation in Australia, you can choose to be admitted to a public (government funded) hospital, or a private hospital.

If you are admitted as a Medicare patient in a public hospital, care and treatment will be covered in full by Medicare. The doctors and specialists attending to you will be nominated by the hospital.

If you are admitted as a private patient in a private or public hospital you can choose which doctors will treat you. Medicare will pay 75 per cent of the government determined Schedule fee for services. Private health insurance will cover most of the outstanding fees. (See section under private health insurance)

Other Services

Medicare also assists with the payment of a number of medical treatments administered out of a hospital. The payment you would be entitled to under Medicare equals 85 percent of the Schedule fee. The schedule fee for services is set by the Commonwealth Government. Health practitioners can however choose to charge more than the set Schedule Fee.

• Other services covered by Medicare include the following:
• Consultation fees from doctors and specialists
• Eye tests performed by an optometrists
• Blood tests and x-rays
• Most surgical and therapeutic procedures performed by doctors
• Some surgical procedures performed by an approved dentist

  Note: Medicare may not pay for a visit to a specialist if you have not received a referral from a General Practitioner.

Pharmaceutical Benefit Scheme (PBS)

The Pharmaceutical Benefit Scheme was established to provide Australian residents with medicines at reasonable prices. Under the PBS scheme, the government pays a subsidy to the pharmacy, which reduces the cost of the medicine to the individual.

Only residents who qualify for Medicare can benefit from PBS. (See section under Medicare Eligibility)

Note: PBS medicines need to be prescribed by a doctor. Not all medicines are subsidised by PBS.

WHAT IS NOT COVERED BY MEDICARE ?

Some examples of what Medicare does not cover:

• Most dental services
• Ambulance services
• Home nursing
• Physiotherapy
• Occupational therapy
• Speech therapy
• Podiatry
• Chiropractic services
• Acupuncture
• Cosmetic surgery
• Hearing aids and other appliances
• Glasses and contact lenses
• Prostheses
• Medication not covered by PBS ( see above for description of PBS)
• Cosmetic surgery
• Compensation claims
• Medical services which are not necessary

Note: Private Health Insurance is available which will cover most of the above. (See section on Private Health Insurance)

HOW TO ENROL?

Steps:

1. Newly arrived immigrants should wait one week before applying in person at a Medicare office, this will allow the Department of Immigration and Multicultural Affairs enough time to notify Medicare of your visa details.

2. A passport or valid travel document needs to be produced for each person when applying for Medicare.

3. Provided that you are eligible to receive Medicare, you will be issues with a Medicare card number, which you can use immediately if required

4. You will receive your Medicare card via mail approximately two weeks later

5. You need to present your Medicare card when visiting a doctor, going into hospital and purchasing prescription medicine

6. Medicare cards are automatically renewed every year

HOW TO CLAIM?

There are a number of different ways that you can claim from Medicare:

Direct Billing

Some doctors accept the Medicare benefit as a full payment and bills Medicare directly. After your consultation you will be given a form to sign. This form of billing is also referred to as Bulk Billing.

Where doctors charge more than the Medicare benefit, you will be issued with an account, which you need to pay then claim your benefit from Medicare.

Claiming by mail

You can submit a claim form (obtainable from Medicare) plus the original account to a Medicare office. If you have settled the account, Medicare can pay the amount owing to you directly into your bank account.

If you have not settled the account, Medicare will send you a cheque payable to the doctor, which you then need to forward.

Claiming in person

If you have paid your account in full and wish to receive a cash benefit, you need to go to a Medicare Office and present the account/receipt and your Medicare card at the counter. You do not need to fill in a claim form

A claim form is however required if you want the benefit paid into your bank account, would like a cheque issued, are placing your claim into a claim box at a Medicare office, or collecting the benefit on behalf of someone else.

Claiming by telephone

If you do not live in a capital city, you can call Medicare and give your claim details. You then need to post your receipt or account to Medicare. You are not required to complete a claim form.

Medicare easyclaim

A number of pharmacies throughout Australia have self-service Medicare claiming booths installed in the pharmacy. Medicare benefit payments can be paid by EFTor cheque

HOW DO YOU PAY FOR MEDICARE?

Medicare Levy

Medicare is charged at 1.5 percent of taxable income.

Medicare Levy Surcharge

Individuals and families that earn a higher income and do not have private patient hospital cover pay a surcharge of an additional 1 percent of taxable income. The income levels for the 2002/2003 tax year are:

• A single person without any dependent children with a taxable income greater than $50,000
• A family, including a single parent with a combined taxable income greater than $100,000. This amount increases by $1,500 for each dependant child after the first.

30% Government Rebate

Anyone who is eligible for Medicare and belongs to a Private Health Insurance Fund is eligible for the 30% Government Rebate on premiums paid toward their Private Health Insurance. It does not matter how much you earn.