Australia has a universal healthcare system that the federal government finances. All of Australia’s residents have access to the subsidized healthcare known as Medicare. The government-run Medicare plan offers generous coverage that takes care of a large proportion of basic costs. Australia’s public healthcare is primarily funded through a tax or “Medicare levy” placed on citizens as part of their basic tax payments.
Medicare covers treatment at all public hospitals, GP visits, and 85 percent of the cost for a specialist visit. Citizens using Medicare also have access to other services, including eye tests, some dental costs, and limited prescription drug costs. With Medicare, however, some services such as ambulance transport are not covered.
While Medicare is available to all residents, almost half of all Australians have private insurance. With private health funds, you’re able to select your doctor and seek treatment at a private hospital. Private health funds can also be purchased to supplement Medicare coverage and help with costs such as specialized treatments. For women having a baby, private health insurance can allow them to give birth in a private room at a private hospital.
Australians seeking private health insurance can purchase coverage from three main categories: hospital cover, general cover, and ambulance cover. Let’s take a look at private health funds in Australia.
Hospital cover gives patients the ability to choose their own doctor and hospital. It will pay for any private doctor’s fees and hospital expenses. Fees such as hospital accommodation and surgery fees are covered whether you are being treated in a private hospital or as a private patient in a public hospital.
Hospital cover pays for the majority of medical services listed on the Medicare Benefits Schedule. The downside to public healthcare is that there can be long wait times in some cases. Hospital cover allows patients to avoid long waits at public hospitals and be treated at private institutions.
General cover, also referred to as “extras” cover, refers to private health funds covering a wide range of health services. The services that are covered vary and depend on the specific policy. General coverages can include things like dental treatment, hearing aids, and glasses. General insurance policies typically provide coverage up to certain limits set by the insurer.
Most general cover policies are offered in three tiers. A comprehensive plan covers general and major dental, endodontic, orthodontic, non-PBS pharmaceuticals, optical, psychology, physiotherapy, and podiatry. The next tier or medium plan covers dental and endodontic treatment. Additionally, a medium plan will cover any five of the other offerings of a comprehensive plan, including hearing aids. The basic level will cover all other policies.
In general, the federal Medicare plan doesn’t provide cover for ambulance services. In a few states and territories, ambulance transportation is covered locally with a subsidy. For the most part, however, a private health insurance plan is needed to pay for transportation. This type of health insurance coverage will pay for the cost of an ambulance ride, but some policies will not pay the “call out” charge. If medics are called to a scene but do not transport you to the hospital, they may charge a “call out” fee. Some plans cover this fee while others do not.
To find the right coverages for your needs, you should evaluate the monthly premium and coverages offered. Additionally, you’ll need to consider your healthcare needs. As an example, many health insurance companies impose a 12 month waiting period for birth-related services. If you plan to start a family, you will need to plan for some of these restrictions. With some research and considerations, you can find the right health cover for your family.
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