First, let’s look at what Australia’s Medicare system is all about. Medicare, the public health system provided by the Australian Government and funded in part by a small levy of 2 per cent of an individual’s taxable income.
Medicare is a universal health care system that subsidises and, in some cases, offers free healthcare to residents and some other eligible people. Medicare was initiated and called Medibank by the Whitlam Government in 1975 after the Liberal Opposition led by Malcolm Fraser had rejected it.
Those with a Medicare card receive a rebate that covers a large part of their medical treatment or the full cost of doctor’s visits (if the practitioner bulk bills), also hospital treatment, pharmaceuticals and psychological services.
Medicare covers many health care costs and is the foundation of Australia’s health care system, with most residents eligible for benefits. If you are an Australian citizen, you can apply for enrolment in the Medicare system, and you will receive a Medicare card. You must meet all the criteria to be eligible for instance you must be either:
- A citizen of Australia
- A citizen of New Zealand
- A citizen of Norfolk Island
- A citizen of Christmas Island
- A citizen of Cocos (Keeling) Islands
- A citizen of Lord Howe Island
- A permanent resident in Australia
- A permanent resident applicant, and
- If a ministerial order covers you
You may also be permitted to enrol for Medicare if you’re visiting Australia from a country which has a Reciprocal Health Care Agreement(1). And importantly, only treatments provided by professional, appropriate, registered medical practitioners are covered.
What Does Medicare Cover?
Some of the many treatments covered by Medicare include:
- Diagnostic Testing. This includes MRIs and X-rays, plus diagnostic tests considered necessary, for example, an optical test for a pilot’s licence is not eligible, but optical tests to diagnose cataracts are covered.
- Anaesthetics. Consultations with an anaesthetist, local and general anaesthetics and specialist anaesthetic requirements for complex surgery or health issues like heart disease and drug allergies.
- Surgery. In public hospitals, the fees for operating theatres, necessary surgical consultations and surgery (elective cosmetic surgery is not covered but surgery to remove a tumour, e.g. is covered by Medicare.
- Dental. Only in some limited situations, Medicare will cover dental treatment. These can include visits to hospital emergency wards, pain, dental work that’s crucial for other kinds of surgery covered by Medicare, and dental work for children from low-income families.
- Medication. Any pharmaceuticals prescribed by an approved and licensed practitioner and which are covered by the government’s Pharmaceutical Benefits Scheme (PBS). The PBS subsidises many medicines dispensed by pharmacists.
More About Surgery
You can find a detailed list on the Medicare Benefits Schedule (MBS) 2019(2) of the surgical services Medicare covers. Since surgeries are done mainly in hospitals, Medicare will cover 100 per cent of all costs that are related to that surgery if it is carried out in a public hospital.
This includes diagnostics and anaesthetics, and all fees. If you belong to a private health insurance fund, and you have your surgery in a private hospital, Medicare pays for 75 per cent of the anaesthesia, diagnostic tests and the surgery at the public rate.
Your private health insurance will cover some of the rest, and you will have to pay your out-of-pocket expenses, which include 100 per cent of any fees.
If you need to visit a doctor outside a public hospital, your Medicare rebate will be 100 per cent of the Medicare Benefits Schedule (MBS) fee for a doctor, and 85 per cent if the services were provided by a specialist. If your doctor bulk bills, you will pay nothing.
References:
- https://www.humanservices.gov.au/individuals/services/medicare/reciprocal-health-care-agreements
- http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Downloads-201907
Author’s Bio
Alex Morrison has worked with a range of businesses giving him an in depth understanding of many different industries including home improvement, financial support and health care. He has used his knowledge and experience to work for clients as diverse as Adroit Insurance, Cosh Living and Me Bank to help them reach their business goals.
