Medicare, PHI, PBS, NDIS Flashcards
What is Medicare?
Medicare is Australia’s universal health insurance scheme that provides free or subsidized medical treatment by the government to all Australian citizens, permanent residents and those from countries with a reciprocal agreement rg, New Zealand, Ireland, UK and Sweden.
What services does medicare cover?
GP consultations
X-rays and pathology
Eye tests performed by optometrists
Subsidized treatment as a patient in a private hospital
Free treatment as a patient in a public hospital
What services doesn’t medicare cover?
Anything that is not considered ‘clinically necessary’ such as cosmetic surgery
Dental care
Home nursing
Ambulance services
Allied services eg. physiotherapy and chiropractors (unless referred by a GP)
Most alternative therapies eg. natural medicine and acupuncture (unless referred by a GP)
Medicare levy
2% of taxable income for most taxpayers (except those on low incomes)
Medicare levy surcharge
an additional tax (1-1.5%)paid by high income earners who do not have private health insurance. The amount of tax paid depends on income (income tested)
General income tax
the medicare levy and medicare levy surcharge do not raise enough funds, so money from general income tax is also contributed towards medicare.
What is the medicare safety net?
Medicare safety net provides extra financial assistance for those that incur significant copayment costs for medicare services in a 12 month period. One co-payments reaches a threshold ($700 for a single, $1000 for a couple) services become cheaper for the rest of the year.
What is bulk billing?
Bulk billing is when the service provider only charges the schedule fee for the service, as outlined by the government. The schedule fee is $37.05. When bulk billing occurs the patient doesn’t make any contribution to the payment as medicare will cover the full cost.
Advantages of medicare:
Free to join
Choice of doctor for out-of-hospital services
Available to all Austrlians
The medicare safety net provides extra cover for vulnerable individuals/families
Disadvantages of medicare:
No choice of doctor for in-hospital services
Long waiting lists
May still have to pay a ‘gap’ fee
What is PBS?
The pharmaceutical benefits scheme (PBS) gives all Australian residents and eligible overseas visitors access to life saving prescription medicine in a way that is affordable, reliable and timely.
The cost of listed prescription medicine is subsidized making it more affordable for all Austrlians.
What is the PBS safety net?
The PBS safety net assists individuals and families if their out of pocket expenditure on PBS listed medicines exceed $1550.70 in a 12 month period. The medication will then be subsidized for the rest of the calendar year.
What is private health insurance?
Private health insurance is a type of medical insurance that can be taken out in addition to medicare and is optional. Users pay a premium to join a scheme. It provides members with greater choice with regards to their health care.
What services does private health insurance cover?
Will cover some or all of the extra costs associated with private hospitals (Medicare contributes 75% of what it would pay if the treatment was in a public hospital)
Can opt for extras (cover for services not covered by Medicare such as dental and physiotherapy)
Extras can also cover ambulance transport and alternative therapies
Lifetime health cover
designed to encourage people to take out hopital insurance earlier in life and to maintain their cover. Those who take out private health insurance over the age of 30 pay an extra 2% on their premiums for every year they are aged over 30 rg. If you take out hospital cover at age 40 you will pay 20% more than someone who first took out hospital cover at age 30.
