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Medicare is Australia’s universal health insurance scheme. It aims to provide access to subsidised healthcare.
REMEMBER: Don't write that Medicare provides free healthcare. This is a common mistake students make.
Out of Hospital Expenses
Out of Hospital Expenses
Consultation fees for doctors (GP’s)
Specialists eg, Dermatologist, pediatrician
Tests and examinations eg. X-rays, blood tests
Eye tests
Most surgical procedures performed by GP’s
Limited number of sessions with a psychologist- need to be referred by a GP and have a mental health care plan
Some dental services for children covered under the child dental benefits scheme.
In Hospital Expenses
In Hospital Expenses
As a public patient in a public hospital, treatment is completely covered as well as the cost of staying in a public hospital.
If someone chooses to go to a private hospital or as a private patient in a public hospital, medicare will pay 75% of the schedule fee for the treatment only.
Scheduled Fee
Scheduled Fee
The schedule fee is the amount set by fed govt for each medical service. Medicare contributes towards certain consultations and treatments
Out of Pocket Expenses
Out of Pocket Expenses
If doctors charge more than the scheduled fee, patients may have to pay an ‘out of pocket’ expense or ‘gap fee’.
Bulk Billing
Bulk Billing
When the doctor accepts the Medicare benefit as the full payment for the service. No out of pocket expenses are required as doctor has only charged scheduled fee.
Medicare pays the doctor directly and the patient does not pay at all.
This is a great example of helping to achieve EQUITY!
Medicare Safety Net
Medicare Safety Net
This provides extra financial assistance given to people who have excessive medical expenses each year…..further support is provided making Medicare services cheaper for the rest of the year.
Medicare does not cover ...
Medicare does not cover ...
Any cosmetic or unnecessary procedures are not covered.
Costs associated with treatment in a private hospital. They pay 75% of treatment scheduled fee but will not contribute to accommodation and other costs.
Most dental examinations and treatment.
Home nursing care or treatment
Ambulance services
Alternative medicines eg. Chiropractic services, acupuncture, remedial massage, naturopathy and aromatherapy. Medicare may contribute if they are carried out r referred by a GP.
Allied health specialists eg. Physiotherapy, podiatry, orthodontics, are not covered by Medicare.
Health related aids such as glasses, contact lenses, hearing aids and prosthesis are also exempt from the Medicare rebate.
Medications
Medical costs where someone else is responsible (eg. TAC, WorkCover, employer, government or non-government authority) do not qualify for Medicare contribution as the person responsible is expected to pay the medical fees.
Funding Medicare
Medicare Levy
Medicare Levy
Most taxpayers pay an additional 2% tax each year which contributes to Medicare. Some low income or people with special circumstances may be exempt from this.
Medicare Levy Surcharge
Medicare Levy Surcharge
High income earners (over $90,000 for individuals or $180,000 for families) who do not have Private Health Insurance have to pay an ADDITIONAL tax. This increases according to their wage, but is between 1-1.5% of their income. It’s an incentive for high income earners to take out private health insurance and decrease the demand on the public system.
General Taxation
General Taxation
Regular income tax is used to help cover costs as the above two points do not cover all the costs.
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