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What’s not covered by Medicare?

Deciding between private health insurance and relying on the public health system mainly comes down to what’s covered by both schemes.

Australians young and old are lucky to have access to such a comprehensive public health system. Sure, you may have to wait for specialist services and assistance, but the fact that we do have access to such medical help is one of the reasons we can call Australia ‘the lucky country’.

Medicare covers you for most health and medical services, but there are some things you’ll have to pay for. That’s why it sometimes pays to have a combination of both private health and access to Medicare.

The latest Medicare Benefits Schedule Book released on 1 July 2018, includes the latest gap charges as well as the extra services covered by Medicare. At 1316 pages, it’s a comprehensive document and it contains all the services covered by Medicare.

Suffice to say, it’s a lot to cover, so to speak, but here’s a quick overview.

The Medicare system has three parts: hospital, medical and pharmaceutical.

Hospital
Medicare will cover you for any treatments in a public hospital where you’re treated as a public patient. You’ll not be charged, but you won’t be able to choose when you’re admitted, and your doctor will be appointed by the hospital. And you can be treated as a public patient, even if you have private health cover.

According to www.privatehealth.gov.au, Medicare will not cover you for:

 

Medical
When you visit a doctor outside of hospital, Medicare will reimburse 100 per cent of the Medicare Benefits Schedule (MBS) fee for a GP and 85 per cent of the MBS fee for a specialist. If your doctor bills Medicare directly (bulk billing), you will not have to pay anything.

Medicare will cover you for:

 

Medicare will not cover you for:

 

Pharmaceutical
Under the Pharmaceutical Benefits Scheme (PBS) you’ll pay a part of the cost of most prescription medicines purchased at pharmacies when you produce your Medicare card. The rest of the cost is covered by the PBS. The gap cost will vary depending on the type of medicine.

The MBS and PBS are updated each year around Budget time, so if your required service or medicine is not currently on the list, contact your local Member or Senator and tell them it should be.

Do you mostly use Medicare, even if you have private health insurance? Are you happy with your private health cover? Is Medicare enough to ensure a worry-free retirement health-wise?

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