MEDICARE

This post is the first in a series of articles that we will publish in an effort to address topics of general interest raised by our existing clients.

We are constantly asked for information relating to Australia's Health Care system and particularly how Medicare works.

Medicare is Australia’s universal health care system introduced in 1984 to provide eligible Australian residents with affordable, accessible and high-quality health care.

Medicare was established based on the understanding that all Australians should contribute to the cost of health care according to their ability to pay. It is financed through progressive income tax and an income-related Medicare levy.

Medicare provides access to:

* free treatment as a public (Medicare) patient in a public hospital, and
* free or subsidised treatment by medical practitioners including general practitioners, specialists, participating optometrists or dentists (for specified services only)


What does Medicare cover?

The benefits you receive from Medicare are based on a Schedule of fees set by the Australian Government. Doctors may choose to charge more than the Schedule fee. The Medicare Benefits Schedule lists all the Medicare item numbers.

Medicare provides benefits for:

* consultation fees for doctors, including specialists
* tests and examinations by doctors needed to treat illnesses, including X-rays and pathology tests
* eye tests performed by optometrists
* most surgical and other therapeutic procedures performed by doctors
* some surgical procedures performed by approved dentists
* specified items under the Cleft Lip and Palate Scheme
* specified items for allied health services as part of the Chronic Disease Management program

You can choose the doctor who treats you for out-of-hospital services.

In-hospital services
Public Patient

If you choose to be admitted as a public (Medicare) patient in a public hospital, you will receive treatment by doctors and specialists nominated by the hospital. You will not be charged for care and treatment, or after-care by the treating doctor.
Private Patient

If you are a private patient in a public or private hospital, you will have a choice of doctor to treat you. Medicare will pay 75 per cent of the Medicare Schedule fee for services and procedures provided by the treating doctor. If you have private health insurance some or all of the outstanding balance can be covered.

You will be charged for hospital accommodation and items such as theatre fees and medicines. These costs can also be covered by private health insurance.

What's not covered by Medicare?

Medicare does not cover such things as:

* private patient hospital costs (for example, theatre fees or accommodation)
* dental examinations and treatment (except specified items introduced for allied health services as part of the Chronic Disease Management (CDM) program
* ambulance services
* home nursing
* physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology (except specified items introduced for allied health services as part of the Chronic Disease Management (CDM) program
* acupuncture (unless part of a doctor's consultation)
* glasses and contact lenses
* hearing aids and other appliances
* the cost of prostheses (except External Breast Prostheses covered by the External Breast Prostheses Reimbursement Program)
* medicines (except for the subsidy on medicines covered by the Pharmaceutical Benefits Scheme)
* medical and hospital costs incurred overseas
* medical costs for which someone else is responsible (for example a compensation insurer, an employer, a government or government authority)
* medical services which are not clinically necessary
* surgery solely for cosmetic reasons
* examinations for life insurance, superannuation or membership of a friendly society
* eye therapy

You can arrange private health insurance to cover many of these services.


Most Australians opt to also have their own private health insurance and there are a plethora of privately managed health insurance companies in Australia.

Information in this post is gleaned from the Medicare website