Lazy Cow

Basic Medicare Explained...hopefully!

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    I thought this might complement Jessica Berry's wonderful dental thread.



    What is covered by Medicare?

    Medicare is the basis of Australia's health care system and covers many health care costs. You can choose whether to have Medicare cover only, or a combination of Medicare and private health insurance. Citizens and most permanent Australian residents are eligible for Medicare.



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




    Under Medicare you can be treated as a public patient in a public hospital, at no charge, by a doctor appointed by the hospital. You can choose to be treated as a public patient, even if you are privately insured.



    As a public patient, you cannot choose your own doctor and you may not have a choice about when you are admitted to hospital.



    Medicare does not cover:

    private patient hospital costs (for example, theatre fees or accommodation),

    medical and hospital costs incurred overseas,

    medical and hospital services which are not clinically necessary, or surgery solely for cosmetic reasons,

    ambulance services.




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



    Medicare provides benefits for:



    consultation fees for doctors, including specialists,

    tests and examinations by doctors needed to treat illnesses, such as 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,

    specific items under the Cleft Lip and Palate Scheme,

    specific items under the Enhanced Primary Care (EPC) program,

    specified items for allied health services as part of the Chronic Disease Management Plan.



    Medicare does not cover:

    examinations for life insurance, superannuation or memberships for which someone else is responsible (for example, a compensation insurer, employer or government authority),

    ambulance services;

    most dental examinations and treatment,

    most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry or psychology services,

    acupuncture (unless part of a doctor's consultation),

    glasses and contact lenses,

    hearing aids and other appliances.

    home nursing.




    Under the Pharmaceutical Benefits Scheme (PBS) you pay only part of the cost of most prescription medicines purchased at pharmacies. The rest of the cost is covered by the PBS. You must present your Medicare card to obtain this benefit.



    The amount you pay varies with the medicine, up to a standard maximum. People with concession cards have a lower maximum payment.


    :smile: LC

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    Wonderful thread. You beat slack me to it.


    To add, there are a few bulk billing Drs around Adelaide.

    The domain at Marion bulk bills, as well as Elizabeth medical and dental centre (the Dr part bulk bills).

    There is also an out of hours Dr service who come to your house, obviously out of hours, who also bulk bill.

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    You beat slack me to it.




    And with a young child, plus moderating, as well as 'normal' life, I doubt you're slack at all, Blossom. Still, :tongue:, seems appropriate :wink:!


    I was just about to add the bulk billing practices we use to your list, Blossom, when I thought maybe I'd see what I could find on google.





    I don't think this list includes all of those out there, since it seems to be compiled from doctors who have contacted, but it's a good start perhaps?


    :wubclub: LC

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    Great link. The only problem I've found with it is most of them listed as bulk billing only actually bulk bill children, so if bulk billing is important to you, just phone and check.

    And for anyone on their way, you can go to any gp here. You don't need to take your notes etc. Also, if you get a referral from a gp, it will list a certain practitioner, but you can generally take that referral to any of that type of Dr.

    One exception is if you are pregnant and going through the public system. You phone up (sometimes your gp will do it for you), and they allocate you a hospital depending on your address.

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    I'm pretty sure that Trinity in Port Adelaide bulk bill adults. Hubby went for his hypertension meds and only had to pay for the prescription. So if you're that way they're worth a visit.

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    Just want to emphasize, Medicare does not cover Ambulance.

    It is really important that you look into getting this asap after your arrival, as you never know what can happen and the bill for a call out can be expensive. A emergency call out can be around $1000.

    Some Health funds do include cover for emergency ambulance calls, but we use SA Ambulance for complete ambulance cover.

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