It provides free treatment in public hospitals and free or subsidised treatment by doctors (including specialists), optometrists and dentists in certain cases. Medicare even covers 75 per cent of the cost of private treatment, so that a private health insurance policy needs to cover only 25 per cent of costs.
General information about Medicare in English is available from the Medicare Information Service (local call rate 13-2011) and information in other languages is available from the Medicare Multilingual Telephone Information Service (Tel. 13-1202). Medicare produces a comprehensive booklet Welcome to Medicare in a number of languages. The benefit system (see below) was revised in January 2005 and is subject to further change; for further information and the latest developments, see the Health Insurance Commission (HIC) website (www.hic.gov.au/medicareinitiatives).
All permanent residents of Australia are eligible to join Medicare, and restricted access is also granted to citizens of certain countries with which Australia has a reciprocal healthcare agreement. If you’re working in Australia, you’re automatically covered for injury and illness as a result of an accident by compulsory workers’ compensation insurance.
Medicare eligibility is immediate upon application (and can even be backdated to your arrival in Australia) but new members may have to wait up to three months to receive refunds. Foreign diplomats and their families also aren’t covered by Medicare. Medical expenses incurred by men aged over 55 and women aged over 51 who have been sponsored in the family reunion migration category are the responsibility of their sponsor for ten years or until they reach retirement age.
Foreign retirees with a temporary residence visa aren’t covered by Medicare and must take out private health insurance. Permanent resident retirees who aren’t in receipt of a social security or veterans’ pension and whose income is below a certain amount may qualify for a range of free and concessionary health services. Retirees can apply for a Commonwealth Seniors Health Card (contact Centrelink Retirement Services ( local call rate 13-2300) and receive prescriptions at $3.80 each for medicines included in the Pharmaceuticals Benefits Scheme (PBS) and a telephone allowance.
The proportion of eligible medical expenses that is covered by Medicare varies according to the type of service and the medical practitioner providing it. Medicare covers a percentage of set fees, as specified by the Medicare Benefits Schedule (MBS), which is drawn up by the Commonwealth government. Schedule fees are increased annually (on 1st November) at half the rate of inflation. In general terms, Medicare pays for 85 per cent of the schedule fee for outpatient treatment and 100 per cent of the schedule fee for hospital in-patient services.
Assuming you plan to stay in Australia for more than a couple of months, you should enrol in Medicare as soon as possible after you arrive, although it isn’t necessary until you use the system, as you can join retrospectively, i.e. claim a refund of previous medical expenses after joining Medicare. You can apply in person at a Medicare office or you can call local call rate 13-2011 and have an application form sent to you. You’re required to show proof of eligibility, e.g. your passport with a residence stamp if you’re a permanent resident. Applicants must also provide details of their assets, income and residence.
You receive a plastic Medicare card (green and gold) by post around two to three weeks after applying, which shows your Medicare membership number, the names of all dependants entitled to use the service and the expiry date of the card. Cards are valid for five years, although you must obtain a replacement card if you change your address or other details change (e.g. your family increases in size). The card has a signature strip on the back and must be signed immediately. If you receive treatment before you obtain your card, you must pay in full and claim a refund or delay payment until you receive your card.
Bulk billing (also called direct billing) is where a doctor (or optometrist) doesn’t charge the patient, but the patient verifies his entitlement to benefits to the doctor, who bills Medicare directly. Most doctors bulk bill at least some of their patients, particularly pensioners and Commonwealth Seniors Health Card holders.
If your doctor bulk bills, you’re asked to complete a form after treatment, of which you receive a copy. You don’t need to pay anything and aren’t required to make a claim to Medicare. However, doctors can bulk bill only if they charge the schedule fee (currently $27 for a standard consultation. But Australian GPs aren’t happy with the schedule, which has fallen in real terms in recent years, and want increased payments. As a result, fewer doctors are bulk billing and even fewer are expected to in the future.