If you’re a millennial mommy in Australia, you might not know too much about private health care. This guide will sort things out for you.
Before we go any further, I want to tell you that this article is based on my personal experience and research and it’s intended to help fresh mothers in Australia.
So if you’re not from here, the private health care I’m talking about does not apply to you.
The health care system in Australia can be quite complex to understand, especially for youth. It’s one of those things that obligates you to take on adulthood and make a decision towards what kind of health care you want to be paying for since you’ll be forced to be paying an extra charge anyway once you’ve turned 30 – talk about another reason to dread the big THREE O!
Basically, when it comes to health care in Australia, the public healthcare (Medicare) is partially funded by the government with any costs that go over the schedule fee (known as the gap fee) to be paid by individuals.
When visiting your general practitioner (GP), Medicare will cover 100% of the schedule fee. However, each individual will have to pay the gap fee, which is the extra amount charged by the doctor over the schedule fee.
If for instance, a GP charges $50, the schedule fee covered by Medicare would be $36.30, leaving the remaining $17.60 to be paid out of your own pockets.
In this article, we have prepared a guide to help you know more about private health care and insurance.
Are You Required To Have Private Health Insurance?
For Australians, private health care is not essential but sometimes recommended even by the government.
One aspect to take into consideration is that once you reach 30, if you don’t have private health insurance, a Medicare surcharge on your tax returns will have to be paid.
This charge increases as you get older and could result in only a small difference between public and private health care costs.
The initial increase is 1.5 – 2% of your gross monthly income on top of the 1.5% already paid to the public health system.
This is one of the governments ways to promote private health care and therefore be able to maintain the quality and standards of public health insurance.
What Does Private Health Insurance Offer?
If you’re being treated in a public hospital in Australia, the costs will most likely be paid by your public insurance and a few out-of-hospital treatments might also be included.
However, in order to get any treatment, you must first visit your GP and be referred to a practitioner registered in a public hospital.
This process can take a various amount of time and when your health is at stake, it is more often than not, that time is of the essence.
With a private health policy, things can move a lot faster as you do not have to visit a GP in order to make an appointment with the required specialist. You can choose the doctor of choice and make an appointment without having to wait.
Even if you decide to go for a doctor within the public health system, you will be able to be fast-tracked and skip a long waiting period that would otherwise be essential when using the public policy.
Does Private Health Care Cover All Costs?
The common misconception about private health care in Australia is that it covers all costs, however, that isn’t true.
While the larger amount is covered by the insurance company, there are additional costs that each individual will still be required to pay as many doctor fees are higher than the cap covered by both the government and insurance.
However, private health care gives you a wider range of doctors and specialists and faster appointment availabilities.
Some plans may even cover many out-of-hospital treatments on a higher level than the public health system such as optical, dental, imaging, and Physio-treatments.
Pregnancy And Birth Care On Private Insurance
If you’re a resident in Australia and considering giving birth there, it is important to have an idea which health system is more convenient for you.
While the public health plan covers pregnancy and giving birth in public hospitals, having a private health plan will allow you a wider range of hospitals to choose from, as well as choosing your own obstetrician rather than having one provided for you.
When you’re supported by the government, your GP refers you to see an obstetrician which could take months for your first check-up, whereas under a certain private plan, you can set an appointment straight away.
The thing about Australian hospitals is that when giving birth, you might be asked to leave a few hours after giving birth on government support, while you could be able to stay a night or two in the hospital on private health insurance.
For postnatal care, private health care also offers lactation support, educational, and parental support guidance when necessary.
It is important to understand that private health insurance doesn’t cover the costs of healthcare consultations or specialists, but works on funding the remaining 25% of the costs that the Australian public health system will not cover.
For example, for hospital costs, the government health system rebates 75% of the schedule fee for in-hospital services while your private insurance will add the remaining 25% of the schedule fee.
However, some doctor fees will be higher than the schedule fee, leaving the gap charge to be covered by the individual, as well as, any extras not included in your plan, such as theatre fees or pathology tests. These fees will be paid for by the individual in both public and private health care.
When it comes to hospital fees and accommodation, 100% hospital scheduled fees are part of your private policy, but certain tests and any additional doctor fees above the scheduled fee would have to be paid as out-of-pocket expenses.
It is essential to note that in Australia, ambulance insurance needs a separate plan and are not free services offered to the general public.
That’s why most Australian residents are encouraged to get Ambulance insurance or make sure it’s part of the private insurance they’ve applied for to prevent paying thousands of dollars when emergencies strike.
Private Health Insurance Rebate
One of the reasons that encourage millennials to seek out private insurance is the Australian Federal Government private health insurance rebate.
Depending on the health care plan you’ve chosen, you may be eligible to rebate a certain proportion of your premiums paid during the year. This includes all fees paid for hospital cover, extra cover, combined cover, as well as ambulance cover.
However, the rebate amount depends on your income and whether or not you earn more than the threshold.
When it comes to health, it’s really not worth taking risks and while getting a private health care system might seem like an unnecessary cost, the benefits of it are worthwhile. And this is why it’s important to always consider this option.
The question is, is private health care worthwhile for you? It’s always best to be prepared and this is the one time you’ll need to be an adult and choose the policy that best suits your health and finances.