Compare Health Insurance for Chronic Pain Conditions

When you compare health cover, what do you look for when you have special health conditions?  What different things should you be aware of with respect to chronic pain conditions and health insurance comparison?  Follow along for some tips on what elements you may want to zero in on for your health insurance plan.

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Basics of the Health Insurance Comparison

It may be helpful to begin with the essential needs of your health insurance plan.  In other words, forget for the moment about any special needs in relationship to your chronic pain condition. Before we move on, look at your current private health cover, if applicable.  What do you have now, and is it adequate for your general health care needs? If coverage amounts, network, prescription medication, or some other factors are particularly important to you, note that down and be sure to sompare those criteria in prospective policies.  By seeing what you do and don’t like with any current policy, you can imagine your ideal policy more easily.

So, identify what basics you want and need in your health insurance plan.  Do you have a certain policy limit you’d like to increase, such as for hospital care?  Do you want to seek out a higher excess in return for a lower premium?  Take some time to identify all your other health insurance needs before dealing with your chronic pain related requirements.

That Isn’t All!

Now we move on to the important special feature of your health insurance – your pain, and what is provided to help you deal with it.  What parts of a private health plan are typically relevant to your chronic pain condition? While there are no universal guidelines, you can identify what is important for your condition.  For instance, consider the following:

• Doctors: How important is it that you continue to see your current doctors?  Note any specialists that you want or need to have access to under your health insurance plan.  How difficult would it be to switch health insurance networks?  Note any special facilities that are relevant, such as rehabilitation clinics for some conditions.
• Prescriptions: Medications on prescription can be expensive.  Note any that you are on right now – you might want to find out about cover if you were to switch health insurance.  Otherwise, a general idea of the strength of the plan in this area can help you anticipate future out-of-pocket costs.
• Special Needs: Consider your condition.  What types of costs have you incurred over the years?  What special treatments have you, or may you need? How is your condition likely to change as time goes by?

Public or Private Health Insurance?

While Medicare will often cover many of your health needs, it may be advantageous to compare private health cover for your pain condition.  Having access to personalised health care on your plan could be well worth the investment, in addition to other advantages such as tax incentives.

Take some time to consider your needs in detail.  Look at both your basic healthcare requirements and then those that are relative to your condition.  Once you do this, you can compare health insurance options in full.  Looking through the whole policies may help you make a final decision on your health insurance.

The Pharmaceutical Benefits Scheme: Reducing Medication Costs

Imagine this scenario: You weren’t feeling well, so you went to the doctor, were diagnosed and now you’re on the way to the pharmacy. This illness has cost you enough already in lost work time and doctor bills, and now you’ll be paying for the medicines you need. Without any help, paying for basic medicines can be a challenge for most families and an impossibility for some.

Luckily, the Australian government realized how burdensome the cost of necessary drugs can be, and instituted the Pharmaceutical Benefits Scheme (PBS) in 1948. Though it has changed somewhat over the years, the PBS is still designed to help Australians afford the medicines they need even without any private health insurance cover.

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What is the Pharmaceutical Benefits Scheme?

The PBS is a program in which the government subsidises the cost of medicine for most medical conditions. By doing so, the PBS provides reliable and affordable access to necessary medicines. It is part of the broader National Medicines Policy. The Scheme is available to all residents of Australia who hold a current Medicare card.

How Does the PBS Work?

The PBS Schedule is a list of all the medicines available to be given to patients at a government-subsidised price. When a patient goes to the pharmacy to get a drug that is on the Schedule, the subsidy is automatically applied when the drug is dispensed. The patient pays a co-payment instead of the full cost of the medication. This may save the patient a great deal of money. Many military veterans are eligible for even lower co-pays through the Repatriation Pharmaceutical Benefits Scheme. Those who pay the lower co-pays have what are known as concession cards.

In 2011, general patients paid up to $34.20 for medicines on the PBS Schedule. Concession card holders would have paid $5.60. If you choose a more expensive medicine or your doctor prescribes one for you, you may have to pay more. The PBS Schedule can be found on-line and is updated each month. The on-line version includes information on all drugs listed on the PBS, the conditions of use for the prescribing of PBS medicines and what you can expect to pay for medicines.

While the amount you have to pay for medicines is, thankfully, rather small under the PBS, it can add up over time. That’s where the Safety Net comes into play.

What is the Safety Net?

If you or your family end up needing a lot of medicines in a year, the Safety Net will help with the cost of your medicines. Once you or your family reach the Safety Net threshold, you can apply for a PBS Safety Net card. This means your PBS medicine will be less expensive or even free for the rest of the calendar year.

In 2011, the Safety Net threshold was $1,317.20 for general patients and $336 for concession card holders. If you are nearing your Safety Net threshold, talk to your pharmacist about applying for a Safety Net card. Once you have one, you will pay $5.60 in the 2011-12 financial year for your PBS medicines if you are a general patient. Those medicines will be free for concession card holders with a Safety Net card.

Helping Manage the Cost of the PBS Scheme

Since the Pharmaceutical Benefits System began, the costs of running have increased tremendously. The cost of the PBS grew nearly 13% each year over the last ten years alone, and it now costs the government approximately $6.5 billion a year to operate.

The government asks consumers, prescribers, dispensers, wholesalers and the pharmaceutical industry to do what they can to help keep costs down.  As a consumer, you are asked to not refill prescriptions earlier than needed, to ask for less expensive brands of medicines, and to not get more medicine than you actually need.

Keeping health care costs down isn’t easy, but the Australian National Medicines Policy attempts to do just that in order to help Australian families. The Pharmaceutical Benefits Scheme is an important part of Australia’s health care program and an important benefit for Australian citizens. If you want to keep your family’s health care costs to a minimum, make sure you understand the PBS.

Before You Switch Health Insurance Companies…

While there may be downsides to switching almost any type of insurance, switching health insurance has its own particular issues.  There might be differences in the coverage offered by the old and new health insurance policies, and you may be faced with waiting periods, so proceed with caution.

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Pre-Existing Conditions and Health Insurance

Indeed, this is the “big one” – many people worry about whether they will be able to get coverage for pre-existing conditions. The simple answer is that you cannot be denied health insurance, but there may be a waiting period before your new policy covers pre-existing conditions.

Your new policy will specify the waiting periods for different types of pre-existing conditions to be covered. It will also explain how pre-existing conditions are defined. For instance, your new policy may define it as having recently received medical advice or treatment for a problem.  Or you could meet the “prudent person” definition, relating to a situation in which symptoms were present that would be expected to cause a prudent person to seek treatment.

These kinds of definitions are important to be clear about – make sure you know how your private health insurance policy works.  Claims for the cost of health care may be denied if you have underestimated the waiting periods on your policy.

Health Insurance in Transition

Take a long look at your coverage and needs before switching private health insurance.  These points will be important to consider before you start your health insurance quotes comparison.

Sure, the premiums and excesses are relatively straightforward, and the basics of a private health insurance policy are easy.  However, you may want to check whether your preferred doctors/specialists are covered by your potential new policy.  Certain special needs such as coverage for contacts or glasses, oxygen supplies, or mobility aids may not be covered as standard.  Your current medications represent yet another point that you’ll need to consider; losing coverage that you’re accustomed to using may undermine your budget.

Use these factors to compare medical insurance policies and consider your options.  You wouldn’t want to switch companies in haste and end up regretting it later.

Timing a Health Insurance Switch

Is the date approaching when the switch will need to take place?  Don’t wait to the last moment to do your medical insurance comparison, unless you don’t mind being left without private health insurance coverage for an interim period while you rush to make new arrangements.

You should also make sure that you have the necessary information ready to go, if you need to switch medical professionals to be treated within your new medical insurer’s network. Data you’ll need at the doctor’s office include:

• Full address, telephone, and fax numbers
• Date of last consultation or treatment
• Previous health care provider’s business details
• Current medications and treatment programs
• Health insurance information

With your essential information in hand, you can be ready to switch health care as well as insurance.  Your physician can usually send your medical records directly to your new healthcare provider.

Overview

Be aware ofthe potential drawbacks of switching health insurance.  For some health problems, such as pre-existing conditions, you may be left without coverage for a set waiting period. If you have a number of special health needs, you may wish to consult with an insurance professional.  Alternatively, you could ask individual insurers’ customer service representatives to clarify the coverage available for your requirements, as well as any ambiguous or otherwise confusing policy points.  Perhaps that could give you some peace of mind if you are wondering where you stand in regard to private health insurance cover.

Private Health Insurance and the Medicare Levy Surcharge?

When it comes to your health insurance, something you should be aware of is the Medicare Levy Surcharge. This is essentially an extra fee levied upon higher-income individuals who choose to use the public Medicare system rather than take out private health insurance. This surcharge was implemented to reduce the number of people relying on the public health care system, and it covers not only yourself but your spouse and dependents as well.

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Who Has to Pay the Medicare Levy Surcharge?

According to the PrivateHealth.gov.au website, the following individuals are subject to the Medicare Levy Surcharge (these criteria may change in future, so check direct on the government website):

• A single person with a taxable income over $80,000 annually
• A family or couple with over $160,000 of taxable income (with $1500 added increments for each dependent)
• Those without appropriate cover with a registered health fund

How Much is the Surcharge?

When it comes to the actual Medicare Levy Surcharge itself, the normal amount is 1% of the taxable income on top of the 1.5% levy that most people already pay. So, if you are single and make $100,000 this year, you would normally have to pay an additional $1,000 in Medicare surcharges if you don’t have private health insurance.

How to Gain an Exemption

Luckily, there are some ways around this. According to the same site (listed above), you are exempt from the Medicare Levy Surcharge if:

• First and most obviously, your income level is below the required threshold.
• Your income is over the maximum but you have hospital insurance to cover yourself and any dependents with a registered health fund (with a deductible of no more than $500 for single filers or $1,000 for couples and families).
• You are a prescribed person with no dependents.
• Finally: you are in a high income bracket but purchased health insurance before 24 May, 2000 with deductibles higher than $500 (singles) or $1,000 (couples or families)

So, if you are making less than the above income requirements, then it’s generally safe to assume that you are exempt. However, if you’re on a higher income and seeking to avoid the Medicare Levy Surcharge, there are other ways of obtaining an exemption.

For instance, if you simply take out hospital insurance that covers a specific amount of general hospital expenses and medical treatments, you would be exempt from the Medicare Levy Surcharge. This is, of course, assuming you are purchasing said hospital insurance through a registered health fund only.

The Private Health Insurance Rebate

Furthermore, when you opt for private insurance over Medicare, you could receive as much as 30% back from the federal government in the form of a private health insurance rebate. These rebates are not based on income levels.

There are special incentives for seniors who purchase their own private health insurance: for those aged 65-69, the rebate is 35%, and for those 70 and older it is 40%. At this point, the gap between paying for the Medicare Levy Surcharge and private health insurance shrinks, making it a viable option for people to choose private coverage over Medicare altogether.

So, even though you may make more than the maximum threshold for the Medicare Levy Surcharge, you can now see that there are a few ways to ensure that you are exempt from having to pay it.