Medicare Teen Dental Plan
With Medicare not providing much help with dental care for most people, many families struggle to afford dental cover. This can be worrying for parents, as it may mean that youngsters struggle to maintain good oral health later on as they have not got into the habit. The Australian government has recognised this concern, and introduced the Medicare ...
Commonwealth Seniors Health Card
As you get older, you may worry about how you will be able to carry on funding your health care. For many seniors, your health needs may be changing at a time when your income is decreasing. If you already have private health insurance, you may worry about how to afford to maintain enough cover for your needs. If you don’t already have health insur ...
Health Cover for a Disability
Health insurance provides security for times when one is unable to work and support one’s basic needs. Health insurance packages vary, though. This is why it is very important to always perform a health insurance comparison prior to obtaining a policy. Disability Benefits under Private Health Insurance No disability coverage is as varied as the one ...
Private Health Fund Problems? Contact the Ombudsman!
If you’re experiencing problems with your private health fund, you may feel you have exhausted all your options. You’ve talked to representatives of the private health fund, gathered and produced necessary documents to state your case, and still feel that your questions are unanswered or that your problem is unresolved. The good news is, there’s a ...
Feeling Tired All the Time? What Your Health Insurance Covers
Are you feeling tired a lot or struggling with other worrying health issues? You’ll want to get it looked into. Many people are reluctant to consult their doctor out of fear for what it may cost. You may be aware that Medicare will cover GP consultations, but what happens beyond that? If your tiredness symptoms need further investigation, you’ll wa ...
What Medications Does Health Insurance Cover?
Australians can get cheaper medications through Medicare, courtesy of the Pharmaceutical Benefits Scheme (PBS). The PBS covers a lot of medicines, but not all. Fortunately, health insurance extras may cover non-PBS medicines. Here are some things to consider if you are not sure how medicines are covered by your health insurance. What is the Pharmac ...
Hospital Cover: Health Insurance for Inpatients vs Outpatients
If you’re not familiar with the ins and outs of hospital cover, you might assume that it doesn’t matter whether you’re in hospital as an in-patient or as an out-patient. Private hospital insurance normally covers you as an inpatient only, so anything beyond that may not be covered. Read your private health insurance policy for the full details. Wit ...
Compare Health Insurance for the Whole Family
When you’re looking to compare private health insurance for the whole family, it may often be the case that a Family policy may provide the best value for money. Within this, there will be things to think about when you’re looking to compare private health cover that will benefit everyone. How long can children remain on a family policy? For most, ...
Will Private Health Insurance Cover Everything?
When you do a simple health insurance comparison between public (Medicare) and private health insurance, it’s easy to see how the latter can supplement the former in terms of coverage. Private health insurance encompasses the benefits provided by the Medicare system, but can offer more as well. Of course, there’s no such thing as an insurance that ...
Private Health Insurance Comparison for Beginners
Through policies like the Private Health Insurance Rebate and Lifetime Health Cover, the Australian government has made private health insurance both an advantageous and appealing option. Doing a comparison of the various products offered by private health funds is the typical way to find a suitable policy for your needs. There are of course a coup ...
Are Alternative Therapies Covered by Health Insurance?
Alternative therapies are fast becoming part of the landscape of standard medical care in Australia. Recently, a survey showed that 40% of all Australians have engaged in some form of alternative therapy, so although they are termed “alternative,” they are not as atypical as their name might imply.
Although they do differ from standard medical care, as the popularity of alternative therapies increases more private health insurance funds are taking notice and adding them into their health cover packages.
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What are Alternative Therapies?
Alternative therapies are those that are not widely taught at medical institutions and are not widely practiced by standard medical practitioners but are said to heal or help various maladies similarly to traditional medicine.
Some of these therapies have been around for a long time and have become somewhat accepted or even integrated into regular medicine. Some have been studied and shown to be effective to a certain extent. Others are newer and less accepted, and may still not be widely recognized by medical professionals or even the general public.
Some of the more well-known alternative therapies are chiropractic, acupuncture and homeopathy. These are all treatments that are said to heal ailments, but are performed by a specialist who is not necessarily a physician but has training in this particular area of alternative therapy. Some of the lesser-known therapies are Ayurvedic medicine, an ancient Indian methodology, or iridology, which proponents claim allows a trained expert to examine a patient’s health based on studying patterns in the eyes.
Why Are They Popular?
There are various reasons why someone would seek alternative therapies:
- They may not have been completely satisfied by medical treatments
- Medical treatments may not have able to cure them
- They are seeking a more natural option, without drugs or invasive procedures
As the internet has paved the way for the “information age,” patients are able to learn about new therapies or even old ones which they have never before been able to research. Patients are generally more educated and more wary about medical practices and are making more informed decisions about their health. This has led many to seek different or more integrated approaches to their health maintenance.
Which Therapies are Covered by Health Insurance?
Today, many private health funds have added at least some alternative therapies to their packages. They are mostly recognized therapies that are widely accepted by the public, such as chiropractic, homeopathy, aromatherapy, naturopathy, Chinese herbal medicine and Western Herbal medicine. Even for these therapies, most health funds will only approve payment for practitioners who are members of accredited Australian Associations.
Some private health funds make use of the ARHG Alternative Therapists Registration Database, which accredits associations and approves practitioners for membership. The database maintains records of the practitioners. Funds may also only pay for part of the therapy, such as the consultation, as opposed to any medicinal goods or active treatments.
When you compare private health insurance policies, you will see the available therapies that each fund offers. They are all likely to differ at least somewhat, so if you believe that you will at some point have an interest in alternative therapies, find out what each fund offers before you choose one.
Health Insurance Cover for Physical Rehabilitation
Have you thought about what you would do after an accident or major illness? Treatment costs can be covered by Medicare or private health insurance, but what about your recovery? You may need physical rehabilitation therapy to get back on track. Here is an overview of physical rehab and how it can be paid for.
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What Is Physical Rehab?
Injury, illness or major surgery can alter your quality of life. You may be less independent, have physical limitations or need to adapt to a new way of life. This can be very unnerving and may require much adjustment. Physical rehab can help with this. It may involve physiotherapy, but can also include the following:
- Exercise therapy. This can be used to improve strength after an accident, illness or injury.
- Occupational therapy. Depending on the severity, you may need this. It can help if you cannot do everyday tasks for yourself. This can include things like dressing yourself.
- Speech pathology. This can help if your speech has been affected.
Physical rehab and Medicare
Physical rehab can be covered by Medicare. Do you have a chronic condition? You may qualify for cover through the allied health initiative. This can be for things like diabetes, high blood pressure, arthritis, depression and stroke. To be eligible for this cover you must be referred by your GP. You must also be on an Enhanced Primary Health Care Plan (EPHCP). You must have at least one chronic condition that requires complex care. Complex means that you are being treated by two or more health professionals as well as by your GP. If you are eligible, you can be covered for up to five allied health care visits per calendar year. This includes physical rehab.
Physical rehab and private health insurance
What if you do not have a chronic condition? Private health insurance is the only option for many people who need physical rehab.
- In hospital physical rehab. Private hospital cover includes rehab costs. There may still be some hospital costs that are not covered. You will often need treatment beyond this.
- Outpatient physical rehab. Treatment will often take place as an outpatient. Hospital cover will not pay for this. Private health insurance will cover it as an extra instead. Take care when you compare private health insurance. Physiotherapy is a popular private health insurance extra, but you may decide you need more than this. Exercise therapy, occupational therapy and speech therapy will often be separate extras. Each has a two month waiting period before you can make claims.
There is scope for covering physical rehab on Medicare if eligible. Most people in need of physical rehab will need private health insurance to cover costs. Hospital cover will cover some costs but you may also need extras cover. Physical rehab often includes outpatient treatments. These will not be covered by hospital cover. Making sure that you compare health insurance is vital for extras cover. Not all private health insurance is the same. Physical rehab may be restricted or excluded on some policies, so always compare health funds to find one that suits you best.
What Medications Does Health Insurance Cover?
Australians can get cheaper medications through Medicare, courtesy of the Pharmaceutical Benefits Scheme (PBS). The PBS covers a lot of medicines, but not all. Fortunately, health insurance extras may cover non-PBS medicines. Here are some things to consider if you are not sure how medicines are covered by your health insurance.
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What is the Pharmaceutical Benefits Scheme?
The PBS covers a big chunk of prescription costs to make them more affordable. This means that Australian residents, and visitors from countries with Reciprocal Health Care Agreements with Australia, pay less for prescriptions that are on the PBS list. You just need to show a valid Medicare card when you pick up medicines.
What does the PBS cover?
PBS medicines are included as a Medicare benefit. From January 1st 2012, you’ll pay $35.40 for most PBS medicines (or $5.80 with a concession card). The rate will almost certainly change in the future, so be sure to check.
Medicines for most health conditions are covered. Some of the medicines covered include those for:
- Diabetes
- Acid-related disorders
- Gastrointestinal disorders
- Cardiac therapy
- Urological issues
- Topical treatments for joint and muscle pain
- Bone disease
- Epilepsy
- Drugs to treat Parkinson’s Disease
- Cough and cold preparations
Only medications on the Australian Register of Therapeutic Goods can be listed on the PBS, though. Not sure if a certain medicine is covered? Browse the online list of current PBS medicines. The list is altered on a regular basis to reflect changes.
The PBS Safety Net
If you are spending a lot on prescriptions, the PBS Safety Net can help. The current threshold is $1363.30 (or $348 with a concession card). If you reach this, you may apply for the PBS Safety Net card to cut your costs. Your payments when you have the card will reduce to $5.80 for the rest of the calendar year. If you have a concession card, they will be free for that period.
Non-PBS medicines
Sometimes you may be given non-PBS medicines. These are full price. They do not count towards the PBS Safety Net. While the PBS list is fairly extensive, it does not cover everything that may be prescribed to you. Sometimes you may get a prescription costing more than the cheapest brand.
However, private health insurance may cover non-PBS medicines as an optional extra. This will often be up to a certain amount, and typically carries a two-month waiting period for new cover. Be sure to compare health cover for pharmaceutical benefits to make the right choice. The annual limit can vary, so compare private health funds to see your options.
A lot of medicines are covered by the PBS, so you may find you get everything you need for less. If you or your family are getting a lot of non-PBS medicines, health insurance extras may start to look like a good idea. Spend some time on health insurance comparison to compare health cover for pharmacy benefits.
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.
Image by Steven Depolo
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.