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 ones extended by private health insurance providers. It is crucial to read through every insurance product disclosure statement when in the medical insurance comparison phase.

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Insurers have different names for different types of disability covers. These are the most common ones:

• Trauma Cover – This insurance gives coverage for those who have been injured. It also applies for illness such as stroke or cancer. The cover may provide assistance for previous and ongoing medical costs not covered by health insurance. The costs for needed lifestyle and housing changes which make the patient’s life more manageable may be included too.
• Income Protection Cover – This insurance provides for a person who is unable to work because of injury or illness. Income replacement may be provided for a set period of time. It can also continue for the rest of the afflicted person’s life depending on the terms of the policy.
• Total and Permanent Disability Cover – This insurance provides steady financial assistance when the policy holder is deemed fully and permanently disabled. Every insurer has its own criteria for determining this medical state. Commonly, total and permanent disability means being unable to work in the former job. It also pertains to being completely unable to work again in any kind of occupation.

Doing a private health insurance comparison does not only entail checking the rates offered by insurers. One should also examine these important points:

• Coverage level – Debilitating injury or illness has a huge impact on one’s life. Think about how much income you and your family will need if you’ll be unable to work. This will help you decide how much disability cover to get. Other kinds of life insurance should be taken into account. For instance, if you have a superannuation fund going and it includes total and permanent disability cover, then there is no point in obtaining similar insurance.
• Waiting periods – Waiting periods basically prevent immediate claims after policy purchase. This tends to increase the costs for all members of the health fund. Providers have varying waiting periods but they normally range from 60 to 90 days.
• Life insurance – If you already have life insurance cover, this may include some coverage for disability such as trauma cover or income protection.

Disability Benefits from the Government

Welfare payments as well as services for the disabled can be obtained from the following. This is based on the National Disability Insurance Scheme and National Injury Insurance Scheme.

Centrelink

Centrelink is in-charge of distributing welfare payments such as:

• Carer Allowance. This may be extended to people who take care of injured, disabled, ill, or aged members of the family who require additional round-the-clock care.
• Carer Payment. This may be provided to people who are unable to work because they provide full-time care to a disabled, ill, or aged member of the family.
• Mobility Allowance. This may be extended to injured, ill, or disabled persons so that they can attend in approved activities. The allowance is meant to cover transportation costs because they can not use public transport without the assistance of a carer.
• Sickness Allowance. This may be extended short-term to wage earners who are unable to go to work because of a medical condition.
• Disability Support Pension. This may be provided to Australians who have a severe physical, mental, or intellectual impairment, and who receive government employment and wage support.

CRS Australia

CRS Australia assists the disabled or injured acquire and keep suitable and gainful jobs. This agency works closely with employers to ensure workplace safety. The focus is of course on the disabled.

Australian Hearing

Australian Hearing provides support to hearing-impaired Australians. Assistance is in the form of medical services. They also help the hearing-impaired access cheaper products that are crucial to improving their quality of life.

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 want to know if you’re covered for tests and appointments with specialists. Here is a guide to what can be covered through Medicare and what you will need private health insurance for if you want to minimise your out-of-pocket expenses.

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What does Medicare cover?

GP consultations. Medicare will reimburse 100% of the Medicare Benefits Schedule fee for visiting a doctor outside of hospital. There is no fee for you to pay if his or her fee is the same as the MBS fee. It may not work out like this, though, as GPs can choose to charge above the MBS fee. This difference between the GP’s fee and what Medicare will cover mean that there may be out-of-pocket costs that you have to pay.

Specialist consultations. Medicare will reimburse 85% of the MBS fee. Even if the consultant’s fee is in line with the MBS fee, there is still the remaining 15% to cover. Specialists, like GPs,  may charge more than the MBS fee, so check the fees before you see a specialist for your fatigue issues.

Diagnostic tests. If your doctor advises that tests are necessary to discover the reasons why you’re feeling so tired, Medicare may cover the costs. Many tests and examinations come under this cover, including x-rays.

If your doctor bulk bills, you pay nothing as they bill directly to Medicare. If they do not bulk bill, you need to pay the difference between their fee and what Medicare will cover. This may involve paying your doctor in full, sending your receipt to Medicare and being reimbursed for the MBS fee amount. Or it may involve being given a cheque to give to your doctor along with any balance that you still owe.

What does the Medicare Safety Net cover?

The costs can soon mount up if you find that you need regular consultations with a doctor who charges above the MBS fee. The Medicare Safety Net is in place to help with these out-of-pocket costs. If your out-of-pocket costs reach the Safety Net threshold, 100% of the MBS fee for eligible services will be reimbursed through Medicare. There may still be out-of-pocket costs to meet though. The Original threshold for all Medicare cardholders is $413.50 in March 2012 . For concession cardholders and families eligible for FTB(A), the threshold is $598.80.

If your out-of-pocket costs reach a certain amount, the Extended Medicare Safety Net can help. For out-of-hospital services, up to 80% of your out-of-pocket costs can be covered. Some services are capped so you will not get this level of help on those. Getting to the bottom of your symptoms should be covered as consultations with GPs and specialists are included in the safety nets. Many diagnostic tests are also covered. The Extended threshold is $1198 in March 2012. This is for all Medicare cardholders.

Will private health insurance help?

The main intention of private health insurance is to cover services that would otherwise be unavailable or unaffordable. Services that are available through Medicare are not covered. More specifically to this scenario, medical services provided out-of-hospital, such as GP visits and consultations with specialists, are not covered by private health funds. The gap between the MBS fee and the fee charged may be covered by Medical Gap insurance.

However, you may choose to compare health insurance for private hospital cover, which may give you greater choice about where, when and from whom you receive treatment. This may be reassuring if you feel that your condition warrants swift attention, for example if tiredness is affecting your ability to work. You may also want to look into extras cover for specific treatments such as chiropractic or optical care, in case you need to access these services in the future.

Summing things up

Are you worried about arranging a consultation with your GP in case the costs start to grow beyond your budget? Remember that Medicare will cover 100% of the MBS fee for GP visits. It also covers 85% of the MBS fee for consultations with specialists. There may still be some out-of-pocket fees if your doctor charges above the MBS fee but Medicare should cover the bulk of the costs. Health insurance will not help with the costs of out-of-hospital medical services, but you may be able to use gap insurance to minimise your out-of-pocket costs.

The Medicare Benefits Schedule

When you compare health insurance, you may see references to “the Schedule Fee”. This relates to the Medicare Benefits Schedule. Not sure what this is or how it affects you? Read on to learn more.

What is the Medicare Benefits Schedule?

The Medicare Benefits Schedule lists the services that are available as Medicare benefits. It is published by the Department for Health and Ageing (DoHA) and updated regularly on their MBS website. Every item on the MBS has its own Schedule fee, which is set by the Australian government.

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Medicare will not necessarily cover the full Schedule fee. For GP fees, 100% of the MBS fee is reimbursed by Medicare. This means that you will have nothing to pay if your GP’s fees are in line with the MBS fee. For specialists fees, 85% of the MBS fee is reimbursed. This means that if your specialist’s fees are the same as the MBS fee, you will still have 15% to pay. This “gap” may be covered by private health insurance.

However, doctors can choose to charge more than the Schedule fee. In this situation, you will need to pay the difference between the MBS fee and what the doctor or specialist charges, plus the “gap” if applicable. The difference is known as an “out-of-pocket” amount. Private health insurance may cover the difference in part or in full.

The Medicare Safety Net

Australian residents and some overseas visitors can get free or affordable treatment as a public patient in a public hospital. However, Medicare does not cover everything. For example, out-of-hospital costs can easily leave you out of pocket. This type of out-of-pocket expense can quickly add up if you need more than a few appointments.

This is where the Medicare Safety Net can come into play. This is designed to reduce your out-of-pocket expenses so that your medical costs come down. Could you be eligible for this? If you or your family’s “gap” payments exceed the threshold in a calendar year, 100% of the MBS fee will be reimbursed through Medicare. Bear in mind that this only applies to out-of-hospital services. This may not always mean that you will not have anything to pay though. There may still be “out-of-pocket” expenses to meet if the MBS fee does not cover the full cost of the service.

The Extended Medicare Safety Net

Your out-of-pocket costs may still add up, even if you qualify for the Medicare Safety Net. If they reach a certain amount in a calendar year, the Extended Medicare Safety Net can help. Through this, 80% of your out-of-pocket costs will be met as long as they are for out-of-hospital services. This applies to the rest of the calendar year.

Some Medicare services are capped under the Medicare Safety Net. This means that you will only be able to receive a certain amount back regardless of the treatment costs. This can include obstetrics, assisted reproductive technology and some varicose vein and cataract treatments. This is known as an Extended Medicare Safety Net (EMSN) benefit cap. For these services, you may receive the EMSN benefit cap amount if it is lower than 80% of your out-of-pocket costs.

Tests and doctor visits are covered by the Medicare Safety Nets. This includes GP consultations, specialist consultations, blood tests, CT scans, x-rays, pap tests and ultrasounds. In-hospital services are excluded, as are medical services not covered by Medicare.

Medicare Safety Net thresholds

For 2012, the thresholds are:

• Original threshold = $413.50 for all Australians
• Extended General threshold = $1198 for all Australians
•  Extended Concessional threshold = $598

MBS Summary

Not previously been aware of the Medicare Benefits Scheme? Every item on it has a Schedule fee, which affects how much you pay for Medicare services. If your treatment costs more than the Schedule fee, you can find yourself with a “gap” amount and “out-of-pocket” costs. The Medicare Safety Net can help with this but it will not cover everything. For non-Medicare services, you may want to compare health insurance to cover them. As always, be sure to compare health funds for the most affordable and relevant cover for your needs.

Understand Your Health Insurance: What Is Palliative Care?

As you compare health insurance policies, you may come across palliative care as an optional extra. If you are not sure what this refers to, you have probably wondered if this is something that you might need. It can be useful as a just-in-case extra to private health insurance cover, although it is available via Medicare too.

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What is palliative care?

Palliative care is for terminal illnesses. This can include conditions such as cancer, HIV/AIDs, Motor Neurone Disease, Muscular Dystrophy and Multiple Sclerosis. The aim is to improve quality of life when there is little or no chance of recovery. As the condition is so advanced that there is no cure, it is simply intended to make the remaining time more bearable. Managing symptoms is the main focus, and this often takes a holistic approach. This can include pain relief and support systems. Palliative care can take place at home or in places like hospitals, nursing homes and palliative care units.

Who requires palliative care?

Anyone who is diagnosed with terminal illness may look to palliative care for support. Palliative care is not limited to patients. Carers and families can also receive support to help them deal with the situation. After the patient’s death, relatives and close friends may also receive grief support.

Palliative care and Medicare

Palliative care is free through Medicare. This usually covers public hospital and hospice costs. Your doctor can refer you to a local palliative care unit, or you can search for one here.

The Chronic Disease Management (CDM) program may also be an option. This is for chronic and terminal illnesses. You may be eligible if you have had an eligible  condition for over six months and require complex care. Complex care refers to treatment by two or more healthcare professionals and your GP. The criteria are not set in stone, though. Your GP will decide if you qualify for the CDM program. If eligible, you can receive up to five allied health services per calendar year.

Palliative care and health insurance

Would you prefer to receive palliative care in a private hospital? You may want private health insurance to help cover these costs. It may seem sensible not to arrange this type of health insurance unless you actually need it, but this may mean missing out on vital support. The typical waiting period is two months, so you will not be able to claim until you have served this. Depending on how aggessive the condition is, you may need palliative care much more quickly than this.

As always, be sure to compare health insurance for palliative care. While it is available as an optional extra on most health funds, the amount for which you are covered can vary. Always compare the palliative care included in the policy as well as any limitations, or you will not be able to judge the level of support covered.

It isn’t nice to think that you may be diagnosed with a terminal illness, but this is a sad reality for some. If it happens to you, palliative care can make the end-of-life stage more bearable. It is available through the public health system, so you may choose not to use private health insurance for this at all. It depends on your condition and your care requirements, which may be difficult to predict in advance, so research your decision with care.

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. With this in mind, it’s important to be aware of what constitutes an in-patient procedure and what doesn’t.

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Are you an in-patient or an out-patient?

You’re classed as an inpatient if you’re admitted into hospital for a same-day or overnight stay. This means you may be covered for the costs of operating theatres, intensive care and labour wards, diagnostic tests, medications included on the Pharmaceutical Benefits Scheme and allied services. However, you should spend some time on health insurance comparison to assess your options, as you’ll only be covered for the services included in your level of coverage. There will often be restrictions or exclusions on more basic levels of private hospital cover, so compare health insurance policies as well as premiums.

Medical costs (for example, from your doctor, surgeon and anaesthetic) can also be covered through private hospital cover – as a private patient, Medicare will cover 75% of the Medicare Benefits Schedule fee and your health fund may cover some or all of the remainder. If medical costs exceed the MBS fee, be prepared to pay a ‘gap’ payment, as private hospital cover may not cover all of the difference. Depending on your private health fund, emergency ambulance cover may be included.

If you’re not formally admitted to hospital for a procedure, you’re deemed to be an outpatient instead. Outpatient treatments may be delivered on hospital premises, in consultation rooms or elsewhere, such as at community health centres. For example, a consultation with an obstetrician during pregnancy will typically be an outpatient service. As an outpatient, you won’t be covered by private hospital cover.  If Medicare pays benefits for a particular service, you may be able to claim the costs of Medicare instead.

Hospital cover and unplanned hospital stays

If you’re involved in an accident, many private health funds will allow you to be covered straight away after you become a member, so it may not be quite so important to compare health insurance for hospital cover as far as this is concerned.

Hospital stays that occur because of emergency treatment may be beyond your control. If you’re suddenly taken ill, the ambulance will most likely take you to the emergency ward of the nearest public hospital. Through Medicare, you can be treated as a public patient with no costs to yourself as Medicare will cover the full fee. If you have private hospital cover and would rather use that, you’ll admitted as a private patient and you should be prepared for some out-of-pocket expenses that will need to be covered by you.

There is also the option of going to the emergency ward of a private hospital but again, you won’t be covered through private hospital cover if you’re not admitted as an in-patient. Bear in mind that private hospital cover doesn’t extend to treatment in an emergency ward, as you’re not admitted as an inpatient in this scenario. Most private health funds will not pay benefits for procedures performed as an outpatient.

It’s easy to think that hospital cover will extend to any procedure performed while you’re in hospital, but in reality, private hospital cover will only pay benefits for inpatient procedures and not for outpatient procedures in which you’ve not been formally admitted to hospital. If you’re taken to an emergency ward for treatment, you can expect to be classed as an out-patient and this won’t be covered by private hospital cover.