So, you have private health insurance and you’re wondering if you can claim both Medicare & private health to lower your costs? The short answer is yes, but not in all cases. Let’s dive a little deeper.
SUMMARY
- Private health insurance can help to cover some private health care costs that Medicare doesn’t
- In some instances, you can claim both Medicare and private health together with Medicare Two-way
- Not every private health fund offers Medicare Two-way, so make sure you check
Can You Claim Medicare & Private Health At the Same Time?
Yes, you can use Medicare services even if you already have private health insurance. In certain scenarios, you can claim benefits from both at the same time.
Double-Dipping: Medicare and Private Insurance
If you go to a public hospital but choose to be treated as a private patient, you can claim benefits from:
- Medicare for their share of the costs.
- Your private insurer for the remaining amount.
The Paperwork: Submitting Claims
If you go to a public hospital but choose to be treated as a private patient, you can claim benefits from:
- Medicare for their share of the costs.
- Your private insurer for the remaining amount.
The Paperwork: Submitting Claims
You’ll have to submit claims to both Medicare and your private insurer. This involves filling out two forms: a standard Medicare claim form and a Medicare Two-way claim form.
- Submitting to Medicare: If you send the forms to Medicare, they will forward the relevant portion to your private insurer.
- Submitting to Your Insurer: Alternatively, if you send the forms to your insurer, they will take care of sending Medicare’s portion back.
How to Use Medicare Two-way
For more details on how to submit a claim using Medicare Two-way, visit servicesaustralia.gov.au.
Coverage Beyond Medicare
Medicare Two-way can also be used for treatments that Medicare doesn’t usually cover. This includes physiotherapy, dental work, and optical care.
Not All Insurers Participate
Keep in mind that not all private health insurance companies offer the Medicare Two-way option. Check with your insurer to confirm. If they don’t offer it, you’ll need to submit separate claims to both Medicare and your insurer.
By understanding these aspects, you can make the most out of both Medicare and your private health insurance.
Medicare vs. Private Health – What’s the Difference?
Australia has a world class healthcare system with Medicare, which helps cover the costs of a range of medical services and medical costs. However, it doesn’t cover all types of health services, and that’s where private health insurance steps in.
What Private Health Insurance Covers
There are two main categories of private health insurance:
Hospital Cover: This pays for expenses like accommodation and theatre fees when you’re in the hospital.
General Treatment Cover (Extras Cover): This is for other services, such as optical, dental and physiotherapy.
Many insurers offer packages that combine both types of cover.
Hospital Cover
Hospital cover allows you to be treated as a private patient, whether you’re in a public or a private hospital. The perk? You get to pick your own doctor, offering more control over your healthcare.
Public hospitals might keep you on the waiting list for non-emergency treatments. In contrast, private hospitals often get you through the door more quickly.
The treatments and procedures you’re entitled to claim for are tied to your specific level of cover. It’s a good idea to confirm in advance whether your insurance will foot the entire bill to avoid any surprise costs, often referred to as ‘the gap.’
Extras Cover
Extras cover is your ticket to claiming for a variety of everyday healthcare services not covered by Medicare. This includes dental care, eyewear like glasses and contact lenses, and various therapies.
Just like with hospital cover, the types of treatments you can claim and the amount you’re eligible to get back (your limits) are dictated by your level of cover.
By understanding both hospital and extras cover, you can better navigate your healthcare options and avoid any unexpected financial hiccups.
Ambulance Cover
Ambulance cover covers the cost of emergency ambulance services (which aren’t covered by Medicare). Most insurance providers cover ambulance expenses, but you need to make sure you have the right level of cover (sometimes it’s in Extras cover and sometimes it’s in hospital cover).
Perks of Private Health Insurance
With most private health insurance plans, you get the luxury of:
- Choosing your own specialist or surgeon.
- Opting for treatment in a private hospital or as a private patient in a public facility.
Insurers can provide specifics about what’s covered and how much they’ll contribute, helping you pick a plan that aligns with your needs and budget.
CHI TIP: Even with private health insurance, there will still be out of pocket costs when accessing hospital treatment and other health services. Waiting periods also apply, so always read the PDS.
What Private Health Insurance Doesn’t Cover
Important to note, private health insurance typically doesn’t cover:
- General practitioner (GP) visits.
- Certain specialist appointments.
- Visits to any hospital’s emergency department.
For non-hospital settings, things like X-rays, blood tests, and other pathology tests are usually not covered. These are areas where Medicare generally steps in.
Maximising Savings with Private Health Insurance
The Rebate
You may be eligible for a private health insurance rebate if:
- You earn below a certain income threshold.
- Your plan includes a sufficient level of hospital cover.
The rebate can either reduce your premium or serve as a tax offset.
Medicare Levy Surcharge
If you don’t have private hospital insurance and earn above the income threshold, you may face an additional Medicare levy surcharge. This is usually included in your income tax.
The Lifetime Health Cover Loading
Lifetime Health Cover Loading is an Australian Government initiative designed to encourage more Aussies to take up private health insurance at a younger age and continue to maintain it long term.
It’s simply a levy that’s charged on top of your premiums every year if you don’t have hospital cover in place after turning 31.
Should you choose to ignore the LHC loading or delay getting the adequate cover, you may have to pay an additional 2% on top of the base rate of your health cover each year come tax time.
LHC caps at a maximum of 70% and is removed once you’ve held hospital cover for a period of 10 continuous years. After that, the loading remains at 0% as long as you continue to hold private health cover.
What Medicare Covers
Medicare is accessible to Australian citizens and most permanent residents. It contributes to the cost of appointments with a GP or specialist. If the healthcare provider bulk bills, the full cost is covered. Medicare also helps cover most prescription medication and offers free treatment and stay in public hospitals.
When you opt for treatment as a public patient in a public hospital, you’ll be under the care of doctors chosen by the hospital. Also, be prepared for possible wait times for non-urgent
What Medicare Doesn’t Cover
There are some gaps in what Medicare offers. For instance, it doesn’t cover:
- Ambulance services
- Eyewear like glasses and contact lenses
- Hearing aids
Certain therapies, such as speech pathology, osteopathy, and remedial massage\
Complementing Medicare with Private Health Insurance
Private health insurance can step in where Medicare leaves off, covering some of the services and treatments that Medicare doesn’t. Additionally, it provides more options when it comes to your healthcare choices, such as the ability to choose your own doctor or receive faster treatment.
Government Incentives: Save Money, Avoid Extra Taxes
If you’re looking to make the most of your healthcare coverage, don’t overlook government incentives. Depending on your income, having hospital cover could help you sidestep the Medicare Levy Surcharge, which is an extra tax you’d otherwise pay. Also, if you hop onto a health insurance plan before turning 31, you can avoid the Lifetime Health Cover loading, ultimately reducing your premium. There’s also the Australian Government Rebate, designed to make private health insurance more budget-friendly.
For a snapshot of what’s out there, you can use the government’s tool to compare different health insurance policies. It’s a good starting point for weighing your options.
Community Rating
In Australia, private health insurance operates on a community-rated system. What does this mean for you? You’ll pay the same premium as anyone else in your state for the same level of cover. This is regardless of your age, health condition, or how many times you’ve claimed benefits. The community rating system is all about keeping private health insurance accessible for everyone, irrespective of individual circumstances.
Understanding these incentives and the community rating system can help you make informed decisions and save money on your healthcare coverage.
FAQs
Can I use Medicare benefits if I also have private health insurance?
Absolutely, you can use Medicare services alongside your private health insurance. For example, you can be treated as a private patient in a public hospital and claim from both Medicare and your insurer.
What is ancillary cover?
Ancillary cover, also known as ‘Extras,’ covers services that Medicare usually doesn’t, such as dental care, eyewear, and therapies like physiotherapy.
How can I avoid unexpected out-of-pocket expenses?
It’s crucial to check with your healthcare provider and insurer about what costs they’ll cover before receiving treatment.
What is the Medicare Benefits Schedule (MBS)?
The MBS is a list of medical services for which Medicare will provide a subsidy.
Does Medicare cover mental health services?
Medicare does provide some coverage for mental health services, usually under a Mental Health Treatment Plan prepared by your GP.
Can I get mental health services covered by private insurance?
Some private health insurance plans offer coverage for mental health services, but the extent of the coverage depends on your specific plan.
