The cost of medical treatment
If you need medical attention while you’re in Australia and you don’t have health cover it can be very expensive, whether you’re treated in the public or the private healthcare system.
Public vs private healthcare system
The public healthcare system (Medicare)
Medicare is the public health system that gives some Australian residents free or discounted health services. If you’re from a country with a Reciprocal Health Care Agreement (RHCA^)you might receive some Medicare benefits, which may be known as Reciprocal Medicare.
The private healthcare system
The private healthcare system (which Medibank is part of) complements the public healthcare system, or if you’re not eligible for Medicare, it helps replace it. Medibank provides private health insurance (also known as overseas health cover) to overseas students, visitors and workers to help with the cost of services provided in the private healthcare system. This includes emergency ambulance trips and a range of treatments as a private patient in a private or a public hospital.
Reciprocal Health Care Agreements (RHCAs)
Australia has RHCAs with:
- United Kingdom
- New Zealand
- Republic of Ireland
Your eligibility may be affected by the visa that you hold. Overseas students from Norway, Finland, Malta and the Republic of Ireland, as well as holders of some other visas aren’t covered by agreements with these countries. If you’re from one of these countries and want to find out exactly what you’re covered for, please contact Medicare on 132 011. If you’re not eligible for Reciprocal Medicare and you don’t have private health insurance you will have to pay for any hospital, outpatient, ambulance and doctors’ fees – even if it’s an emergency. And for many visitors to Australia it’s a condition of your visa that you have private health insurance.
How overseas cover helps with hospital visits
When you’re treated in hospital by a doctor, surgeon or anaesthetist the set fee is called the Medicare Benefits Schedule (MBS) fee. If the person treating you charges only the MBS fee (and the service is included in your policy) you will be covered by Medibank for the service. If they choose to charge above the MBS fee then you will have to pay the difference. This is referred to as an out-of-pocket cost because it literally comes out of your own pocket. Medibank has agreements with most private hospitals and day surgeries in Australia and we call this our Members’ Choice network. When you visit a Members’ Choice hospital you will generally get better value for money compared to a non-Members’ Choice private hospital (as long as the service you receive is covered by our agreement with the hospital and is included in your cover).
Doctor (GP and specialist) visits
Most of our covers include medical services provided by a doctor outside of hospital (like at a clinic). There is a set fee for each of the services and this is referred to as the Medicare Benefits Schedule (MBS) fee. Generally, on our overseas options that include outpatient medical fees, Medibank covers at least 100% of the MBS fee. For Overseas Student Health Covers we pay 100% of the MBS fee for GP’s visits and 85% of the MBS fee for specialists. This means if your GP doesn’t charge above the MBS fee, you won’t need to pay anything. If they choose to charge above the MBS fee you’ll have to pay towards the service (an out-of-pocket cost).
For example: The MBS fee for item 23 (a GP visit) is $37.60. You visit a doctor that charges $50. Your overseas health cover pays only 100% of the MBS fee. So you would pay $50, get back $37.60 and have an out-of-pocket cost of $12.40.
The cost of medication
The benefits we pay towards medication provided as part of your hospital treatment depends on your cover, so it’s a good idea to call us before your treatment to understand the benefits you should receive. It’s important to note that if high cost medicine is required for your treatment (such as some antibiotic or cancer medicines) you might have to pay a significant amount of your own money.
Our Overseas Student Health Covers and Top 85 Working Visa Health Insurance include benefits for pharmaceuticals. This means they can also help with the cost of prescription-only medication prescribed by a doctor (GP and specialist) outside of hospital. Benefits will only be paid after a set charge has been deducted and we don’t pay benefits towards most oral contraceptives or medicines prescribed for cosmetic purposes.
^If you’re from a country that has a Reciprocal Health Care Agreement (RHCA) with Australia, you might receive some Medicare (public healthcare system) benefits. This may be known as Reciprocal Medicare. These benefits could include free basic medical services and emergency treatment. They won’t include things like emergency ambulance trips, dental work or private patient hospital costs (you need overseas health cover to receive benefits for these).