Australian mnetters - please tell me about health care

[overtheseatoskye]

I'm hoping all the down under mumsnetters might be able to help.

DH has been offered a job in Melbourne. His package is good but it doesn't include any private health cover. I don't know much about Australian healthcare but I kind of thought you have to pay for everything and so need a private scheme Have I got that right? If so how much do you typically pay (we are a family of four)? Do you normally get healthcare with a work package?

PS Will I like living in Australia?

Hi overtheseatoskye

1. Yes you will love living in Australia. It is nice. (although I can often be found having a good moan, but on the whole it is lovely here).

1. Healthcare is generally very good here, lots of people have private medical insurance but it's not essential. We have a gvmt scheme called Medicare here which means you pay a % of your treatment costs and the gvmt pays the rest. This means that it is more expensive than the NHS, but you get better choice and better service at the GPs for instance. I have never had to use a hospital (apart from having a baby) but have heard from friends that their A&E service has been much like the UK crap, leaves a little to be desired.

1. We have recently started paying into a Private Health scheme and I think it costs us about $600 a quarter for a family of 4. I think if you have maternity included and extras ie orthadontics and massages it costs more. Actually looking at that sum I'm tempted to cancel it.

I think you need to weigh up how long you will be here for, how old your kids are (ie with they need expensive dental work as goofy teenagers), are you generally healthy?

My DH works in a managerial role and has no company healthcare. I don't know if that is standard or not.

Hi
Something you also ought to know is that there is something called lifetime health cover, which is a govt initiative to get people to take out hospital cover. Basically, if you don't take out health cover by the time you're 31, then if you do decide to take out private health care later, you will pay a 2% loading on top of your premium for every year you are aged over 30. So, for example if you don't get it until you're 40, you pay 20% more than someone who is 30. If you're moving to Australia and are over 31, you have a year from when you arrive to take it out.

This is what we did (being well into our 30s when we moved here!) but that said, I am still not convinced that it's worth it. We pay 200 per month for a family of four, and it completely covers us for dental check ups and optical check ups (although you can sometimes get these free through Medicare). However for most things (except hospital cover) it only pays a portion of the cost and there are yearly limits for different treatments. So, recently one of my sons had to have extensive dental work including five crowns, root canal, etc costing over $2500. The private health fund only covered around $800 of that. So, to my mind, it's not really worth it. Similarly, with glasses, contact lenses, my cover only pays around a quarter of the cost of a pair of glasses, and about 1 month's worth of lenses per year. For most things eg physio, optical, etc you'll still need to pay the gap between the total cost and what the insurer pays.
As Claudia Shiffer said, I'd wait until you get to Oz, see how long you're going to be here for and then decide. You have a year at least before the lifetime loading kicks in.

As for Oz, I'm sure you'll love it, especially Melbourne! Good luck with the move.

Wow, it seems confusing. So can I ask which if these we would have to pay for and so would need private cover

1. need to take children to A&E

2. DS needs orthopaedic help (with feet)

3. one of us suddenly gets a serious illness that needs diagnosing and hospital treatment

4. need to go GP with routine problem

5. kids need to see dentist

Well, um, I'm a bit confused about it too, but I think depending on your income you pay for everything. Then the Medicare system (gvmt run health system) pays you back a %. That % depends on how much you earn ie if your salary is teeny weeny you get a greater %.

Look here at the Medicare Website it may give you some pointers.

But basically you have to get the NHS free for all system out of your head. It is very different here.

Also even if you have private health cover you still have to pay for a % of your medical fee. For instance I take the kids to the dentist for a check up the bill is $150 our insurance pays $100 we pay $50. So don't imagine that even with Private Health cover you get everything for free.

Oh, just read Papoosa's post again who basically says exactly the same thing. Sorry.

We have lived here without health insurance for some time as my DP objects strongly to it on principle. We have a safety net in place re Medicare which means that after you spend a certain amount a year, you get 80% back instead of the usual percentage. This made IVF more affordable for us without health cover than it would have been with - bizzarely - and then any out of pocket expenses that are not rebated under Medicare are offset under your personal tax provided you are not a high income earner. An ambulance ride is expensive here, but otherwise I think emergency treatment is generally free straight from medicare if you have no cover. Also, we have an excellent "bulk billing" GP, which means you pay nothing for GP appointments, as they bill Medicare directly, just as under the NHS - but it is hit and miss whether you get a good doctor so you need to hunt around.

Any A&E treatment is free. Depending on which GP you see you may not have to pay for visits. Some GP's Bulk Bill which means rather than charge the patient they bill the government directly. Here where we live in Melbourne most GP surgerys bulk bill.

Any extras like dental, chiropractics, physiotherapy you must pay for out of your own pocket or use private cover to part cover. Our private health cover is only for extras like dental, chiro, physio, opticians etc. We get 2 free check ups at the dentist each year. Dh gets 2 free pairs of glasses each year. With this cover we only have public hospital cover. It costs just over $200/month. I regularly see a chiropractor and he charges $47/visit of this I only pay $17 our health cover pays the other $30.

I am currently pregnant with DC4 and all of my pre natal care is through a midwife lead team at the local hospital. This has all been free/bulk billed apart from the scans which I have had to pay a portion of. My hospital stay when the baby is born is free too.

There is also no set price for prescriptions so they can get a little expensive if you need a few things. Contraception is not free either!

Compared to the GPs and local NHS hospital we used in London I find the standards of health care here a lot higher especially when I had my last two DC. My local hospital here is more like the Portland Hospital than the NHS hospital where I had my DD.

I hope this helps and makes sense!

If you chose not to get private health cover make sure you have Ambulance cover or you will be charged for any trips you make in an ambulance which is very expensive!!

Not sure if anyone has mentioned the Medicare Levy. If you earn over a certain amount (and it's not v much I don't think) you will be charged an additional tax if you don't take out private health insurance. So when weighing up the costs, remember it will cost you either way.

Dental is not covered under any public health scheme. You can go to any doctor you want- I have at least two clinics that I use regularly (ie if I can't get an appointment to see my usual dr on the day I just go to the large clinic down the road). Melbourne has a very good children's hospital- only yesterday it moved into fabulous new premises - it even has a meerkat enclosure in it, courtesy of the zoo which is close by.

The public hospitals are variable in their standards just as in the UK & further dependent on your actual ward/doctor/individual situation. I've experienced two here for obstetrics, one was better & one was worse than my local hospital in the UK (Slough!). We also don't have private cover due to moral/ethical considerations - don't think we could afford it either.

I don't understand it three years down the line. I have only been to the Doctor once and it was $120. It is weird when you come out and they say $120 please, but nobody misses their appointments. We have got Medibank Private insurance.

My best friend has no insurance and her toddler got pneumonia and was hospitalised and the bill was $1200. Then when she had a baby I couldn't believe how bad her experience was. The hospital was awful and so full that they forced her to go home 8 hours after a caesarian. She was in a lot of pain. On the other hand my sister gave birthing a hospital in the UK and there was no midwife available at all and she ended up with nobody but her dh.

Firstly, no one can actually answer your question as to whether you will like it here or not, because it is so personal. I used to love it, but certain aspects now annoy me & we are planning a move back to the UK eventually. Dh has never liked it, even tho he lived here for 18 yrs with his parents & loved that place.

I has dd2 here, she was a section delivery & I was in the best care I have ever had for 6 days! In a private room. A far far stretch to my experience with dd in the UK. I didn't pay a cent for that!

I have had to take both dds to hospital (A&E), they were efficient & prompt & I didn't pay a cent for that either.

I pay for each visit to the dr, but you can find drs who bulk bill, so you don't pay. Prescriptions are costly if you don't have a health care card (low income means tested). There is no fixed rate like in the UK. I have paid $20 for antibiotics for dd & I pay $62 a quarter for the pill. Although I can claim about $25 of that back through private health insurance.

Only I have private health cover at the moment, and that is because I need dental work done & that is $$, we couldn't do it without help. I pay $18 per fortnight, for basic, extras only cover (no hospital)

Ambulance cover is ESSENTIAL! There are no free rides here, regardless of the circumstance that leaves you needing one. So states include it in utilities, private health cover gives me 1 use per year, but other than that, we pay $110 per year. It varies state to state.

Oh, I would second the wonderful care I had when I had dd over here. No private health insurance but hardly paid a cent and the small cottage hospital I had her in was WONDERFUL. Really really lovely. So much lovelier than my UK experience with dd1. I would love to go back now, just to stay a few days and be looked after really

Also IVF is MUCH cheaper here than in the UK, at least it was 5 years ago, as the gvmt subsidised it hugely, dunno if that's changed.

The first thing to ask is what kind of visa will you be on? If you are on a 457 technically you are only entitled to "immediate and necessary" treatment under the reciprocal health agreement between the UK and Australia. On a 457 your employer is legally responsible for any medical costs so you will not be a "drain" on the system, in reality most employers shift the onus onto the employee by asking them to take out private health insurance - read your DH's contract carefully because it may stipulate that you must provide your own health insurance. If you do, 457 holders only have access to a specific, limited number of private health insurance policies which are more expensive than those available to citizens and those with PR.

In reality I know plenty of people on 457s who rely on Medicare and haven't had any problem. Do remember though, if your DH earns above a certain amount (at the moment the family threshold is $160,000pa plus $1,500 for each child after the first) you will pay the "Medicare Levy" of 1% of your taxable income on top of your normal tax bill so it's generally worth it to have cover - it's not hard to run up the difference between what the levy would be and the annual health insurance bill if you have a few kids to go to the dentist regularly!!

Public hospitals here are normally really good and the standard of care excellent. It is often not worth actually using your private cover unless you want to be in a private hospital - you can get what you need done without it costing you a cent.

God it is so complex. Thanks for all your tips. It sounds like we might be better having private health

Coming late to this conversation but AFAIK employer-provided private health insurance is not common and when it exists is usually negotiated as part of a package...

It is bloody complex. We are on a 457 visa, i.e. a temporary, employer sponsored visa. Dh earns enough to be stung with the Medicare levy surcharge. But when I looked into hospital insurance I found we weren't allowed to get normal family health insurance as we weren't permanent residents (just as sunnyd said). The only cover I could find was $5,000 pa for some special cover they offer for people from overseas which is basically aimed at people who don't have the reciprocal health deal at all . It didn't offer us anything above what we can get on Medicare in any case. And dh doesn't earn $500k a year! So I thought stuff that, we can pay the tax instead.

So far I think I've paid a bit for a couple of GP visits, one ultrasound scan, one set of blood tests, a visit to the orthopaedic specialist with ds3 (broken elbow) and some antibiotics for ds1. Add the cost of all these to the Medicare levy surcharge and it still doesn't reach $5k so we are still in pocket, so to speak.

I've been to the GPs a few times with the kids and not had to pay. You don't have to pay for child vaccinations either (otherwise no-one would do them, I suspect).

I'm kind of keeping my head in the sand about the lifetime cover thing. If we decide to go for permanent residency I think we'll probably have to reconsider. If I have it right, you have a certain time from arriving in Australia before it applies to you anyway (something like a year, so we're close approaching that one).

We do,however, have 'extras' cover, which covers ambulance, dentistry and other similar things. I haven't had to use it yet but was worried in case I had to go to hospital in a hurry when pregnant with dd. I should actually claim back some of ds1's prescription charge on my extras cover but I haven't bothered yet.

Each state has a different deal with ambulance cover so it's worth checking out what the situation is in Victoria.