Healthcare System - Medicare and PBS in Australia - what's covered and what's not

Medicare

Medicare is a healthcare system in Australia. If you have a medicare card, you will be covered for many health related services as mentioned below

1. GP (General Practitioner) visits. It is covered as MBS (Medicare Benefits Schedule) item 23 (cap of $37.05 per visit)
2. Specialists fees upto certain threshold amount
3. Certain blood tests
4. Goverment hospital treatments
5. Emergencies
6. In certain states (e.g. in QLD), Ambulance cover is also provided
7. ...and many more

Below things are not covered by Medicare

1. Dental
2. Eye treatments (Optical)
3. Hearing aids
4. Acupuncture
5. Cosmetic Surgery
6. ......and many more

If you are not sure about if the specific service will be covered by Medicare or not, you can ask to your doctor. Alternatively you can also search online at http://www9.health.gov.au/mbs/search.cfm

PBS

PBS stands for pharmaceutical benefits scheme. You can claim certains costs related to medicines. You can find more details on http://www.pbs.gov.au/pbs/home

Bulk Billing

Bulk billing simply means no out of pocket expenses. You go to a doctor, get a treatment and come back without paying a single penny. All costs will be taken care by medicare and processing will be done by health service provider or medical center. For example - If you visit a GP, he or she may charge you $75 for first visit and $55 for next visits. But medicare will only cover GP visit costs upto $37 as of 2018. So you need to make a gap payment of $18 (55-37). This is not a bulk bilking as you are making gap payments or you are paying $18 out of your pockets. Some GPs will only charge you $37 but you do not have to make any payment because medicare will paye GP that amount and your medicare records will be updated. This is called as Bulk billing.

Not all GPs will provide bulk billing. Some GPs provide bulk billing with main intention of growing customer base. Especially GPs who have just started practising will do bulk billing in order to gain popularity. 

Public Hospitals vs Private Hospitals

If you take a treatment in public hospital, most of costs will be covered by Medicare so less out of pocket expenses. On the contrary, if you take treatment at private hospital, there will be more out of pocket expenses. Only benefit of taking treatment at private hospital is that there are no waiting periods and you can choose which doctor will do treatments, which is not the case in public hospital.

Major public hospitals in Brisbale QLD are Royal Brisbane Women's Hospital, Mater hill Hospital.

Pregnancy and Medicare 

Most of the people prefer to go to Public Hospital for pregranancy related services as costs are very less.

What do you think on this topic? Please express your opinion or ask any question through comment below. You can write to me at reply2sagar@gmail.com