Wendy Jenkins, from Moving2Plan www.moving2plan.com.au has provided us with a guest post today, to explain the maze of the Australian Health Care system, and how you, as a migrant, can navigate your way through it.  

Moving to Australia is an exciting prospect. However inevitably the question of health care is raised. No one wants to become ill or injured while living in Australia and then be left with an enormous bill to pay. We have therefore answered below some of the more common queries that arise.

Does Australia have free health care?

Medicare is Australia’s publicly funded health care system however it does not provide 100% coverage. Medicare provides eligible individuals access to free or subsidised medical, optometrical (eye care) and public hospital care. Medicare does not pay towards ambulance costs, physiotherapy, spectacles, podiatry, chiropractic services, or private hospital accommodation.

Medicare also does not cover dental costs, with some exceptions for low-income earners. There is a suggestion that a nationwide Denticare Australia program may be included in the next government budget, however the specific details are yet to be announced. Some dental organisations provide interest free payment plans, member discounted services that attract an annual fee, or discounts for regular patients to help manage costs.

Individuals can also choose to access private health services that charge for their services, and may choose to take out private health insurance to cover these types of costs.

Will I be eligible for a Reciprocal Health Care Agreement?

The Australian Government also has Reciprocal Health Care Agreements with some countries that provide ‘restricted access’ to public health care while in Australia. Restricted access usually limits care to ‘medically necessary’ treatments eg. Ill health or injury which occurs while you are in Australia and which requires treatment through a public hospital before you return home.

Individuals from New Zealand and Ireland do not get issued with a Medicare card and instead present their passport at public hospitals or pharmacies. Non-hospital care, such as attending a local GP doctor, is not covered. Other reciprocal agreements will pay Medicare benefits for out-of-pocket medical treatment provided by doctors through private surgeries and community health centres. All agreements cover subsidised medicines under the Pharmaceutical Benefits Scheme (PBS).

Note: Reciprocal agreements technically only cover individuals if they have come directly from the reciprocal country eg. If you were previously living in another foreign country prior to coming to Australia you may not be eligible, as you have not been recently been part of the health system for your country of nationality. However application of this requirement varies between Medicare staff.

Medicare Information Kits for migrants are available in 19 different languages.

What amount is subsidised by the government?

The benefit (or refund) that you receive back from Medicare is based on the Medicare Benefits Schedule (MBS) for that specific service which is set by the government. Doctors and other health service professionals can choose to charge over the schedule fee or bulk bill. Bulk billing is when doctors bill Medicare directly, accepting the Medicare benefits as full payment for the service. If doctors charge a higher amount the patient wears the extra costs.

Many doctors now offer to process Medicare claims electronically at the end of the appointment. Alternatively you can lodge most claims online, visit a Medicare office or post in your claims. Refer also to How does Medicare work?

Some benefit examples based on the current schedule (1 Nov 2011) are below:

o    Standard doctor Level B consultation for less than 20 minutes with a GP (General Practitioner) in their consulting rooms:
Fee = $35.60 and Benefit = 100% so you receive a $35.60 rebate.
Therefore if the doctor charges $65.00 for an appointment you will be out of pocket by $29.40.

o    Specialist doctor consultation initial appointment in a hospital or their consulting rooms:
Fee = $83.95 and Benefit = 75% (hospital in-patient) or 85% (out-of-hospital) so you would receive either a $63.00 or $71.40 rebate.
Therefore if the doctor charges $130.00 for an appointment you will be out of pocket by $67.00 or $58.60. You will need a referral letter from a GP to see a specialist so will need to budget for both out of pocket costs. Specialist fees can also vary considerably with some charging several hundreds of dollars if they are highly specialised and sought after. It is worth checking fees prior to making appointments so you are prepared for any out of pocket costs.

o    Comprehensive dental oral examination, limited to 1 per provider every 2 years: Note: Any preventive services like removal of plaque and/or stains, or any fillings etc are billed separately and can quickly add up to a sizeable bill even with the rebates.
Benefit = $40.50 so if the dentist charges $95 for this item you will be out of pocket by $54.50

Note: If you are not eligible for Medicare you will have to pay the full appointment fees. However you are also exempt from paying the Medicare Levy and any surcharges (see below for more information on these).

The Pharmaceutical Benefits Scheme (PBS) details the medicines subsidised by the government, which must be purchased through a pharmacy. Non-PBS medications will be charged at full price.

The government also protects high users of medical services from big out-of-pocket costs through the Medicare Safety Net, and provides pension and health care concessions for pensioners and low income earners. The PBS Safety Net is available for individuals who need a lot of medicines in any year.

Individuals may also be able to claim a tax offset of 20% for net medical expenses over the threshold, currently $1,500 for the tax year for eligible expenses.

Note: The above protections may only apply to individuals on full Medicare so check further with Medicare before applying.

Are there any costs when I use an ambulance?

Ambulance cover varies between the different Australian States & Territories.

In Queensland and Tasmania, ambulance services are provided free for local residents.
In all other States & Territories, fees may be charged. The fees can vary depending on: how far individuals travel by ambulance, the type of transport eg. helicopter, the nature of the illness, whether an emergency or not, and any concession eligibilities.

Residents living outside Queensland or Tasmania can insure against ambulance costs, either through membership schemes provided by the relevant ambulance service (in the Northern Territory, South Australia, Victoria and country areas of Western Australia) or through a private health insurance fund (in the Australian Capital Territory, New South Wales and metropolitan Western Australia).

Note: Check the details of any ambulance cover provided by private health insurers carefully as it may only be limited to ‘emergency’ transportation eg. not covering trips between hospitals or non-critical call outs. Membership with ambulance services may be more comprehensive.

In most cases, local holiday or business visitors to other States & Territories will be covered if they were covered in their home State or Territory due to reciprocal arrangements. However it is worth checking this before travelling to other States or Territories.

Do I have to pay anything towards Medicare?

Medicare is funded by a Medicare Levy tax deduction taken from your income with the contribution level based on how much you earn. The Medicare Levy is currently 1.5% of taxable income.

In addition, the Medicare Levy Surcharge of 1% is levied on high-income earners who do not have private hospital cover. The income threshold for 2011-12 year is $80,000 for singles and 160,000 for couples / families increasing by $1,500 for second and subsequent dependents. The surcharge is designed to encourage individuals to take out private cover and therefore reduce the demand on the public Medicare system.

If you are not eligible for Medicare then you may qualify for a Medicare Levy exemption and will not have to pay the Medicare Levy or Medicare Levy Surcharge. You must however complete a Medicare Levy Exemption Form in order to be exempt from the tax.

What are the differences between Medicare and Private Health Insurance Cover?

The Health Insurance Ombudsman has a good comparison of Medicare and Private Health Insurance.

Do I have to take out private health insurance?

You do not have to have private health insurance unless it is a requirement of your Australian visa to make arrangements for a minimum level of health insurance. A sponsor could still offer to pay the insurance, however if not the visa holder is responsible. Student visa holders are required to have Overseas Student Health Cover, although students from Sweden or Norway may have special arrangements.

However you may still want to consider taking out private health insurance to give you more health care options, to cover items which aren’t covered on Medicare such as dental costs, or if you are not eligible for full Medicare.

There are two types of private health insurance: 1) Hospital policies and 2) Ancillary or extras cover for treatments such as dental and physiotherapy. Most health funds offer combined policies. Insurance policies may also have exclusions and restrictions, excess payments and waiting periods for certain claims. Insurance claims may also be subject to annual limits for certain types of claims. Insurers often have preferred suppliers who may offer higher benefits for members.

How much does it cost to have private health insurance?

The costs of insurance vary considerably depending on what health cover plan and insurer you choose. You should only choose a registered Australian insurer and one way of choosing is to use the many free comparison sites available. The Private Health Insurance Ombudsman website also has excellent information.

If you are currently with a recognised international health fund you may be able to obtain an insurance clearance certificate and transfer without incurring waiting periods for some claims. Continual coverage will depend on the old and new policies being similar. Many Australian insurers refer to the International Federation of Health Plans to determine whether a fund is recognised under their transfer policies.

Health insurance rates can increase on 1 April each year in line with government regulation and in 2012 this resulted in average increases of 5.06% for new and existing premiums.

In addition to the Medicare Levy Surcharge, the government also has two other key private health insurance incentives including:

o    Private Health Insurance Rebate – 30% to $40% rebate (not applicable for overseas visitors health cover)
o    Lifetime Health Cover – Additional loadings that increase the later you take out health insurance during your lifetime with a maximum loading of 70%.

1 July 2012 Changes

From 1 July 2012, the Rebate and the Medicare Levy Surcharge will be means tested. This could result in substantial benefit reductions for high-income earners, particularly singles earning $130,001 or more, and couples/families earning $260,001 as their rebate will drop to zero.

You can read more about these changes at privatehealth.gov.au.

About the Author

Wendy Jenkins is the owner and creator of Moving2plan, a unique online relocation solution for anyone moving to Australia. The innovative application allows members to plan and track their own move online saving time and money.

As the former Expatriation Lead for Shell Oceania, one of the leading experts in this field, Wendy has had extensive experience assisting hundreds of individuals and families to move to and from Australia. Wendy’s advice was also constantly being sought by external individuals who wanted to move to Australia, but who did not have the budget for costly traditional relocation services. She therefore developed the Moving2plan application to fill this gap in the marketplace, working hard to offer a low cost yet high quality online relocation tool.

Moving2plan is testament to Wendy’s understanding of the complexity, challenges and personal needs involved when moving to Australia. Moving2plan’s customised solution provides members with a tailored online guide and planning tool specific for their needs. Wendy brings together over 14 years experience as a qualified human resources professional with multinational experience. She also has over 7 years of experience studying and working within the international travel & tourism industry, receiving several accolades during this period.

Wendy is pleased to offer Emergico readers a 30% discount on Moving2plan membership. Simply enter discount code EMERGICO when purchasing.

Emergico Career Connect - finding skilled workers

We are pleased to announce the launch of Emergico Career Connect – our International Recruitment Service!  Here’s a link to our Corporate Brochure.   At Emergico, we have a wealth of experience in International Recruitment and Strategic Migration which supports international movements of skilled people into Australia.   While we’re specifically targeting Australian businesses who need skilled workers, we can also assist job seekers to find an employer.  There’s a range of options for businesses who want to sponsor overseas employees; and in many cases, sponsoring an employee can be easier than you think!    Don’t let the skill shortage hold back your business – contact us today!!

And while we’re on the subject of July 2012 proposed migration changes, there will also be changes to Employer Nominated Sponsorship.  A streamlined pathway to permanent residency will become available to eligible Subclass 457 visa holders.  Also, IELTS requirements will increase for both ENS and RSMS to 6.0.  Will these changes make it easier or more difficult for you?  Why not contact us to talk about your situation?  We’re always happy to help…

Skilled Migration

We’re just 9 weeks away from arguably the biggest and most significant changes ever made to Skilled Migration in Australia.  From July 1, 2012, the six Points tested skilled migration visa classes will be replaced by just three classes.  The new classes will be:

• Subclass 189 – Skilled – Independent (Permanent)
• Subclass 190 – Skilled - Sponsored (Permanent)
• Subclass 489 – Skilled – Regional (Provisional)

There wil be no differentiation between onshore and offshore visas.

Importantly, after July 1, prospective migrants will not be able to lodge a visa application for any of these visas unless they are invited.  The process will involve an Expression of Interest, which needs to be lodged online.

Further information can be found here.

There are some interesting implications of the new process and we would be happy to discuss these with you.   Bear in mind that the changes are not final until the legislation is passed, which will be closer to July 1.   If you are considering a Skilled Visa for Australia, please contact us for more information.

Lest We Forget

On April 25 each year Australians remember the sacrifices made by members of the Australian and New Zealand Army Corps (ANZAC) who fought at Gallipoli in World War 1.  On this day over 10,000 ANZACS lost their lives.  Around Australia, dawn services are held at the exact time the ANZACS landed at Gallipoli (4.20 am); and memorials are held throughout the day.  The day of rememberance now incorporates all casualties of war since WWII.  ANZAC Day is a public holiday throughout Australia.  In recent times, the number of WW I and II veterans has dwindled significantly, however attendance at services and marches continues to grow at a remarkable rate.  It’s a very important day in the history of Australia.  “At the going down of the sun, and in the morning, we will remember them.  Lest We Forget”.

Hairdressers are in-demand!

All the talk in Australia is that the job market is very tight because of the current mining boom – particularly in Queensland and Western Australia.   That’s certainly true – but what some people don’t realise is that this is actually causing vacancies in other jobs – as existing workers move across to mine sites.  For example, some regional areas have extreme difficulty staffing farms because most of their staff have packed their bags and headed to the mines.  So even if you have a skill or occupation which is totally unrelated to mining – such as hairdressing – chances are you could score a good job in Australia right now.   Talk to us - we have a range of employer clients looking for skilled people right now!!

Today, the Minister for Imigration announced that there will be major changes to the Employer Nominated Sponsorship Visa Stream, with effect from July 1, 2012.   The changes include:  An increase in the upper age limit to 50 years; a change in the IELTS requirement for RSMS and ENS; a consolidated Sponsored Occupation List; and a reduction in visa classes from 6 to 2.  Maybe these changes will open doors for you which were previously closed?  Contact us to discuss your situation.  More information about the upcoming changes can be found here.

A Resident Return Visa is a permanent visa which allows a current or former Australian permanent resident, to return, if they travel overseas.  It’s required if your permanent visa has expired, and you wish to leave the country for whatever reason.  (You can avoid the need for the RRV by taking out citizenship when eligible!)   A recent change to the RRV has been to reduce the validity period from 5 years to 1 year, when a person has not lived in Australia for more than 2 of the last 5 years.

A recent change to the Student Visa Program has meant that, not only does a prospective student have to prove that they are a “Genuine Student”; they must now also prove that they are a “Genuine Temporary Entrant” to Australia.   Since November 2011, the new requirement has resulted in a high number of offshore student visa refusals.  If you are contemplating a student visa, now more than ever it pays to get professional advice first.

Do you need help?

Bob came to see me, seeking visa advice.  He listened intently to my proposed strategy for him and the advice; made some notes, then,  some weeks later advised me that he would prepare his own visa application.  A few months later I received a panicked phone call from Bob.  “Help!  My visa has been refused!  What do I do?”

What has gone wrong?  Quite simply, between my meeting with Bob and the time he lodged his own application, there had been a significant change in the legislation, which he did not know about.

Bob thought he’d save a few dollars on migration agent fees.   As a result, Bob may now struggle to get a visa because a refusal is on his record.

Migration law is constantly changing.  At Emergico we’re keeping on top of those changes, so we give our clients the best advice and follow through.  Can you afford not to have professional support, when you are talking about making one of the biggest decisions of your life?