How to access low-cost medical services in Australia

Key pointsMedicare and the Pharmaceutical Benefits Scheme are part of Australia’s subsidized universal healthcare systemMedicare cardholders pay little or nothing on many medical services. If you visit a medical practice that pays ‘bulk bills’, you don’t have to pay anything out of pocket Medicare cardholders sometimes have to pay the difference between the full cost of a product or service and the amount the government subsidizes Australian citizens, permanent residents and refugees can get free or low-cost medical care and medicine by enrolling in Medicare, Australia’s universal health care system. Medicare works with the Pharmaceutical Benefits Scheme (PBS), which subsidizes prescription drugs. The first step to accessing these schemes is by registering with , through the going to see a doctor,” Services Australia Community Information Officer, Justin Bott explained.

“You can use that Medicare card to access reduced prescriptions from your pharmacist or reduced bills from the doctor, or potentially pay nothing through bulk billing.”

What to do when you are sick

When you feel ill in Australia, you should first visit a general practitioner (GP) at a clinic or medical center unless it is an emergency. In that case, you can go straight to a hospital’s emergency department.

In most scenarios, people who feel unwell or need a medical check-up visit someone like Dr Douglas Hor, a GP who has been practicing medicine in Sydney’s northern suburbs for decades.

The GP in Australia can probably deal with 80-90 per cent of most conditions that the patient comes in to see the doctor for… Whatever comes through the door they will treat.

“He will listen to your symptoms and try to determine what your problem is, and then what needs to be done for treatment and try to explain it all to the patient. They are the best doctors who can treat the patient holistically,” said Dr. The GP may then decide to refer patients for further tests or other medical procedures, as required.

The GP can also refer patients to other specialist doctors for further review – including mental health specialists – or send them to a hospital. GPs also provide patients with prescriptions to buy medicines from pharmacies, and recommend vaccinations.

Bulk billing and how to claim your money back

Some medical services may be fully subsidized by Medicare, or only partially covered. This means that patients may sometimes have to pay the difference between the full fee or cost of the product or service, and what Medicare funds. An important feature of the Medicare and GP subsidy system is called bulk billing. If you visit a medical practice that ‘bulk bills’, you won’t have to pay anything at the end of the consultation.

“Depending on which practice you go to, which doctor you see and in what circumstances, it is up to the doctor and the practice whether they pay the consultation directly to the government via Medicare, or whether they charge the patient privately. If you go along to a bulk billing doctor, who is happy to waive a private fee and is happy to charge the consultation to Medicare, you don’t have to pay any money out of pocket,” says Dr Hor.

Seniors and low-income Australians can access additional discounts. Credit: Philadendron/Getty Images

If you visit a doctor who does not do bulk billing, you will likely have to pay the full fee at the end of the consultation. However, you can still claim some of that money back through the Medicare rebate system.

The easiest way to claim that money back from Medicare is in your doctor’s office. They can submit the claim to Medicare for you. Medicare will then make the payments into your bank account later. If you can’t, you’ll need to go to Medicare and you can do that online.

Justin Bott, Services AustraliaAustralian Taxpayers fund Medicare via the income tax system, through the Medicare Levy. The amount contributors pay into the system varies according to their age and personal family circumstances. Vulnerable, low-income Australian citizens and permanent residents, such as Concession Cardholders and Commonwealth Senior Cardholders, receive additional Medicare benefits and PBS discounts. Mr. Bott adds that both the Medicare system and the Pharmaceutical Benefits scheme also have spending thresholds. Once these are exceeded, patients’ medical costs are further discounted. “When you pay enough in medical costs throughout the year, you reach those thresholds and what you pay becomes much cheaper after that,” he explains.

“If you register as a family, the husband, wife and the children together will reach those thresholds sooner, and you will be able to get cheaper medicines or cheaper trips to the doctor faster.”

Medicare and private health insurance

Patients can also choose to supplement Medicare with private health insurance, to help pay for services and treatments not covered by the public system, such as visits to the dentist, ambulance services and some vaccinations. Private health insurance also allows patients to pay privately to attend hospitals. , speeding up their access to non-urgent surgeries and other tests.

“Under the public system, you are put on the public list and you have to wait until your name comes up to get an operation done. The private health insurance allows you to choose your own doctor in a private or public hospital and have the operation done earlier than if you had to wait on the public system,” explains Dr Hor.

Doctors and medical centers in Australia are also used to examining patients who do not speak English very well. Dr Hor says he often uses translation mobile apps to convey simple concepts. For more complex explanations, however, he relies on the government’s free interpreter service.

“We can actually call on the spot. It is a government subsidized interpreting service. They can actually translate for the GP on the spot on the speakerphone and patient conversations and the interpreter can understand and translate back to the doctor what the problem is.”

Telephone and online virtual consultations have become more common in Australia since the COVID-19 pandemic. Credit: Phynart Studio/Getty Images

Telehealth and e-scripts

Many patients can also benefit from Telehealth appointments and e-scripts if they cannot attend the doctor’s office in person. These services are also covered by Medicare and the PBS. To be eligible for Telehealth, the patient must have been a patient of the doctor in the previous 12 months.

“Telehealth allows the doctor to talk to the patient either through direct audio or through a video consultation. We are able to treat the patient because we can now do e-scripting which allows us to write a script with a QR code on it, email the script to the patients and they can to the pharmacy and handed out the script item without even touching the GP,” says Dr Hor.