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Health Insurance

Private health insurance gives you more choice when accessing mental health services. Here are some of the major differences between private cover and Medicare.

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Tips for choosing a Private Health Insurance

  • Avoid online forms, and call the insurer directly so you can explain what you are looking for.

  • Ask the insurer about the different levels of coverage and the mental health benefits they have, as some insurers exclude many mental health services from cheaper plans.

  • Ask the insurer about extra fees for hospital stays, such as costs for private rooms, consultations with doctors, and medications.

  • Review how the insurer describes their mental health coverage, and check whether they exclude certain conditions or problems.

  • Remember to check the fine print in the Product Disclosure Statement before you purchase an insurance plan.

Private Vs Public Health Insurance

Private Cover

Medicare

Going to hospital

You can choose to be treated as a private patient in either a public OR private hospital.

Treated as a public patient by a doctor chosen by the hospital.

Choosing your doctor

You can choose your own doctor. There are more doctors to choose from.

You cannot choose your own doctor. You may not have a choice about when you will be admitted to hospital.

What’s not covered in hospital

Medicare will cover you for 75% of the scheduled fee for associated medical costs. The remaining hospital and medical costs will be charged to you. This may include:
 

  • Hospital accommodation

  • Intensive care

  • Diagnostic tests

Medicare does NOT cover the following:
 

  • Private patient hospital costs

  • Theatre fees

  • Accommodation

Out of hospital services

You can choose to use community mental health services OR private psychology services. There are more psychologists and counsellors to choose from.

You may have access to a community mental health centre, but you will not be able to choose your doctor or counsellor.
Medicare will pay 75% of the scheduled fee for some private psychology services.

“Gap” charges

There may be a “gap” on some medical services, such as psychiatrist consultations. Some doctors have “no gap” agreements with some health funds.

There may be a “gap” on out of hospital medical services, such as psychiatrist consultations, when the Medicare scheduled fee is less than the consultation cost. The Medicare Safety Net limits the amount you pay each year in gap costs for these services.

Medication

Some health funds may cover part of the cost for expensive medications. Regular medications are still covered by the Pharmaceutical Benefits Scheme.

Medications covered by the Pharmaceutical Benefits Scheme can be subsidised if you have a low income or a concession card.