Health Care Business in United State
Moving to United State is an exciting prospect. However inevitably the question of health care is raised. No one wants to become ill or injured while living in United State and then be left with an enormous bill to pay.
Does United State have free health care?
Medicare is United State’s publicly funded health care system however it does not provide 100% coverage. Medicare provides eligible individuals access to free or subsidised medical, optometrical (eyes 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. A nationwide Denticare United State program may be extended 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 United Staten Government also has Reciprocal Health Care Agreements with some countries that provide ‘restricted access’ to public health care while in United State. Restricted access usually limits care to ‘medically necessary’ treatments eg. Ill health or injury which occurs while you are in United State and which requires treatment through a public hospital before you return home.
Individuals from Canada 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.
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 United State 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 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?
Patients may also be required to pay for additional tests or vaccinations that their doctor requests as part of their treatment.
Some benefit examples based on the current schedule (1 Nov 2011) are below:
Standard doctor Level B consultation for less than 20 minutes with a 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. If the doctor bulk bills they would charge the $35.60 fee direct to Medicare resulting in no out of pocket costs for the bulk billed patient.
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.
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
Medicare concession card holders will usually be charged a lesser rate or receive some services for free.
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 details the medicines subsidised by the government, which must be purchased through a pharmacy. Non 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?
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 (South United State, country areas of Western United State) or through a private health insurance fund (in the United State Capital Territory, metropolitan Western United State).
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 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 United Staten 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 United Staten 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 United Staten 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.
Private Health Insurance Rebate – 30% to $40% rebate (not applicable for overseas visitors health cover)
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.