Health Insurance


Story Details


Reporter: Helen Wellings

Two medical industry experts, Mitchell Watson - Senior Analyst at Canstar .. and Byron Kaye, Health Journalist for the Medical Observer .. show us CAN make private health insurance and medical services, including your GP's, lots cheaper, even zilch. But there are hidden catches costing a bomb.

Kym Cross was trying to economise by paying for private health insurance for herself and not being liable for the Medicare levy. Her husband chose not to be privately insured and pay the levy. But despite the fact that he works and pays tax, out of the blue she's been slugged with a $1800 retrospective tax bill .. for the levy.

"They just said it applies, that that's the rule .. but if you're going to be slugged with a levy because your partner or spouse doesn't have cover, you'll have to think twice." Said Kym

So the best ways to save ...

"Bulk billing is a terrific way to save money on medical bills and its really easy to do." Said Bryon Kaye

"You can receive a policy for around $60 a month, which will actually provide you cover for both hospital treatment as well as extras treatment, so it isn't out of the reach of the everyday Australian." Said Mitchell Watson

First, getting the best and cheapest policy means carefully assessing your specific needs to MATCH the cover, like hospital plus certain extras, or just hospital, or just certain extras. USE those benefits .. and avoid crippling GAP payments - charges that are more than the size of the benefit payable.

"If you utilise both your preferred networks as well as choose the right policy, there is no reason why you cannot receive all these services with no out-of-pocket payments." Said Mitchell Watson

Saving money is not JUST about the cost of premiums. You have to keep out-of-pocket expenses on claims to a minimum. So .. you need to choose a provider in your health fund's preferred network of suppliers. Your fund has a list of dentists, physiotherapists, chiropractors, podiatrists, optometrists, acupuncturists and so forth who give the largest rebates on claims.

BUPA has 5,800 plus dentists, HCF over 4,500, Medibank over 4,000, Australian Unity 380.

"If you do hold private health insurance and you are going to a provider who is outside of that insurer's network, you may be paying more for the same service than what you would actually by using one of their own preferred providers." Said Mitchell Watson

Canstar compared the gap or out-of-pocket expenses between the major funds, on their top or ultimate cover product. DENTAL, a full crown veneered .. lowest out-of pocket expenses .. Australian Unity $165, Medibank $206, NIB $341, highest amount to pay .. BUPA $565 and HCF $730, but note that their premiums are amongst the cheapest. Generally, the cheaper the premium, the more you pay out of pocket.

"Amongst the five funds that there was a difference of around $500 between the lowest out-of-pockets to the highest out of pockets." Said Mitchell Watson

A PHYSIO consultation ... lowest out-of-pocket expenses, again Australian Unity $15.50, NIB $19.30, and highest gap HCF $24.

"So even if you are paying more month to month, just by making claims you may be getting more back from your health insurance then what you are paying out." Said Mitchell Watson

"If you go to a doctor who bulk bills, you don't have to pay a cent for that service." Said Byron Kaye

Byron Kaye says seek out GPs who bulk bill, otherwise for a $60 consultation, Medicare might rebate $45, leaving $15 to for you to pay.

As for Kym .. she's now considering, after that massive penalty, whether to ditch her private cover, or get her husband to join a fund.

"It would be very easy to be caught out because its a fairly complex wording and difficult for anyone to understand. So everyone needs to be aware that just because they have private health cover, doesn't mean they won't have to pay the medicare levy surcharge." Said Kym Cross