What is the difference between Medicare and Private Health Insurance? Top things to know before having Private Health Insurance.

I knew the importance of having a Private Health Insurance in India, but was always confused with Australian System. This is all because of Medicare and the way the hospital works in this country. I used to wonder why Insurance companies exist in this country because Medicare provides free GP visits and treatments in public hospitals.

However, we took the private insurance based on some benefits we knew like avoiding Medicare levy surcharge and have Ambulance cover. Whenever I tried to find the difference, I was more confused with many more questions in mind. After working in Health for 5+ years; I have slowly understood some differences between Medicare and Private Health Insurance.

Medicare – Public Health System	Private Health Insurance
The Public Health System is managed my Medicare Australia. Citizens and Permanent Residents are eligible to  obtain a Medicare Card.	The Private Health Insurance do not have requirements, it serves all ages and sex irrespective of their visa status. There are many companies to choose from if you prefer to have Private Health Insurance cover. The Companies like HCF, Health.com, Medibank Private, Bupa and others.
Medicare pays for the patients to be treated in the public Health System.	Private Health Insurance pays for the patients to be treated in the Private Health System.
Every Medicare Card holder pay 2% Medicare levy on their annual income (if the earnings are above $18k) to support the government for availing the Public Health Services.	It is up to each individual depending on their affordability to choose the policy. The premiums range from policy to policy based on the features of the policy.  We chose Health.com for 65% expenses cover with extra services.
Through Medicare, Patients receive free or subsidized treatment by Doctors, Specialists and Accommodation in Public Hospital as a public patient. Most of the treatments in public hospital are bulk billed. If they are not covered in any circumstances, then you pay the gap between the fee charged by the Doctor and the amount paid by Medicare.	The private patients pay the gap between the Doctor or accommodation fees and the benefit paid by the Health Fund. However, this depends on the coverage of your policy. Some policies do not cover certain treatments and some cover whole treatment cost. In our case, we are with Heart Hospital+ High 65; this policy gives us 65% back on the extras and covers heart and lung diseases.
My experience working with Health exposed me to some areas of processes within Hospital. I know how waiting lists are prepared and monitored in Public Hospitals. The minimum wait is 1 month to 1 year depending on the surgery type.	Patients with Private Health Insurance have a much shorter wait. Private patients can even chose a treatment date for some surgeries like C-Section.
In the Public System, you are treated by the doctor who is on call at the time of your appointment or treatment. You may be seen by different doctors or one doctor during your period at the hospital depending on their shifts or rosters.	Patients with Private Insurance allow you to choose the doctor of your preference. You get treatment by the same Doctor during your stay at the Hospital.
Usually Public Patients share room with other patients. It can range from 2 to 4 people in the same ward	Private Patients have the option of choosing to stay in a shared room in Private Hospital or private room in Public or Private Hospital. This all depends on the policy you are covered by. Some policies cover the cost of shared room or private room. However, this all depends on the availability of the rooms.
Even Public Hospital has Dental Care, but they have a very long wait period and subject to income test. Medicare does not cover for Optical (glasses), Chiropractic, Physiotherapy or any other remedial massages.	Private Health Insurance cover Dental care, Optical, Chiropractic, Physiotherapy and others. We visit optometrist yearly for glasses for both my husband and myself. We do not pay any dollar. We also visit Dentist for Dental Care and incur minimum gap for cleaning and scaling. If we had to go without the insurance, we would have paid for these services out of pocket.
When we initially opt for Private Insurance, we were not 100% sure the real benefits of Health Insurance. However, we took to avoid 1.5% Medicare Levy Surcharge on the family income. Medicare Levy Surcharge is an extra tax paid up to 1.5% by the high income earners ($90,000 for Singles and $180,000 for Families)	This is an advantage to high income earners to avoid Medicare Levy Surcharge and use that money for better health.
Lifetime Health Cover loading is an extra charge that increases health insurance premiums if you did not have health insurance when you turned 30.  Premium prices increase by 2% for every year you did not have health insurance after your 30th birthday.	If you obtain health insurance before turning 31 helps you to avoid Lifetime Health Cover Loading as long as you maintain the policy.
Medicare Card does not cover the Ambulance fee. If you call the Ambulance, you are charged with a call out fee to be paid out of pocket.	Private Health Insurance covers the Ambulance fee. You do not need to pay when you call out for Ambulance.

Do you know the below?

1. You can admit as a Private Patient in Public Hospital. This provides the same benefits as being in Private Hospital.

 

2. Some of my friends ask me whether to have private insurance for Pregnancy. Yes, you can have if you can afford extra on your premiums apart from your normal premiums paid.

 

Once you take the policy, you need to wait for one year to avail the service. You also need to be prepared to pay Anesthetist fee out of pocket. You may need private health insurance if you have complex pregnancy and need specialist advise on regular basis otherwise it is not required to have one.

 

Public Hospitals provide world class treatment in relates to pregnancy. I had two C-Sections in a Public Hospital, it was a happy and wonderful experience before and after service delivery.

 

3. If you are planning to have any planned surgery, you can request the Doctor how much the surgery costs and what private insurance covers and what not. On this basis, you can decide to admit as a public patient or private patient depending on your affordability. This gives you peace of mind and also helps you to budget accordingly.

 

4. Private Insurance policies reduces the long wait list and helps you to treat quickly than as the public patient. For example, you had to visit emergency and have private insurance, it is up to you to choose to go as a private patient or a public patient. However, the emergency treatments are undertaken by relevant doctors irrespective of your insurance status.

 

5. From my understanding, Private health insurance is beneficial for elective surgeries. Elective surgeries are those that are planned and can wait to perform in the future periods.

I understood some differences between Private health insurance and Medicare in Australia as stated above. If you know any more benefits apart from the above, please share in the comments.