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Understanding Medicare

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Medicare and private health insurance

Medicare provides access to free or low-cost public healthcare and the ability to claim some medical expenses to eligible individuals.

However, Medicare doesn't cover everything which is why having access to private health insurance can help. With private health insurance you can claim back some or all of the costs associated with your healthcare that you can't claim through Medicare and potentially avoid public hospital waiting lists.

What is covered by Medicare?

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Benefits covered by Medicare include:

  • A stay in a public hospital as a public patient

  • Part of the cost of pharmaceutical prescriptions, through the Pharmaceutical Benefits Scheme

  • Part of the cost of GP and specialist consultants through the Medicare Benefits Schedule

  • Part or whole consultation fees for doctors, including specialists

  • Part or the whole cost of tests and examinations by doctors needed to treat illnesses, including X-rays and pathology tests

  • Part or the whole cost of eye tests - undertaken by optometrists

  • Part or the whole cost of psychology services - you must be referred by your GP, psychiatrist or paediatrician to receive the benefits

What is not usually covered by Medicare?

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Items not usually covered by Medicare include:

  • Private patient hospital costs (for example, theatre fees or accommodation)

  • Dental examinations and treatment

  • Ambulance services

  • Glasses and contact lenses

  • Home nursing

  • Physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services, podiatry

  • Psychology services (unless as part of an agreed procedure referred by your GP, psychiatrist or paediatrician)

  • Acupuncture (unless part of a doctor's consultation)