Medicare and My Aged Care are both integral government-funded services in Australia that, together, provide holistic medical care and support for older Australians.
But how do they differ, who is eligible, and what services do they provide? We’ll answer all of these questions and more down below.
What is Medicare? Understanding the Basics
Medicare is Australia’s universal public healthcare system. Introduced in the early 1980s, it replaced the previous Medibank system and was established to provide easy access to quality subsidised or free healthcare services and public hospital care to all Australian residents. We’ll dive into it more in-depth below.
Who Does Medicare Cover?
Medicare provides coverage to individuals who are:
- Australian citizens
- Permanent residents
- Temporary residents covered by Ministerial Orders
- New Zealand citizens living in Australia with a Special Category Visa
- Visitors from countries with a Reciprocal Health Care Agreement (RHCA)
What Does Medicare Cover?
Medicare covers various health services in Australia, either by paying for them in full or by offering significant subsidies. Such services Medicare covers either partially or completely include:
- Public Hospital Care: Free accommodation and treatment in public hospitals.
- General Practitioners (GPs) & Specialists: Free or subsidised consultations with doctors and specialists.
- Mental Health Services: Subsidised sessions with psychologists and psychiatrists under a Mental Health Care Plan (MHCP).
- Medicines: Subsidised prescription drugs under the Pharmaceutical Benefits Scheme (PBS).
- Tests, Imaging, & Scans: Free or subsidised preventative pathology, blood tests, ultrasounds, x-rays, & MRIs.
- Private Hospital Costs: Medicare will help cover medical treatment costs in private hospitals, but won’t cover all private hospital fees, including accommodation and theatre costs.
- Some Allied Health Services: Medicare will subsidise five individual allied health sessions for individuals on a Chronic Disease Management (CDM) plan.
- Optometrist Eye Tests: If you’re under 65, you’re covered for one eye test every three years, whereas for those over 65, you’re covered for an eye test once every year.
What Does Medicare Not Cover?
Medicare does not cover the following services:
- Cosmetic & Elective Procedures: Procedures that Medicare considers cosmetic or elective, such as face lifts, nose jobs, and cosmetic breast surgery.
- Ambulance Costs: Ambulance costs are managed by individual states and territories, not by Medicare, and each has different rates.
- Most Allied Health Services: For those not on a CDM plan, you will not be covered by Medicare for the cost of your allied health appointment.
- Dental Care: Most dental examinations, treatments, and procedures for adults.
- Glasses, Contact Lenses, & Hearing Devices: Any devices required to assist with hearing or seeing are generally not covered by Medicare.
Common Medicare Services Used by Seniors
The types of Medicare services most used by seniors in their retirement are:
- GP’s & specialist consultations
- Diagnostic imaging & pathology
- Prescription medications on the PBS
- Yearly eye tests
- CDM plans
- Annual 75+ health assessments
What is My Aged Care? A Guide
My Aged Care is the Australian Government’s primary portal for finding and accessing aged care support services. It serves as a starting point for seniors and their families to navigate the aged care system, apply for support, and find appropriate care providers.
Key Programs
The three main government-funded programs available to you under My Aged Care include:
- Commonwealth Home Support Program (CHSP): Entry-level support for individuals who are independent but require assistance with specific tasks
- Support at Home (SAH) program: More comprehensive support for individuals who need higher levels of care but can still live independently.
- Residential Aged Care: Accommodation, care, and support for individuals who can no longer live at home independently.
Key Services
Key services available to individuals on an approved government-funded program include:
- CHSP & SAH: Care that enables individuals to continue living independently at home, such as domestic assistance, personal and nursing care, respite services, and transport assistance.
- Residential Aged Care: Around-the-clock care for higher-needs individuals. Includes accommodation, daily living services, and personal and clinical care services.
For more information regarding the different care options available to you under My Aged Care, check out our article, Future-Proofing Your Finances: Preparing for Long-Term Care Costs.
Aged Care Assessments
If you’ve come to the conclusion that you need some help and would like access to aged care services, the very first step is to get assessed. You can do this one of three ways:
- Online: Complete the quick and easy online application form found on My Aged Care.
- Over the Phone: Apply by calling My Aged Care on 1800 200 422.
- In Person: If you prefer to speak with someone in person, you can make an appointment with an Aged Care Specialist Officer at a Services Australia centre by calling 1800 227 475.
Once you have completed the initial assessment, you will be contacted to discuss your needs further and arrange a date for an at-home assessment by a trained assessor. For more information about the assessment process, head over to the My Aged Care website.
Cost Considerations
Although Medicare and the funding you receive for being on an approved My Aged Care programs do cover a significant amount of the cost of medical and support services, there are times you may be required to contribute a portion of the cost.
Medicare
Medicare out-of-pocket costs are the payments you make when the provider charges more than what Medicare covers, and you have to pay the difference. Examples of out-of-pocket costs under Medicare are:
- GP Visits: If your GP doesn’t bulk bill, you may be required to pay a portion of the cost.
- Prescription Medications: The PBS subsidises prescription medications but does not make them free. You will be required to pay a small portion of the cost.
- Specialist Appointments: As with the above, Medicare does not cover the full cost of specialist consultations, so you will need to contribute a small portion.
- Allied Health Appointments Under a CDM: Medicare offers a rebate of up to $61.80 for those on a CDM, and recipients will be required to pay the remainder.
- Diagnostic Tests: Some diagnostic imaging providers offer bulk billing, so you don’t have to pay anything. Sometimes you can claim back some of the cost of your testing; however, you will be left with an out-of-pocket fee.
- In Hospital Services: If you’re a private patient in a public or private hospital, you may be required to cover some of your costs.
My Aged Care
Payments you may have to make when you receive aged care support services include:
- CHSP: CHSP providers receive government funding; however, you are required to pay a small fee to help cover the costs. Don’t worry if you can’t afford it; this policy is designed to ensure that those who can afford to pay do, while protecting those who can’t.
- SAH: You will be required to make a small contribution to cover the costs of some services. The amount you pay will depend on the results of your income and assets assessment, as well as the type and amount of services you receive.
- Residential Aged Care: You will be required to pay a basic daily fee of $65.55. Based on your means assessment, you will be required to pay a hotelling contribution, a non-clinical care contribution, and a means-tested care fee.
For more information about potential long-term care costs, check out our blog, Future-Proofing Your Finances: Preparing for Long-Term Care Costs.
Key Differences Between Medicare and My Aged Care
Medicare and My Aged Care services are similar in that they both subsidise essential services for seniors, but differ in the services they provide. Their differences, however, are exactly why they complement eachother so well. While Medicare offers subsidised clinical care, My Aged Care offers tailored support services that make everyday living easier.
Together, these two systems ensure that older Australians receive quality, holistic care tailored to their needs.
