Medicaid Health Cover in Australia

RUNNING HEAD: MEDICAID HEALTH COVER IN AUSTRALIA
Medicaid health cover in Australia
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MEDICAID HEALTH COVER IN AUSTRALIA
Medicaid health cover in Australia
Medicare is a scheme started by the Australian government to provide healthcare services
to all Australian citizens and some of the permanent residents. The initiative is under the
department of human services and works by providing free or subsidized healthcare to the
citizens. It covers doctor visits, specialists and in some cases, healthcare specialists such as
dentists. Under the Medicare cover, all Australian citizens have access to free medical services
from public hospitals. All those covered by Medicare are given a Medicare card, which is
presented to the hospital every time a patient goes to the hospital. Medicaid covers lab tests
performed on the patient, pharmaceutical bills and the fees payable to the doctor. The medical
cover, however, does not include medical nursing services, provision of glasses or contact lens,
ambulance transport and acquisition of hearing devices.
Those eligible for Medicare healthcare services include Australian or New Zealand
citizens, permanent residents of Australia, those who have applied for permanent residency,
those covered by ministerial order, those having a resident return visa and those people covered
by a reciprocal healthcare agreement with another country. Those who are over 15 years old are
eligible to apply for their personal Medicaid card. Children under 15 years have access to their
parent’s Medicaid cover. Those babies born in Australia are automatically enrolled in Medicaid
health insurance.
Medicaid operates using a Medicaid Benefits Schedule (MBS), which assigns a fee to all
the medical services provided by the healthcare facilities in the country. The government does its
assessment on the current costs of medical care and decides on a reasonable fee for the various
medical services. The MBS schedule fees are then set based on the value of the medical services.
The MBS covers all the costs of treatment, including medical tests on a patient and the

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MEDICAID HEALTH COVER IN AUSTRALIA
consultation fees for seeing the doctor. The amount of money that is reimbursed by Medicaid is
dependent on the MBS schedule fee for that particular treatment. Patients can even get a 100 per
cent reimbursement of the medical charges. Those patients seeking the services of a specialist get
reimbursed 85 per cent of the MBS fees allocated for seeing the specialist. Those seeing a
general practitioner get 100 per cent reimbursement of the MBS fees allocated for the particular
treatment. Most doctors charge according to the charges set by the MBS structure, but specialists
and other healthcare professionals can charge more than the costs on the MBS structure. Patients
seeking these services are then forced to pay the exceeded amounts using their cash.
Pharmaceutical Benefits Scheme is a program under Medicaid that was set up to provide
affordable medication to all the people under Medicaid cover. Under the scheme, the prices of
most of the prescription medicines are subsidized. The health consumer status of a patient
determines how much a patient pays for the prescription drug (Nicholas et al 2011).
Some of the doctors bulk-bill. The term means that they accept full payment of the
medical services through the Medicaid program. Doctors mainly take bulk-billing for children
and low-income earners. Specialists rarely accept bulk-billing and patients mostly end up paying
for the services from their own pockets.
The main target for Medicaid health services is low-income earners. The service ensures
that all Australian citizens have access to a medical cover. High-income earners under the
program pay additional charges for Medicare covers. Australian citizens pay for the insurance
cover through a two per cent medical levy and are administered through the tax system. Low-
income earner and the pensioners are however exempted from the charges. Discounts for
families also exist to help all the people to take up healthcare insurance. The government also
funds the program from general revenue (Morong et al 2017).