Private Health..Yay or Nay

Has to be the right cover and not the basic option, as basic doesn't cover the real issues.
For us as a couple it's about 5k-6k per year, won't be renewing after this year and will just pay for future problems when they happen, and I'm a realist so I know they will happen eventually. If you don't have health insurance just make sure you can get funds to cover the procedures when they do occur.

 

Nay
Health funds COST, all the admin and management (even for the non profit members owned funds) it all adds up

Had it back in the hey day (18-20) at my parents insistence .
Seemed that every qtr my premium would increase....
Had nothing to claim anyway !
So I ditched it

Put all of those funds into my mortgage
Now over 27 year later I am

Sure the day will come when I do need something major, #redraw

(Like the other halfs tummy tuck, quote with health fund was $19k, direct deposit price was $14k and it was done in 4 days, and still got exactly the same refund thru Medicare) go figure

 

I just cancelled my Bupa membership.

 

I am reviewing my level of cover. It won't include Extras. The additional cost versus the benefits paid isn't worth it for me.

BUPA has been in the news as of late regarding it's nursing homes. Definitely not a good advertisement if the allegations are true. Possibly a matter of ethics versus money and money may have won (Let's include charges for this because they wont find out.)

 

So I am still undecided what to do with my private health but more and more I see and hear is leaning towards getting rid of it.

Just recently my wife was informed glasses may help. Called BUPA and they will provide a whopping $150 of a pair. If however I go to BUPA optical (who probably charge more) they will have me an extra $50....

And I was speaking to a mate on the weekend who needs a knee reconstruction. When it comes to operations like this you really only want to use the best. Well turns out when you do actually want to use elective surgeons they need to be a BUPA first. If not then they hardly cover a thing. My mate is now up for $$$$$$$ and he has one of the top covers.

So more and more I’m learning you may be “covered” but what are you actually even covered for....

 

I had an operation where the OOP was about $5K, but the amount I didn't pay (for surgeon, hospital, prosthetic) was about $20K. Going public for this operation is not an option for adults, children will get priority.

My partner has a monthly infusion which is $400/month, paid the $250 excess once this year and the rest is covered. Going private means he can go on a Saturday, otherwise he'd have to take a day off every month. Those cover the PHI bill.

As to Extras cover, we get back more than we pay (*) with dental checkups (2 times per year for 4 people), glasses for 3 of us, and the odd physio/podiatry or whatever.

(*) PS what other insurance cover is there that people expect to recover their costs every year?

 

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Bad news, Lizzie.

Only the top covers include joint replacement. You may be able to take a higher excess to reduce the premium.
Marg

 

The way to optimise this is to drop extras and self insure - since the benefits are capped and you have a good idea of what you spend, it is easy to work out the value.

My rough math indicates it is worth keeping extras with a family but definately not during your 20s and 30s sans kids. That's 30k I'll never get back

Just keep top hospital.

 

We dropped our private health cover when our youngest was 3 and we no longer needed/wanted cover for pregnancy and birth. Always planned to take it up again later.

We re-joined when the LHC was to be introduced. We have top cover but no extras.

A tale of two knees.

While overseas last year hubby realised the time had come and he could no longer put off his knee replacement surgery. Home early October. Phoned surgeon of choice (family connection) and fluked an appointment on 15th November, xrays to be done before visit. Doctor confirmed replacement necessary but not urgent - want it done before or after Christmas? Replied we wanted it as soon as possible, operation performed 28th November. Health fund paid $25K, out of pocket expenses around $4K (advised beforehand).

A person I know has been on the public waiting list for well over two years. Operation finally scheduled for early December 2018. Phoned a day or two before, operation cancelled (more urgent cases), wait for another surgery date. Advised surgery date early March, 2019, yes, cancelled again. Still waiting for another date for surgery with no certainty it will actually happen.

On the other hand, our elderly next-door-neighbour fell and broke his hip. He had a (public hospital) hip replacement within two days.

The public system is great for emergencies but not for what they consider elective surgery. The public ED at QE2 hospital saved hubby’s life after his anaphylactic reaction to the Endone they gave him.
Marg

 

Try Specsavers!

I have basic reading glasses, nothing fancy, simply scrip. $39 using their very limited range of cheapest frames, luckily found one I liked. Bought 2 pairs.

They have a large range of $149 frames - must be the common health fund allowance!!
Marg

 

PHI pays bugger all for almost any op since PHI is intended to pay 75% of the SCHEDULED fee. Medicare picks up the 25%. What it does pay is the very expensive costs of the bed. In full subject to the hospital and the duration of the stay.. Thats from $600 a day. Otherwise every other cost will results in gap unless the insurer has cut deals with providers which is pretty limited.

One way to game the system is private health and a public hospital electing to be treated as a private patient. They push you to the front for NO outlay for any procedure. If they ask for an excess you dont need to pay it. They are happy with any $$$ they can get. Depends on the procedure too. Some procedures are not available in public hospitals. Some not available in a private hospital. Some procedures are best undertaken in a public hospital. Depends...But without PHI you get no choice. Can you pay cash to jump the queue ? No, strangely. Apparently the Govt doesnt want to start a health auction.

And dont ignore taking out ambulance cover if you do drop PHI.

 

Except if youre a resident of QLD.

If you're a permanent resident in Queensland theQueensland Government will cover your ambulance costs across all Australian states. Just forward your invoice through to the Queensland Ambulance Serviceand your bill will be paid by them, with no out of pocket fees for you.

 

That's because everyone has ambulance cover already in QLD. What you're suggesting is the same as someone covered by Ambulance cover in Victoria and gets injured in QLD.

Every state should use the QLD model, just include it in rates or whatever. After all we don't directly pay for fire brigade services - it's covered by tax, rates or whatever.

 

Anyone done the figures to show much far ahead/behind you are when you choose PHI vs putting in offset? For a family of four or more it's a lot of money which could be put to better use and yet still be available should you need elective/queue-jumping hospital care.

 

I would have thought that with a family, you are better off using PHI than for a couple. I cant compare singles, sorry. Singles I think are half the premium of a couple/family.

Why? They charge the same premium whether you are a family of two or six or whatever.

 

What about the Medicare Levy Surcharge for those who earn more than $90k?
Sounds like we don't have a choice but to get a private health insurance even if we're not using it

 

Qld excepted, it might be worth taking out ambulance cover even if you've got PHI. My PHI policy says that ambulance costs are covered in the event of a medical emergency. Last year I needed ambulance transfer from acute hospital to rehab and Ambulance Victoria covered this without argument. Would BUPA?

 

I used to have it through Bupa but cancelled it a couple of years ago as I couldn't justify paying 3k/year plus still having significant out of pocket expenses.

I had a colleague in my previous job who would go to Specsavers and get the eye test bulk billed and then use the prescription to buy glasses online. There are apparently some Asian websites that sell most of the same types of glasses (non designer ones) really cheaply.