Do seniors need private health insurance, or is Medicare enough?

  • November 02, 2020 09:30 PM AEDT
  • Edita Ivancevic
    Journalist Edita Ivancevic
    212 Posts

    Edita is a young journalist who graduated in 2019 from the Faculty of Political Science in Zagreb, Croatia, specialising in Television and Public Relations. Since the teenage years, Edita gained knowledge of news reporting and analysing complex curre...

Do seniors need private health insurance, or is Medicare enough?


  • With age, individuals become prone to developing an illness that might not be covered by Medicare.
  • For that reason, it might be a good idea to purchase a private insurance policy that will cover extra treatments. Seniors aged between 55 – 75 years are the ones that utilise these extra benefits the most.
  • However, some experts argue that public facilities are more than well equipped for adequate patient care, even for senior citizens.
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Should I opt for private health insurance? Is Medicare enough for my needs? Seniors and pensioners often grapple with these questions.

The answers to these questions can vary depending on an individual’s situation. While some seniors may feel healthy and without significant health issues, others can suffer from pre-existing illnesses or develop common diseases at an old age.

ALSO READ: How does age impact the cost of health insurance plans?

Australians have access to the 9th best healthcare system in the world, according to a recent study. In 2017, the system was ranked as second-best, only behind UK’s National Health Service (NHS). Given this data, it is safe to assume that Australian public healthcare is already more than satisfactory, but is it enough for seniors that often require additional private health policies?

MUST READ: How does health insurance work?

What treatments are covered by Medicare?

As older generations entail more care and medical treatments, it is vital to know what is already offered for free.

Medicare is Australian public health insurance that is available for most residents and even some tourists that have specific agreements with their countries. The coverage includes three components:

  • Hospital treatments – Medicare offers free-of-charge hospitals services that include all doctors’ appointments and other in-hospital treatments. Patients cannot choose their doctor as hospitals appoint available doctors in the public healthcare system. As public patients, they might be put on waiting queues so hospital treatments may not be instant. Within this category, Medicare does not cover for private healthcare costs (accommodation costs, theatre fees etc.), hospital costs for overseas treatments, cosmetic and unnecessary surgeries, ambulance cover, facility fees, and emergency administration. These services could be accessed for free (or mostly free) if one has a private insurance policy.
  • Medical – Within this component, Medicare covers all general practitioners (GPs) consultations, and 85 per cent for specialists. Some GPs are already charging Medicare directly (bulk billing), so in that case, patients are not required to pay for anything. Apart from consultations, all tests that determine whether the person is sick or not (e.g. MR scans, blood tests, and similar) are entirely free. Other medical services covered by Medicare are eye tests, most surgeries, some dental surgeries, particular elements under the Cleft Lip and Palate Scheme, certain items under the Enhanced Primary Care (EPC) program, and some health services under the Chronic Disease Management Plan.
  • PharmaceuticalPharmaceutical Benefits Scheme (PBS) allows eligible Medicare holders to get a part of medicinal costs covered. Depending on the drug type, the amount individuals need to pay differs. All individuals need to hold a physical Medicare card to obtain this advantage. Moreover, eligible seniors that are holders of Commonwealth Seniors Health Card get further discount on the cost for medications.

RELATED: What are the different types of health insurance available in Australia?

What should seniors look out for?

Respectively, seniors do not require the same medical care as they needed when they were in their 20s or 30s. Even though the necessity for medical attention is likely to increase over the years, many people are not entirely sure what policy and benefits to choose.

Image Source: © Kalkine Group 2020

Image Source: © Kalkine Group 2020

That said, seniors are advised to get a policy that will pay for a sufficient level of hospital cover, as well as extras for the most common diseases. Most private insurance companies have already overseen this need, so they created special retirement health packages.

It is essential to read all the terms and conditions before signing up for a policy, as private insurance is often expensive. Other family members could also help out with choosing the right insurer, so high out-of-pocket costs would not occur when the time comes.

DID YOU READ: Australian Health Insurance Got Expensive in October; How can you save?

What are the benefits that private insurance offers and Medicare does not?

As previously mentioned, public healthcare patients cannot choose for their surgeon or a doctor that will perform the medical treatment. Private insurance owners have an option in this matter. However, private insurers have specific partners so seniors should double-check if their wanted specialist is under the contract. The insurers may even refuse to cover for a doctor that is not with the assigned hospital.

Another significant advantage for private health bearers is no waiting lines for therapies. According to sources, some surgeries like kneecap replacements may take up to 200 days to take place, and it is safe to assume that some seniors cannot wait that long to have a functioning knee. With private insurance, waiting queues are nowhere near as long. Once the surgery is quickly done, seniors can start with their recovery sooner and get back to their normal lives.

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Extras under private policies allow seniors to have less out-of-pocket costs for preventative remedies, such as acupuncture, naturopathy, and others. Medicare does not cover for secondary medical services such as these so it might be a good idea to get private coverage if these services are needed. According to experts, seniors aged 55-79 years use extras the most, saving A$600 on average.

Last but not least, seniors might enjoy their retirement more if they hold an extra healthcare policy. By paying for additional policies, older generations might get the feeling of reassurance if it comes to the worst-case scenario.

RELATED: 6 Important checklist items to consider while buying health insurance plans

Is private insurance a good option for seniors?

Private insurance does have a lot of benefits compared to Medicare. Some experts may argue that private health insurance could be too pricey for what it offers.

There were some known cases where private hospitals would refuse to admit seniors, even if they were privately insured. All private insurers guarantee to cover for medical fees in hospitals, but they cannot ensure that hospitals will accept the patient for treatments.

Erin Turner, the CEO of an independent group, CHOICE argues that public hospitals may be a better choice on certain occasions, especially when in need of emergency assistance. All public hospitals are equally equipped with qualified doctors and nurses, so there should be no fear of not being under proper care.

Seniors that tend to purchase additional insurance are usually the ones that think they will be in better care in private hospitals. However, if there are more cases where individuals are refused admission to the hospital, is private insurance worth it?

Getting private insurance is an individual’s decision and all things mentioned above should be considered. If one can afford to pay insurance premiums for three decades on average while in retirement, it could be a good choice for their peace of mind. Everyone is advised to look into all options and possibly take some advice from a family doctor that has a good understanding of the individual’s long-term health.

GOOD READ: What factors can impact your health insurance premiums?



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