When you elect to get covered by insurance how are pre-existing conditions dealt with? Can you wait until you need a surgery then get insurance?

Shifu said..
In Qld we pay a small levy on our electricity bills to pay for free ambulance for all. Very Socialist and a sweet, sweet deal.

It's almost as if when we all chip in we get a discount or something. How does that work?

Harrow said..
I pay about $75 a week for hospital cover. If I didn't have the private health insurance, I would be paying close to this in the additional medicare levy surcharge anyway for not having private health insurance. Makes the decision pretty simple.

This is not the increased premiums you pay if you join late, this is additional medicare levy tax you may have to pay every year at tax time if you don't have private health insurance.

Imagine all the money we have to spend on private health care going into the public system instead. I know it's pretty crazy.

And what sort of a competitive private health system do we have when we all have to give them money? Where's the incentive for them to provide a better service? They have a captive market. What is this system? I feel like I'm taking crazy pills.

I'm waiting for some New Zealanders to comment. I lived there a year and their public system is, in my experience, better than our private. It's free for Australians. I've talked to some Europeans lately too and they are all shocked at our so-called free system.

cauncy said..
If you have a condition the private health company requires 12 months payments before acting on that condition,

Well that's an option. A lot of problems don't require immediate surgery, I have the same hip problem as Mark but I haven't done anything about it for a few years now.

Unless you live in Elysium, insurance is only for the rich and foolish

Beaglebuddy said..
Well that's an option. A lot of problems don't require immediate surgery, I have the same hip problem as Mark but I haven't done anything about it for a few years now.

No, it does not work that way.....if you have an existing condition even after the waiting period it is not covered....you sign a statement when you take the cover that you don't have pre-existing....of course you can lie, and they may not catch you....but if they do ????

In your case in the public system you would be put on a list that depends on need and availability....best to go on list before you really need it.

Mark _australia said..
USA guys: what happens if you need surgery for say a heart problem?
Do you have to pay?

Well when you have insurance which you are now required by law to have or pay a hefty fine, the insurance company pays for it minus your deductible and a probable small copay. If you have no insurance you would most likely get the surgery and if you are poor it will be free, if you have a job but no assets i.e. middle class you will likely have to go bankrupt to escape the debt. If you have considerable assets they will likely find a way to get their money from you.

kinda-sorta related,
income insurance -

generally the policy premiums are totally tax decuctible - but it must be a"stand alone" policy, and not attached to a superannuation policy.
so in effect it is a free policy.

when I couldnt work due to a few health problems and the subsequent operations, and recovery time - my income protection policy kicked in and saved our necks.


stephen

You are able to have private hospital insurance only (no extras) and this saves a bundle (I pay $2000 a year for the family, I'm married with two kids).

You can even have hospital cover with one fund and extras with another fund if this saves you a dollar or two.

I dropped extras cover five years ago on accountant's advice and am well ahead.

I am a dentist so family teeth sorted, but the Australian Dental Association for a number of years now has been advising we advise our patients to drop extras cover and just bankroll dental expenses...the funds make more than a billion a year from extras premiums alone.

A few physio sessions, some new prescription glasses, a massage or kids orthotics don't really cost much...even my high end procedure being a crown ($1650) with the highest rebate I have ever seen being $1100, still leaves the client out of pocket in this case $550 AND the probable $2000-odd additional for the year's extras premium.

You can see they should have just financed the $1650!!!

Cambodge said..

sn said..

generally the [income insurance] policy premiums are totally tax deductible ..[].....
so in effect it is a free policy.

Not free at all. But you do effectively get a discount on it equivalent to your marginal tax rate. So, if your top tax rate is effectively 49% then you effectively get a 49% discount on those premiums ('cos you'd have paid that 49% to the tax man but instead you're paying it to the insurer).

Also, pay the whole 12 months of premiums upfront in June and you'll get an immediate tax saving for the whole amount.

Oops - my bad.......

As I understand it, premiums paid to an income protection policy that is attached to a superfund are not tax deductions - and these premiums eat big holes in your superannuation.

It pays to have a close look at your super statement - and see where all the fees go.



stephen

One thing to take into consideration
Your private health will have a list of surgeons
If you choose a surgeon at the top of their field then you generally have a decent top up to pay or they might not be on the insurers list, so you don't get who you want, better check

Beaglebuddy said..

Mark _australia said..
USA guys: what happens if you need surgery for say a heart problem?
Do you have to pay?

Well when you have insurance which you are now required by law to have or pay a hefty fine, the insurance company pays for it minus your deductible and a probable small copay. If you have no insurance you would most likely get the surgery and if you are poor it will be free, if you have a job but no assets i.e. middle class you will likely have to go bankrupt to escape the debt. If you have considerable assets they will likely find a way to get their money from you.

The reason I asked that is you and/or mastbender were suggesting your healthcare was not that bad, as Aussies have to have health insurance. I was not sure as all I have to go on is movies like JohnQ hahahah but seems it is like that. In the US, it seems that a normal family with no insurance is fkd if somebody gets truly sick. Bit like overseas with no travel insurance, $10K a night and all that rubbish.


See everyone gets everything paid for here. A middle class person like u just mention would be looked after. No expense for them.

Our health insurance is only to get a choice of doc and private hospital etc.
The ancillaries like physio or dental are 75% covered to ease the load.
Plus obviously you get faster treatment, as per my example a windsurfer with a hip discomfort is waayyyyy below a old person needign a replacement so instead of a 3yr - 5yr wait I get it now and a private room and choice of docs etc. And I pay nil.

Health insurance is such a mess. It's my opinion owing to my experiences and research that the primary reason for the spiraling costs of healthcare are lawyers and judges. The easy ability to sue and the absurd judgements given out for things that aren't even a doctors fault causes doctors to practice "defensive medicine" which means they call up expensive tests and procedures for trivial complaints. You have a headache? Oh let's get an MRI in the odd event it's a brain tumor and there is a tiny possibility of being sued.
All that and people are so damn fat everywhere, half the populations come down with diabetes and their joints and internal gizzards are failing from the stress of carrying around all the extra weight.

Cambodge said..

sn said..

generally the [income insurance] policy premiums are totally tax deductible ..[].....
so in effect it is a free policy.

Not free at all. But you do effectively get a discount on it equivalent to your marginal tax rate. So, if your top tax rate is effectively 49% then you effectively get a 49% discount on those premiums ('cos you'd have paid that 49% to the tax man but instead you're paying it to the insurer).

Also, pay the whole 12 months of premiums upfront in June and you'll get an immediate tax saving for the whole amount.

Correct, and.... If you make a claim the money you receive is treated as income and taxed accordingly, hence the premiums are deductible.

Premiums on loan protection insurance covers are not deductible (unless business use), but the claims are not considerable taxable income.

^ This is all too common and the reason private health is on the national agenda/radar. It feels like a scam. It really, really does.

Mark _australia said..
But costly yeah. $170 per fortnight for 2 adults 2 kids.
Better to have it and not need it, than need it and not have it. But gotta balance that with the $$$$ and yeah it is hard.

I hear you Mark. The peace of mind and all. What is that worth?

But the cold maths just keeps getting under my skin.

You pay around $4,500 per year.
That's $45,000 over 10 years.

If you put that money in, say, an offset account against your mortgage @ 5% then you would have saved another $11,000 over 10 years.
(Assuming you didn't have to use the money for repairs. You of course did. Normal).

But the point I'm getting at is that $55,825.02 that is now in your offset account returns a saving of $85.82 per fortnight. If you hadn't pulled any money out of that savings account (in reality you will pull some out of course) your fortnightly costs are now half. And you can go injure yourself up to $55k.

I get that insurance is not supposed to be an expense that you come out ahead. Of course not. But does anybody come out ahead? Ever?

Reevesy said...
so far I have spent $18000 and I have another $15000 to go (minimum).

I have fully private top hospital cover for me and my family of 4. About $6000 a year. my rebates total less then $5000 including Medicare. In fact the Medicare rebates make up more then half (significantly more).

Reevesy didn't either.

The costs appear to be absurdly high, and we are all both literally and actually forced to pay them.

I've yet to get any money back from my private health insurance that was more than the premium for a single month. And I'm probably speaking for nearly everyone. Why is it so expensive?

I'm in the camp of being pro insurance. Had a shoulder issue. Tried to work it out through Physiotherapy but it kept popping out. Saw a specialist that does top footy players and cricketers. Shoulder done, as good as new in less than 3 months start to finish. The waiting list on the public healthcare would have been 2 years plus. Only reason I waited 3 months is that a friend got me in to someone who was considered to be one of the best of the best so it was worth waiting for.

Out of pocket was $150.