Home Telehealth Consults Medicare and Telehealth – Are You Protected?

Medicare and Telehealth – Are You Protected?

Medicare is the foundation of the Australian health care system. It is used to help covers for the cost of healthcare among Australians as well as other eligible people. This can be supplemented by private insurance for those who want their pick of doctor or hospital, or for those who want to skip waiting lines.

However, due to the ongoing COVID-19 pandemic, some changes have been made to the current Medicare scheme to accommodate those with valid health concerns but were previously not allowed to access telehealth services.

The purpose of this is to unclog hospitals and unburden health workers as they battle the outbreak. This will also ensure that those with minor cases of COVID 19 as well as those suffering from other medical conditions can be taken care of despite the quarantine protocols currently in place.

This article discusses telehealth and how Medicare can help cover for the cost of these services.

What Can Telehealth Do for You?

Telehealth allows you to consult with a doctor or other health professional for medical conditions. This can cover consultations, diagnosis, treatment, as well as routine check-ups. Using telehealth services, the medium for communication is not face to face. Rather, telehealth services can be availed of through video or phone.

Prior to the COVID 19 outbreak, Medicare only covers telehealth services under specific situations, namely:

  • Patients that are 15km away from the practitioner
  • Non-admitted hospital patients
  • Aboriginals or Torres Strait Islanders
  • Residents of aged care facilities

Current protocols, at least after March of 2020, have allowed Medicare to cover costs for telehealth services. This is limited to all Medicare-eligible citizens, however. Policies for making claims remain the same, although some regulations do change from a day to day basis in light of recent events.

Bulk billing is allowed, with the government providing incentives for those who do this. However, patients must be informed of this and they must provide consent. Those with Commonwealth concession cards, those aged 16 years old and below, as well as those more vulnerable to COVID-19, will still need to be bulk billed, though.

What is MBS?

MBS stands for Medicare Benefits Schedule. This includes a listing of all services covered by Medicare. The amount covered by Medicare is indicated here as well. The amount covered has certain limitations, though, so out of pocket expenses may be incurred. Private insurance may cover the rest, too.

MBS covers most consultations and tests, although some items are not covered. Items excluded from the MBS include but are not limited to:

  • Treatment or hospitalization as a private patient
  • Cosmetic surgeries
  • Acupuncture
  • Hearing aids or glasses
  • Ambulance services
  • Some prostheses

Prescriptions are not covered by the Medicare Benefits Schedule. However, this is covered by the PBS or the Pharmaceutical Benefits Schedule. Under PBS, medicine can be purchased at a discounted price. However, out of pocket expenses may be incurred if branded medicine is preferred, although this has certain exceptions.

Due to the COVID 19 pandemic, several new items have been added to the MBS, and the list has been expanding as agreed upon by the Australian government. These, however, are only temporary and may be removed in the future.

Will Telehealth Still be Covered by Medicare After COVID 19?

The government has been very lenient when it comes to covering telehealth services under Medicare. This is due to the ongoing COVID 19 pandemic, and the government has released 1.1 billion dollars to help expand and further support the initiative in March of 2020.

Incentives for bulk billing for certain items included in the MBS has been extended until September 30. There has been no news on whether this, along with the other policies that have changed during the outbreak, would be retained as part of the new normal.

However, there is a possibility that, at the very least, Medicare’s wider coverage of telehealth services would be expanded. This is due to the positive benefits that telehealth is capable of providing, even after quarantine protocols have been lifted.

While data on how telehealth would benefit the health care system is not yet available, it is most likely that it will show numerous advantages. Wider coverage will mean that a larger population of Australians getting quality health care. This is especially important for those who live in remote areas or who are having trouble accessing a hospital.

The Australian government will also greatly benefit from telehealth services when it comes to cost.  This is due to the lower cost incurred when compared to face to face consultations and treatments. Perhaps most importantly, it can help unburden health workers and health centres especially during times like these when personnel and equipment are being stretched too thinly.

Will Private Insurance Help Cover Telehealth?

Private insurance is an optional purchase among Australian citizens. Not only does it help prevent being charged with additional Medicare contributions, but having private insurance makes you a priority over those who use Medicare.

Having private insurance also lets you pick your doctor and where you would like to be admitted. Some procedures and treatment not covered by Medicare may be covered by private insurance as well. As such, it is highly recommended that private insurance is acquired on top of your default Medicare coverage.

There are many private insurance companies in Australia that provide health insurance. You should make sure that they are duly registered and recognized, and that they have the proper package and coverage as well as the extras that you prefer.

Conclusion

The ongoing COVID 19 pandemic has greatly affected the country. Fortunately, the government has adapted in order to satisfy the needs of the citizens with regard to health care. This way, all Medicare-eligible citizens can still get quality health services even during these trying times.

Telehealth is a very powerful tool that can now be used by all. Hopefully, those who can avail of telehealth services now can still utilize this to some extent after the crisis has ended. This will definitely help the health care system in numerous ways, while also helping those who are currently challenged due to restrictions in the current scheme. 

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