3 Facts about the Medicare Benefits Schedule (MBS) for Prospective First-Time Beneficiaries

The Australian Federal Government helps patients receive quality and affordable medical services by paying Medicare rebates. The Government prescribes different schedule fees for a range of tests, consultations, and procedures. Note that the Pharmaceutical Benefits Scheme (PBS) is responsible for the provision of rebates for prescription medication since the charges are not under MBS. Here are some facts about MBS that prospective first-time beneficiaries might find useful.  

How it Works -- After the Australian Government sets schedule fees for each medical service, consumers may claim 100% of the costs if they use general practice services. Services provided by medical practitioners but under non-GP services enjoy 85% of rebates. If you receive medical attention in a private hospital, the government will pay 75% of the schedule fee. However, medical practitioners can set their market prices to cover practice costs and income. If the GP's fee is higher than that set in MBS, then the patient must pay the difference out of pocket. The schedule is reviewed every month to reflect changes in medical services pricing.

Things not Covered by MBS -- Before checking into a hospital, you should understand that MBS does not provide benefits to a range of medical services. The spirit of the Medicare Benefits Schedule was not to offer full coverage of all medical services but to provide financial assistance to patients. For example, surgery that is intended for cosmetic effects, eye therapy, and contact lenses are not covered by MBS. Also, the MBS will not cater for hospital bills if you incur hospital costs when overseas. Other expenses not covered include; medicines, prostheses, hearing aids, acupuncture, ambulance services, and dental treatments. Remember that if another entity such as a government authority, private employer, or insurer covers your medical costs, then you will not be entitled to the MBS.

Bulk Billing -- Bulk-billing refers to a system where health practitioners such as doctors bill the federal government directly for services offered under the Medicare Benefits Schedule (MBS). For example, if the schedule fee for a physical examination is $50 and the General Practitioner (GP) bills you the same amount, the GP will bulk-bill this amount to the government. However, if the fee by the GP says $60, the patient would have to pay the whole amount out of pocket and claim a refund of $10. Requesting a refund can be accomplished by visiting your nearest Medicare office, through the mail, and online application. It is illegal for a practitioner to bill a patient and government at the same time. Also, note that bulk billing is not available in all health facilities, and thus, you might have to check with your preferred provider first before admission.