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What Health Insurance Will and Won’t Cover

Health coverage is a necessity for people in all parts…
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Health coverage is a necessity for people in all parts of the world if they hope to receive affordable healthcare. There are various levels of coverage, and the one that’s best for you will depend on you and your family’s needs. In Australia, most basic healthcare needs are covered under Medicare, but many residents choose to buy private health coverage to cover the gaps left by Medicare plans.

Private health coverage is also useful for things like ambulance coverage, which isn’t automatically provided in every Australian state, and it allows patients to choose their doctors and stay in private hospitals if they opt to. If you’re looking for private coverage, then it’s a good idea to compare health insurance plans online to see which offerings make the most sense for you. Here, we’ll take a deeper dive into health coverage, starting with the things it will typically cover.

Medicare Coverage


Medicare is Australia’s universal health coverage plan, and it’s offered to all citizens and to certain visitors. It grants access to many healthcare options for free or at a lowered cost for those covered. Free services include emergency hospital services, although these will be provided at a public hospital, and a private room isn’t guaranteed. Medical services provided by primary care physicians are typically free as are certain prescription medications. Medicare also covers all diagnostic imaging services, such as X-rays, MRI scans, ultrasound, and CT scans. For services that aren’t covered for free, you’ll generally receive reduced costs through the Medicare Benefits Schedule, which is updated each year.

Private Health Coverage


For individuals or families who want more coverage than is provided by standard Medicare plans, they can opt for private health plans in exchange for monthly premiums. Rates will depend on the amount of coverage offered and the age of the policyholder. It’s cheapest to purchase private health cover before the age of 30. This is to encourage early adoption of private coverage and take some strain off the public plans.

With private coverage, you’ll be able to be treated in a private hospital, with your own room, and by a doctor of your choosing. You’ll also be able to receive dental and vision coverage, which aren’t provided on a typical Medicare schedule. You may be able to find plans that will cover more advanced medical devices or that will assist with technology that typically isn’t covered, such as hearing aids.

While your various health coverage options can help you pay for most things, there are some limitations and things that health plans typically won’t cover. Here are a few of the main ones.

Elective or Cosmetic Surgeries


Any surgery that isn’t considered an actual medical need is unlikely to be covered by insurance plans. This goes for any kind of plastic surgery, and it usually applies to dermatologist procedures as well. When it comes to elective surgeries or any surgery that isn’t a medical emergency, things can get complicated. Your provider may cover a lot of elective surgeries, but each one has to be deemed medically necessary. Unfortunately, you, or even your surgeon, have little sway over what an insurer will deem “medically necessary.” If your insurer’s opinion doesn’t match your own, you may find yourself without coverage for the procedure.

Lost Wages


While health plans are great for treating illnesses and injuries, they aren’t good for covering losses you may have suffered due to the events. For example, if you’re injured in a car accident, your health coverage will cover any surgeries or other medical treatments needed on your road to recovery. If you lost wages because you missed work due to the injuries, however, you’ll have to seek help elsewhere.

This scenario is a great reason to hire a personal injury attorney. These lawyers can help you file a suit to claim compensation for lost wages or for your pain and suffering after sustaining an injury due to negligence or the fault of others. Most injury attorneys also work on a contingency basis, meaning that you’ll only pay them a percentage of the settlement if you win.

With a combination of Medicare and private coverage, you’ll be able to withstand most healthcare needs that come your way. If you find yourself unable to cover something through insurance, then legal professionals may be able to help you find another way.