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7 Your right to health

Older people have the right to enjoy the highest possible standard of physical and mental health. To achieve this, older people have rights to access quality health care services. This chapter explains the services and subsidies available to you.

7.1 Access to basic healthcare services and Medicare

Medicare entitles eligible people to free or subsidised health care, including treatment by general practitioners, specialists, optometrists, dentists, and in some circumstances, allied health practitioners.

Eligibility for Medicare is generally restricted to people who permanently reside in Australia and are Australian citizens, New Zealand citizens, permanent visa holders, or in certain circumstances, applicants for permanent residence visas.

Medicare entitlements include free treatment and accommodation as a public patient in a public hospital and subsidised medicines through the Pharmaceutical Benefits Scheme.

As a public hospital patient funded through Medicare you are not able to choose your doctor or surgeon. Outside of the hospital system, people can choose their own doctor.

People covered by private health insurance are able to select their hospital doctor or surgeon. Medicare also provides a level of subsidy for private hospital services and for out-of-hospital services such as consultations with general practitioners or specialists.

People who are eligible for Medicare are also eligible for medical treatment in countries with which Australia has a reciprocal health care agreement. Australia currently has reciprocal agreements with eleven countries: the United Kingdom, New Zealand, Ireland, the Netherlands, Italy, Malta, Sweden, Finland, Norway, Belgium, and Slovenia.

Where to go for more information

Phone Medicare on 132 011, or go to www.humanservices.gov.au/medicare for more information.

To find a doctor, pharmacy, or hospital near you, visit the National Health Services Directory at www.nhsd.com.au.

Healthdirect Australia is a telephone health advice line available 24-hours a day, seven days a week. You can call 1800 022 222 at any time to speak to a registered nurse.

The after-hours GP helpline is an extension of healthdirect Australia. Based on the caller’s symptoms, the registered nurse can transfer the caller to an after-hours GP. Call 1800 022 222.

For quality information about health matters, visit www.healthinsite.gov.au.

Where to go for help or to make a complaint

If you have a complaint about any services provided by a health professional or hospital, contact the relevant office in your state or territory:

ACT
Health Services Commissioner, ACT Human Rights Commission
02 6205 2222
NSW
Health Care Complaints Commission
1800 043 159 or 02 9219 7444
NT
Health and Community Services Complaints Commission
1800 004 474 or 08 8999 1969
QLD
Health Quality and Complaints Commission
1800 077 308 or 07 3120 5999
SA
Health and Community Services Complaints Commissioner
1800 232 007 or 08 8226 8666
TAS
Health Complaints Commissioner
1800 001 170 or 1300 766 725
VIC
Health Services Commissioner
1800 136 066 or 03 8601 5200
WA
Health and Disability Services Complaints Office
1800 813 583 or 08 6551 7600

You can make a complaint about Medicare to the Commonwealth Ombudsman on 1300 362 072.

7.2 Concessions on medicines and other health related expenses

The majority of older Australians are entitled to concessions to reduce the cost of buying medicines, and other health-related expenses.

(a) Pharmaceutical Benefits Scheme (PBS)

The Pharmaceutical Benefits Scheme (PBS) helps to cover the cost of prescription medicines.

If you have a Medicare card, you can get prescription medicines under the PBS at a subsidised cost. Over 2 600 medicines are covered under the PBS. However, if your doctor writes a non-PBS (private) prescription, you will need to pay the full price for the medicine.

If you need a lot of prescription medicine and you or your family reach the PBS Safety Net threshold, you may be able to receive a PBS Safety Net card from your pharmacist. Under the PBS Safety Net, your medicines will be less expensive or free for the rest of the calendar year.

Make sure you show a valid Medicare card (and a concession card if you have one) every time you get a prescription filled. Ask for cheaper brands – all brands of the same medicine have the same active ingredients, even though they may look different.

(b) Commonwealth Seniors Health Card

The Commonwealth Seniors Health Card is for Australians who have reached Age Pension age, but do not receive a Centrelink payment. Eligibility depends on your annual income. This card may entitle the holder to additional refunds for medical expenses, and greater discounts on prescription medicines.

(c) Pensioner Concession Card

The Pensioner Concession Card is for recipients of the Age Pension. It is also available to people receiving some other payments, including Carer Payment and the Disability Support Pension.

A Pensioner Concession Card entitles you to reduced-cost medicines under the Pharmaceutical Benefits Scheme.

  • You may also be entitled to various concessions from the Australian Government. These could include:
  • Bulk billing for doctor's appointments (this is your doctor's decision);
  • More refunds for medical expenses through the Medicare Safety Net;
  • Assistance with hearing services through the Office of Hearing Services; and
  • Discounted mail redirection through Australia Post.

You may get some of these Australian Government concessions for a dependent child.

You may also be entitled to various concessions from state and territory governments and local councils—these could include:

  • Reductions on property and water rates;
  • Reductions on energy bills;
  • Reduced fares on public transport;
  • Reductions on motor-vehicle registration; and
  • Free rail journeys.

Pensioner Concession Card concessions are different in each state and territory and vary between local councils.

(d) The Extended Medicare Safety Net

The Extended Medicare Safety Net (EMSN) provides additional Medicare benefits for Australian families and singles who have out-of-pocket costs for Medicare-eligible out-of-hospital services. An annual threshold of out-of-pocket costs must be met to be eligible for the EMSN.

EMSN applies to out-of-hospital services including GP and specialist attendances, as well as many pathology and diagnostic imaging services. Once a relevant annual threshold has been met, Medicare will pay for 80 percent of any further out-of-pocket costs for the remainder of the calendar year, except for services where an upper limit or ‘EMSN benefit cap’ applies. Services include consultations and a number of procedures and diagnostic imaging services.

Eligibility for the Extended Medicare Safety Net is calculated automatically by the Department of Human Services. Families can register with the Department of Human Services so that their combined out-of-pocket costs count towards their relevant threshold. Singles do not need to register.

Where to go for more information

Visit the Department of Human Services website at www.humanservices.gov.au/pbs or call the PBS Information Line on 1800 020 613 for more information on the PBS.

Call Centrelink on 13 23 00, or visit www.humanservices.gov.au for information on concession cards.

For more information, or to register your family for the Extended Medicare Safety Net, contact the Department of Human Services. Call 132 011, or visit www.humanservices.gov.au.

Where to go for help or to make a complaint

Call the Department of Human Services Feedback and Complaints Line on 1800 132 468 to make a complaint about Centrelink or Medicare services.

You can also contact the Commonwealth Ombudsman on 1300 362 072.

7.3 Payments to help with medical costs

If you receive income support from Centrelink, you may be entitled to further payments to help with medical costs.

(a) Pharmaceutical allowance

The pharmaceutical allowance is a fortnightly allowance to assist with the cost of buying prescription medicines. It is only available to those under Age Pension age who receive certain types of Centrelink payments. Eligibility is automatically assessed.

(b) Essential medical equipment payment

The essential medical equipment payment is an annual payment made to eligible people who experience increased home energy costs from the use of essential medical equipment such as an electric wheelchair, heart pump, or insulin pump.

(c) Continence aids payment scheme

The continence aids payment scheme is an annual payment to help eligible people with permanent and severe incontinence with the costs of incontinence products.

Where to go for more information

Phone Centrelink’s Disability and Carers line on 132 717, or go to www.humanservices.com.au for more information.

Call the National Continence Helpline for more information on continence matters and the continence aids payment scheme on 1800 33 00 66.

7.4 Private health insurance

Private health insurance can give you more extensive and flexible access to health care services.

You must pay premiums in order to be covered by private health insurance. If eligible, you may be able to receive a government rebate of up to 40 percent of your private health care costs, depending on your age and income.

Sometimes older people experience trouble with insurers because insurers believe they are too old. The law ensures that private health insurance cover is available to you if you choose it irrespective of your age or any chronic health conditions you may have. Insurers must also charge everyone the same premium for the same insurance policy. However, insurers may impose waiting periods. This means that if you have a pre-existing condition, you may not be able to claim on your private health insurance for up to 12 months. Be sure to seek more information on your rights, or make a complaint if you think you may be experiencing a problem with private health insurance.

You can transfer between insurers to a similar level of cover for hospital treatment without having to re-serve waiting periods. However, it is important to check carefully as normal waiting periods apply for higher benefit levels or for additional services that were not available under the previous policy.

Where to go for more information

Visit the Private Health Insurance Ombudsman’s consumer information website at www.privatehealth.gov.au The Ombudsman is an independent service to help consumers with health insurance problems and enquiries. This site provides detailed information on each private health insurance product available in Australia, as well as general information on how private health insurance works. Phone 1300 737 299 for more information about private health insurance.

The Private Health Insurance Administration Council is an independent Statutory Authority that regulates the private health insurance industry. Visit their website at: www.phiac.gov.au/consumers.

For more information on the private health insurance rebate, call Medicare on 1300 554 463, or visit the Department of Human Services’ website at: www.humanservices.gov.au/privatehealth.

Where to go for help or to make a complaint

You can make a complaint about any matter related to private health insurance to the Private Health Insurance Ombudsman by calling 1800 640 695.

7.5 Preventative care

Various preventative health care services are available for older Australians including immunisations and screenings.

(a) Flu immunisations

Annual flu immunisations are available free for all Australians 65 and older through your doctor or immunisation provider.

(b) Pneumonia immunisation

Pneumonia immunisation is available free for all Australians over 65 through your doctor or immunisation provider.

(c) National Bowel Cancer Screening Program

The National Bowel Cancer Screening Program is available free to Australians turning 50, 55, 60, or 65 years old. Speak to your doctor.

(d) Breast Cancer Screening

Breast Cancer Screening is free for all women over the age of 40. Mammograms are encouraged every two years between the ages of 50 and 75. Regular reminders will stop when you are aged 75, however you can discuss your ongoing needs for screening with your doctor.

(e) Cervical Cancer Screening

The National Cervical Cancer Screening Program encourages women to have a free pap smear every two years up until the age of 69. Regular reminders will stop when you are aged 70; however, you can discuss your ongoing needs for screening with your doctor.

Where to go for more information

Phone the Immunise Australia Information Line on 1800 671 811.

Phone the National Bowel Cancer Screening Program information line on 1800 118 868.

Contact BreastScreen Australia on 13 20 50.

Phone the Cervical Cancer Screening Information Line on 13 15 56.

7.6 Palliative Care

Palliative care is the care provided to people of all ages who have a life-limiting illness with little or no prospect of cure. The primary treatment goal of palliative care is to maintain a quality of life. This type of care involves managing pain and other symptoms while also addressing the physical, emotional, cultural, social, and spiritual needs of the person, their family, and their carers.

Where to go for more information

Your doctor can offer further information on palliative care.

The Australian Palliative Care Knowledge Network (CareSearch) is an online resource with palliative care information and evidence for researchers, health professionals, patients and their families, and the general public. Visit www.caresearch.com.au or phone 08 7221 8233.

Palliative Care Australia has a set of detailed brochures on palliative care that are available in a number of languages. Phone 1800 660 055.

You can also use the National Palliative Care Service Directory. To search online for palliative care services near you, visit pallcare.gky.com.au/c/pc.

Life Circle provides telephone counselling, mentoring, and ongoing support to people facing a terminal illness, and their families. They also have a series of help sheets. Phone the LifeCircle HOPELINE on 1300 364 673.