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Do you really need health insurance in Australia?

Health insurance is something I have ummed and aahhhed about in Australia because we have a pretty good medical system in many areas, which is completely free. That is hospital is free, there is access to free therapy and so on.

More and more I have been thinking about taking our private health insurance. The main reason being if anything serious like cancer were to happen to us the public waiting list can be 2 years long, whereas with private you can have it done within weeks.

Obviously with serious cases or massive emergencies you get treated straight away, but it is up to them to determine how serious it is. If you are about to die, then yes it is treated as quickly as possible, but since cancer has various stages you could be in a lower stage but by the time they can fit you in for surgery it may have spread and be in a more serious stage.

I had planned on taking it out last year, but with my husband having issues with work and then us playing catch up once he did get work it kind of fell by the wayside.

Now I am kicking myself.

I need my wisdom teeth out. It will cost $3,000+ If I had health insurance a large portion of that would be covered. I also need a filling now. Health insurance would have covered that. Yes, there is free dental where I am, but I need the filling now, not to wait until I can get it for free, but which time I will probably need root canal (yes, I have been down that road before).

If I had taken out health insurance some of my therapy for BPD would be covered. And now my daughter needs speech therapy at $85 a session, minimum of 2 sessions a week because she has a severe development delay.

All of the cover I looked at would only have covered a small portion of these things, but had I taken out cover a year ago the amount I would have paid in fees is less than I am currently facing needing to payout for everything.

I am still going to take out health insurance. I want the peace of mind that if something major were to go wrong we are first in line to get treated. I want the 2 free dental check ups a year and things like that.

If used properly it does not need to cost a lot. If I take out health insurance now, I may only need to wait a few months before I can claim on some of these things, but the wisdom teeth I won’t be able to for at least 12 months.

Either way, I now have 2 children and the past few weeks with my daughter needing speech therapy and my teeth absolutely killing me with pain I have realized that the healthcare system, while free, is just not set up to be able to provide everyone with the help they need.

Speech therapy has a 2.5 year waiting list in my area. My daughter is classed as high needs for it, yet she would have to wait 2 and a half years, but which time the issues would be extremely hard to fix, if I did not have the money to pay for it.

I am able to apply for and hopefully receive carer’s allowance at $114 a fortnight I think it is for my daughter. I find out in a couple of weeks if I am successful in the claim so that will help. There is also a $50 rebate for 5 sessions a year, so that is another $250. If I had health insurance I would be able to claim money back after using up this rebate so my out of pocket expenses would be minimal.

My thoughts and that of many members of my family always were that health insurance isn’t really necessary here in Australia. I will admit I had both my daughters in the public system, and with my first my midwife managed to get me a private room anyway. I got stabbed in the leg and was seen in the hospital instantly a few years ago. I know if there is an emergency I will get straight into the hospital and treated, but what about everything else?

And with those emergencies, did you know they fix you up enough so you are not dying, but then you have to wait anyway? So say you broke your leg and needed surgery. They would stop any bleeding and stabilize you, then you would have to wait for surgery and it could be a couple of weeks. By which time your bones have started to heal causing more problems.

I am not trying to scare you all or say you HAVE to have health insurance. I am just telling you my experience and thoughts on it and how it has changed. It is completely up to you. For the most part I prefer natural therapies over surgery/medication etc. I am also fortunate that where I live my GP is free and many things are cheaper than other areas. But because of that the wait list for services here is very long.

I’d love to know though if any of you have health insurance? Do you use all the benefits or only claim if you have to? Have you had any good or bad experiences etc?

14 Responses to “Do you really need health insurance in Australia?”

  1. Jess xx says:

    Such an interesting topic, I have private healthcare cover and the biggest thing that convinced me was when a friend needed to call an ambulance and had to pay for the fee up front as she didnt have cover. It was something like 1000 dollars, money which as a student I would just not be able to afford upfront. I am always suprised by the things I can claim back and how much I actually get back, I think the biggest thing is making sure you get a policy that suits your needs and thatou are you are totally aware of all your benefits so you can claim all your entitled to!

  2. David says:

    Both my wife and I come from families that have always had PHI, so there was no decision necessary for us. Both our children were born privately, which admittedly cost us a lot more than if they’d been born in the public system, but my wife had health issues which meant having her own doctor was better.

    We got married just over seven years ago, but I’ve had the cover for around nine years, since taking out the cover we’ve had two lots of wisdom teeth out; one appendix removal, one gall bladder removal, two tonsillectomies and two children born. Plus we all go to the dentist for a checkup and clean every six months. All of these have been claimed through PHI, they’ve all got some out of pocket costs though.

    We also use our extras cover for massage, chiropractor visits, the list goes on. Some people says PHI isn’t worth it, I’d rather pay rather than end up waiting months, possibly years to have a non-emergency surgery.

  3. David says:

    We were recently able to claim back around 70% of the cost of some travel vaccines.

  4. Shelly says:

    When the Lifetime Cover was implemented in 2000, I railroaded my husband into getting health insurance by getting my mum to side with me while she was out for a visit.

    He grumbled every year when we’d receive the letter advising us of an increase in premiums. Every single year.

    Then I got breast cancer.

    I was diagnosed on a Friday and the following Thursday, I’d had the surgery and it was out. If I had relied on the public system it would have been three months later before I could have the surgery.

    Being diagnosed at a younger age, my cancer was considered agressive. If I had had to wait, things could have turned out very differently.

    My husband still grumbles every time we get the letter about the premium increase, but he knows in his heart that our having private health insurance saved my life.

  5. Amy says:

    This is something that has been on our minds lately too. I mostly want PHI for the dental. Growing up, my parents could never afford a dentist so we never went. I don’t want my kids to have to wait for us to find some spare cash before we can have their teeth seen to. Thanks for the reminder to look this up again.

  6. Rachael says:

    We keep looking but have yet to take out insurance. I had both kids in the public system and I had issues with the second one it was only because my GP is on the hospital board that I got seen to quickly and my issues corrected without that I’d have had to wait 4 months which would not have ended well. I know we need it since I too will be needing my wisdom teeth out soon and J needs optical things.

    Also I will add the one time I really needed surgery I was covered thanks to my proper payment of fees for sporting clubs and they paid for the whole lot through insurance – surgery, physio etc I ended up paying a total of $30 for a knee reconstruction. I can see the good in it I just need to get of my butt and get it!

  7. Kylie says:

    Jess – $1,000 is HUGE! I was told as a teen if I get nothing else to at least get ambulance cover for that very reason.
    Wow David, you have got good use out of yours and I agree, I would rather pay and not wait possibly years.
    Shelly, thank you so much for sharing your experience. I am so glad you had PHI and were able to get the necessary help. I know how long wait list can be and in your case it definitely saved your life. xx
    Amy – That was one of my thoughts too. I remember going to the dentist once as a kid because I had to and the other time was free through the school. We just didn’t go and I want my kids to have check up etc.
    Rachael I remember your knee surgery and the health insurance. And there can be so many complications surrounding birth. If I were ever to do it again (not likely! lol) I think I would prefer private.

  8. Cathy says:

    We have PHI and hardly use it. It’s expensive and a drain on our resources, but we are too scared to abandon it for the reasons mentioned by you and others. I really think there should be some sort of rebate – maybe different percentages depending on how much you claim. Everything just keeps going up in Sydney – everything except wages!

  9. This is another side to consider.

    For me, I am fit, healthy and working, only part time, but we are managing. We don’t have extras cover, but we have full hospital cover and pay for whatever other services we need as they come up. I just feel while we can scrap the money together we should, the public system is pretty good, but if those that can don’t use it, it makes it even better for those that don’t have the option.

    If our circumstances were to change and we had to cut back on something, I would probably still try and keep my PHI.

  10. Jac says:

    Oh PHI… Definitely a must these days. There are endless stories of people who could have used it etc.
    Wisdom teeth is on my list too, but I think after Dad’s accident it really showed that even super fit healthy people can suffer in a matter of seconds.
    The whole point of insurance is to minimise the financial damage.
    Even in Aus, we need it.

  11. Trish says:

    I wouldn’t be without PHI . My hub had a high grade malignant tumour and the wait could have been up to a month or more publicly in 2010 at a major Syd hospital and we were seen in public Cancer Care clinic. A very amazing place.
    The other thing is you don’t get your Dr of choice , a capable registrar surgeon overseen maybe by specialist Surgeon.
    Once we said private the Dr whipped out the private hosp forms and it done within a week .
    He then went back through Cancer centre as public patient for radiotherapy (covered @$10000 for the 6 wks) about 6 wks later.
    He couldn’t have started radiotherapy either till after the surgery though.
    I can’t fault the care but the system is shocking for waiting .

  12. Fran Dishon says:

    Speech therapy costs make sure you get a referral to the speech therapist purely for taxation purposes, also ask GP for extended care plan so you can claim back 5 sessions of speech therapy through medicare. Also ask medicare about early intervention funding as some new funding has been introduce. No one offers any funding you have to go out and find it yourself. Sounds harsh but it is true. I find my health fund only allow me to claim a small amount back for my son’s speech therapy, however my husband has not had to wait for orthopaedic
    elective surgery, which has meant less time of work and saved us money that way. Also son doesn’t have to go on long waiting list for grommets he gets his surgery within two weeks now not 6 months.

  13. MLM247 says:

    Get that private health cover as soon as you can. You have a family and that is where the priorities lie concerning this. Get full hospital, dental, everything. Agree to pay an excess and actually keep that amount of money aside, like maybe in a purse hidden under your nightgowns in your drawer. Private health insurance is just that – insurance. It seems like money down the drain, but it is part of the cost of living in this day and age. (Never neglect your teeth or the teeth of your children. It comes back to haunt you in middle age.)

    On a slightly different tack … If your daughter is having speech problems then get her singing. I was an early childhood teacher for more than 30 years, blah, blah, blah. Music connects in the brain in ways we do not really understand but any music therapy works wonders. You do not necessarily need a specialist therapist. Just singing nursery rhymes and children’s songs also works. Clap along to Mozart and Beethoven. These pieces play at about the same beat as the human heart and connect with emotions. Go to live music concerts for children. Play the flute or the recorder. The experiences must be real and alive not films or DVDs. Be interactive and proactive.

  14. Kylie says:

    @Cathy – I hear you about everything going up. I too am in Sydney and it is crazy.
    @ClaireyHewitt – true. I do think if you can afford it you should have it and those that use it make the strain on the public system less, which helps everyone.
    @Jac – Dad’s accident really made me think too, I was not in a financial position to get it at the time, but looking at what they have gone through really made me rethink PHI.
    @Trish – Thank you for sharing your experience with your husband. I am so glad you were able to get the treatment needed within a decent timeframe. The wait list on public is one of the biggest concerns for me.
    @Fran thanks for that. Interestingly enough it was the preschool and speech therapy who both told me about available rebates and things, but you are right, normally no one tells you. Thanks so much for that info, I will look into the new one too. All the funds I looked at offered a piddly amount back for speech therapy, but the other benefits such as the short time for your sons surgery and less time off work for your husband make it worth it.
    @MLM247 When I wrote the post I was already researching PHI for us, as to me it is necessary, not optional anymore. If you can afford it, get it. Thanks for your suggestions with singing for speech too. She loves to sing and we do it a lot. Her biggest problem is actually understanding the meaning of words, but she has a fantastic memory so singing would be great.

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