Hospital Coverage of Medicare and Private Insurance

浪淘沙

The following is a summary about coverage on hospital treating of Medicare and private insurance (Medibank), which I studied recently.

Here we are talking about hospital treating , not extras. Usually, extras is covered by private insurance.

As to hospital treating, it can be devided into 2 part, one is Out-of-hospital service that means you are not admitted into hospital. The other is
In-hospital service, which you get for staying at hospital, including same day admission.

1) Out-of-hospital service （指普通看病）
medicare will cover the service you get from public hospital. Maybe you will pay a part for medicine.


2) In-hospital service （指住院服务）
Medicare will cover all costs including treatment, surgury, accommoation in public hospital as a public patient.
If you'd like to be private patient in public hospital or choose private hospital (member hospital), medicare will pay 75% of Medicare schedule fee in Service & procedure you get from treating doctor, the rest 25% will be paid by Medibank, and the charge beyond Medicare schedule fee is paid by yourself. Accommodation and some medicine or service in agreement will be paid by Medibank.
Usually you will get better service in private hospital, and you can point the doctor you trust, but you will pay the amount up to excess each time when you are admitted into hospital, unless your exceed annual excess.

But Here is a question, who will pay if I visit private hospital for out-of-hospital service, for example cold, headache, etc.?

JACK

you!

you will have to pay the balance that not covered by medicare.