Private health insurance is a necessity. This is especially true considering Medicare does not cover everything. A lot of critical conditions including dental care remains outside of your Medicare health care plan.

This translates to patients paying for availing of treatments that are not covered. Problem is, fees for some treatments can  be high. Or treatments need to be continuous such as those for dental care.

To avoid extra costs, dentists advocate prevention. This translates to early detection and action to quell any dental issue. Otherwise, patients may have bigger oral health problems that would need more money for treatments.

Medical gap explained

Compensation from a private medical insurance plan depends on your level of cover. There is Medical Gap when your doctor (or dentist) charges a fee that’s higher than the Medicare Benefit Schedule, or MBS. The MBS is a schedule (or listing) of the Medicare services that is subsidised by the Government of Australia.

But some clinics and doctors do help their patients avoid the Medical Gap by participating in Medical Gap cover schemes by various health care funds such as the HCF. Hence, one way to avoid the Medical Gap, is to talk to your doctor about it.

A doctor usually has three options:

  1. Not participate in any Gap cover scheme

This means you as their patient will pay for all the  expenses that exceed the MBS scheduled fee.

  1. Participate in a Known Gap cover

In this, there are out-of-pocket expenses that are capped for you. Getting treatment from a doctor that participates in a Known Gap cover scheme means that you will be charged a known gap expense for every procedure.

Yet every fee that you have to pay would have to be clearly explained to you. The doctor should give you with all details in writing before starting on the procedure for what is referred to as “informed financial consent.”

 

PARTICIPATE IN A NO-GAP COVER SCHEME

This arrangement means that there are absolutely no extra out-of-pocket expenses for you.

Your doctor receives all his or her payment for each procedure from your fund, because they have often entered an agreement to charge no Medical Gap fees as stipulated by your healthcare fund’s No-Gap scheme.

Hence, it is ALWAYS a good idea to get your treatment from a doctor that participates in your fund’s No-Gap scheme.

A good example of such schemes is Dentist Chatswood  No Gap Dental service which offers members with eligible cover preventative dental treatment at absolutely no out-of-pocket fee – up to your annual limit.

If you are covered by HCF for instance, you can check your eligibility in their website. The fund makes it easy to access a list of all the doctors who participate in the No-Gap program as well as those that participate in their Known-Gap scheme.

Aside from working with doctors, HCF also negotiates charge agreements with hospitals around the country to let their members access no-gap treatment for services listed in their (members’) policies.

Why you should participate in a no-gap cover scheme

The obvious reason is that you enjoy a 100 percent cover on the selected extras cover.

Services included are the ones on eye care, chiropractic or osteopathic care, treatment for hearing problems, physiotherapy and podiatric treatment and dental care.

Increased control over your health care

You can access the funds when you need them – that’s one of the biggest benefits. Since your health care is completely covered by your health care funds provider, you can get treatment whenever you need it.

How to avoid the wait list

The difference between Medicare and a no-gap membership from a private health insurance plan is that you can access your health care funds easily. This is because the arrangement is between your doctor and the fund. As long as you’re covered, you can promptly get your treatment as the funds are processed by your insurer.

Given its advantages, nothing beats a no-gap scheme as far as health insurance cover is concerned.