Table 1 Arrangements for out-of-hospital medical (MBS) and pharmaceutical (PBS/RPBS) services in Australia for individuals with and without DVA Gold Cards

Medicare

Medicare

· Medicare pays 85-100% of scheduled fee for GP/specialist visit up to threshold (see below)

· Always bulk-billed i.e., no gap or out-of-pocket costs

· Person pays gap of up to 15% plus out-of-pocket costs (difference between scheduled fee and GPs/specialist’s charge)

· DVA pays GPs higher fees according to its own schedule 

· GPs/Specialists may accept Medicare payment (bulk billing). This is most common for concession card holders and in areas of lower SES

· Covers a comprehensive range of Allied and Dental Health services

· Provides for rehabilitation appliances

· Funds in home nursing and domestic support services

· Medicare Safety Net threshold (2012 Figures):

· All Medicare card holders (Australian residents)

· Once $413.50 for gap payments has been met annually, Medicare will pay 100% of scheduled fee

· Once $1198.00 for out-of-pocket costs for extended Medicare Safety Net services has been met annually, Medicare will pay 80% of out-of- pocket costs

· Concession card holders – Once minimum $598.80 for out-of-pocket costs for extended Medicare Safety Net services has been met annually, Medicare will pay 80% of out-of-pocket costs

PBS Co-payment

PBS/RPBS Co-payment

· General patient - $34.40 per scripts up to threshold

· $5.80 per script up to threshold of $348.00

· Concession card holder - $5.80 per script up to threshold

PBS Safety Net threshold (2012 Figures):

PBS Safety Net threshold:

· All Medicare card holders (Australian residents) - Once $1363.30 has been spent annually on pharmaceuticals listed on the PBS, further pharmaceuticals are maximum $5.80

· Once minimum $ 348.00 has been spent annually on pharmaceuticals listed on the PBS/RPBS, further pharmaceuticals are free 

· Concession card holders – Once $348.00 has been spent annually on pharmaceuticals listed on the PBS, further pharmaceuticals are free