Healthcare | Slack Investor

Slack Investor vs Centrelink – My Application for a Commonwealth Seniors’ Health Card (CSHC)

Slack Investor likes the quiet life, and doesn’t usually go looking for trouble, but a recent birthday put me at 67 – this is the age threshold for the Australian Aged Pension. Other than feeling old, this is not too much of a concern as I am a happy self-funded retiree.

However, in a generous flourish, the previous government made it much easier for self-funded retirees to qualify for the Commonwealth Seniors’ Health Card (CSHC). This card provides savings on some Pharmacy costs and gives easier access to higher rates of reimbursement for out of pocket expenses (Medicare Safety Net). Some GP’s will offer bulk-billing to CSHC holders as they can get a higher Medicare fee for these consultations. So, this card looks worth the effort if you qualify and, looking at the new numbers, most retirees not on the pension, would.

Health savings available to CSHC holders – From Laterlifeadvice.com.au

Do you qualify?

Age pension age and an Australian citizen? The critical test is your income … and not just any income … but your “Adjusted income”.

To meet the income test, your “Adjusted Income” must be less than the following:

$95,400 a year if you’re single

$152,640 a year for couples

$190,800 a year for couples separated by illness, respite care or prison.

These values are valid for 2024 and they get inflation adjusted each year

For Slack Investor, it was a matter of gathering scans of our most recent ATO Notice of Assessment for my partner and myself. Plus contacting my Super Provider to send me an income schedule for each of my Pension accounts – These are known as form SA 330 and are often requested for dealing with Centrelink, DVA, etc.

As we do not own an investment property, the only inputs to our Adjusted Income were our taxable incomes and deemed income from our account based pensions.

Any money in our accumulation accounts or bank accounts was not considered in our deemed “Adjustable Income” as a couple.

Noel Whittaker provides a handy calculator to work out your total deemed income from your pension assets (Currently about 2% of assets). I stress it is not the actual income from these pensions that is relevant – but the deemed income! The asset amounts of our pensions (Estimated for the application date – from your super fund or SMSF) were put into Noel’s Calculator. As the total of our deemed pension income plus our taxable incomes was under the $152,640 a year for couples, we proceeded with the application online through MyGov/Centrelink/Make a Claim or Review Claim Status. This is where the fun begins.

Handy Tips

Before applying, get some identification documents ready and your latest ATO Notice of Assessment (in pdf form). Make sure you have a MyGov account and have Centrelink linked to it. I used the online form to apply, and it was frustrating at times, but generally OK. Others have downloaded the form, filled it out and taken it to Centrelink for checking.

Contact your Super Funds for a SA 330 schedule that will give you relevant details of any Account-Based Pension that you own for the last tax year.
If you have a SMSF, contact your provider and they will furnish you with information on each of your pension funds. You will then have to download and fill out your own SA 330, as a trustee, for each of your income streams.
At one of the forms sticking points, I found the video on the application process by Brendan Ryan of Later Life Advice very useful – worth a watch for a 22 minute overview of this process (the video is found in the top left third of the page).

I must warn that this application is not for the feint-hearted – But do not give up! If you are having trouble, book an appointment with Centrelink – They will also check your documents if you are not sure.

The complexities of dealing with Centrelink and the CSHC have been entertainingly documented in the SMH and YourLifeChoices. There were several points where I was having what my mother would describe as “Sailor’s Talk” with my computer.

For all the frustration and “dead ends” encountered during the application process, I found a strategy of “Walk away – and try again another day” did the trick. Although, I will not find out about whether my application will be successful till July 2024, I did learn something useful along the way … How to Edit pdf forms – which came in handy as SMSF trustees have to populate several SA 330 forms with mostly the same data.

Using Google Chrome to fill out PDF forms

I don’t have any form-filling PDF software (e.g. Adobe Acrobat full version) and I am reluctant to install the “free” clients that usually come with some adware or a trial period. I was delighted to find out that this form-filling task can be done in my Chrome browser without installing anything extra. Locate the PDF you want to edit in File Browser.

Right-Click the file to open up the context menu – Scroll down to “Open with” a new dialogue box will open showing Google Chrome if you have it. Select “Google Chrome”.

The form will then open as a Chrome Tab and you can edit away then save or print your changes (Download and Print Symbol at top right of the Chrome tab).

General Practitioners (GP’s) in Australia … and April 2023 – End of Month Update

Slack Investor is a great believer in writing about experience and a few (fortunately) minor health matters has had him recently exploring Australia’s health system. In Australia, the General Practitioner (GP) is usually the first port of call if you have a health problem and of Medicare will fund a portion of your costs for a consultation. Your relationship with your GP is an important one and it is vital that you feel comfortable with your GP’s manner, knowledge and skills. There are two tiers of GP pricing in Australia.

Bulk Billed – where there is no extra consumer payment required if you have a valid Medicare card.
Mixed Billing – where patients will pay a a bit extra in addition to the Medicare allowance

Bulk billing doctors are becoming harder to find as the rate of bulk billing has fallen to its lowest level in 13 years . According to government figures, it was 80.5% in the 2022 December quarter. Though this figures is likely to be “grossly inflated” as many practices have charged a separate eftpos transaction at the desk and this does not appear in Medicare figures.

What should happen is that either the patient is bulk-billed and pays no money – or they are charged a private fee, a portion of which is rebated by Medicare directly into the patient’s bank account.
Dr Margaret Faux, Health Insurance Law Academic

Levels of bulk-billing are probably closer to 40% as shown in the recent survey by The Age. In answer to the question “Does your GP Bulk-bill or charge you a gap fee?”

Survey results from the Resolve Political Monitor conducted by The Age

This Age poll is in line with results by an excellent organisation called Cleanbill that are driven by a mantra that Slack Investor wholly agrees with …

” … healthcare is at its most accessible when you can see all of your options and their costs before you’ve made a booking.”
The mission statement for Cleanbill

The Cleanbill site is easy to use for locating GP’s in your area and transparently gives their total fees for a standard, or a long consultation. Once you have narrowed your search, you can usually make a booking straight from the site.

Only 42.7% of GP clinics serving nearly 18 million Australians
bulk bill (charge no out-of-pocket fee to) all patients.

At the 57.3% of GP clinics that charge an out-of-pocket fee the average extra cost for a standard, 15-minute consultation is $40.25 (out of a total cost of $80).
Australia-wide survey by Cleanbill – January 2023

The decline in bulk billing is not the GP’s fault as practice costs have continued to rise and the Medicare rebate has not kept pace with the rise in these costs. In 2013, the rebate was frozen for 6 years – and, even last year, though inflation was 6.1%, the Medicare rebate was only increased by 1.6%. The chart below shows how the rebate has failed to keep pace with inflation (CPI) and average weekly earnings (AWE).

The Medicare GP rebate has failed to keep pace with inflation (CPI) and average weekly earnings (AWE) – From ochrehealth.com.au

… more than half of GP practices (55%) plan to reduce bulk-billing and increase gap fees this year
2023 GP Insights Report

Are we heading down the track to a US – style system?

Slack Investor has lived in the US – and hopes not! … and, is pleased that the new Australian government is putting a bit of thought and money into this problem with an announced $2.2b injection of funds into Medicare – no detail yet.

Now Slack Investor does not want a completely “free ride” as he realises that healthcare must be paid for. Even in the much admired Scandinavian health systems there is usually a co-payment associated with a visit to a doctor of $20-25 AUD.

In Australia, many patients pay hundreds of dollars for non-GP specialist consultations, and $40–$50 out of pocket for GPs.
Dr Jillian Farmer – Insight Plus

So perhaps it is just a matter of nudging the co-payment down a bit by increasing the Medicare rebate, and some other reforms – all will be revealed on the Australian government budget night – 9 May 2023.

Slack Investor is hoping for some progress as the Australian Healthcare system is generally good … but could be better. In the meantime, if you are looking for a GP, use Cleanbill to help you find one.

April 2023 – End of Month Update

Slack Investor remains IN for Australian index shares, the US Index S&P 500 and the FTSE 100. It was a positive month for the Slack Investor followed markets. The ASX 200 up 1.8%, the S&P 500 up 1.5%, and the FTSE 100 powering on, and up 3.1% for the month.

All Index pages and charts have been updated to reflect the monthly changes – (ASX Index, UK Index, US Index).

Live Long and Prosper … Not in the US

Spock from Star Trek with the Vulcan Salute … “Live Long and Prosper” – Paramount +

The Vulcan salutation that Spock would give his fellow Vulcans is a catchphrase of the Star Trek series and a reminder that “living long” in a state of good health, would be a nice thing to achieve.

Slack Investor has been thinking about health lately and his research tells him that good health outcomes are not always just a matter of spending more money. The US is a good demonstration of this point. In an analysis of health data for the 38 OECD countries, though spending nearly twice as much as the average OECD country on health care, the US has the highest rate of people with multiple chronic health conditions.

2021 per capita health expenditure (spending: government + private programs + out of pocket expenses) for OECD Countries – From CNN Health

Money and Healthcare – What’s gone wrong in the US?

“16% of all officially recorded COVID-19 deaths (worldwide) occurred in the US, despite having only 4% of the world’s population”
The Commonwealth Fund

In most countries, using the broad indicator of life expectancy, as health expenditure increases, so does life expectancy. However, the US is an outlier. The populations of countries with much lower health spending than the US enjoy considerably longer lives and better health outcomes with other measures. The interactive chart from ourworldindata.org demonstrates this.

” … the U.S. is the only country we studied that does not have universal health coverage, but its health system can seem designed to discourage people from using services,”
The Commonwealth Fund

Universal Health Coverage (UHC) is defined as everyone having access to good quality health services without suffering financial hardship but this is a complex area and each country does it differently. UHC is usually funded by taxes or access to insurance schemes.

There are many reasons for this disparity with the US and other countries. The American Public Health Association say that improvements could be made by improving access to a UHC system, increasing primary care prevention, and more money spent on social services to support their citizens, rather than “sick care”.

The US has two streams of healthcare, those with insurance (usually tied to employment) and those without. In 2021, 70 million Americans are either not insured, or underinsured. Those without insurance usually get a much poorer health service and yet, in the other stream, the top 5% of spenders are incredibly well serviced and account for almost half of the health spending.

There are lessons to be learned here for all governments – it might mean an increase in taxation, but I would rather have the top ranked Norwegian style of healthcare rather than a US style.

Dying is expensive

Medical spending in the last twelve months of life accounted for approximately 8–11 percent of aggregate medical spending in most countries
2009-2011 Health Affairs study – using data sets from 9 OECD countries

As we get older, we get more expensive to run – more things going wrong! There are high costs associated with dying, as this is often in association with hospital care.

Overall, the average annual health service cost per person for people in their last year of life was 14 times as high as for those not in the last year of life ($24,000 and $1,700 respectively).
Australian Institute of Health and Welfare

It seems that it is not just our last year that is expensive to the health system, One 1993 U.S. study found that 30 to 40 per cent of costs incurred in the last year of life were incurred in the last month of life! Slack Investor calculates this as meaning 3-4% of lifetime aggregate medical spending is spent in our last month!

Cripes … Slack Investor is worried that he might turn up to hospital and some bureaucrat with a clipboard (or AI Bot!) will tell me that they have crunched the numbers …. and it’s just not worth it to admit me.

This deep dive into healthcare has made me determined to take a bit of control. I will try to stay as healthy as possible for as long as possible … better stop here and go for a jog – and have a healthy meal tonight!

Healthcare Haggle … and February 2023 – End of Month Update

Slack Investor’s Dental Shenanigans

Laying in the dentist’s chair recently, I was confronted with the bad news that I was up for a dental implant and this would probably set me back about $8000 – Lucky I was lying down!

After the initial shock, Slack Investor resolved to start treating his interaction with healthcare in the same way that he would treat any other professional service. I have decided to be an informed consumer and take control of the financial side of my healthcare. Lets get some quotes!

An internet trawl and a few phone calls later, I had a quote for around $4000 – dependent on an inspection and a dental scan. After the initial consultation, I asked for a written quotation. The quote was emailed to me and, subject to some caveats about extra costs if any bone grafts were necessary, came in at $4050 – Bewdy, lets go with this. In a classic piece of “anchoring bias”, if someone mentions $8K … and you end up with a price of $4K, this new price feels like an absolute bargain.

In retrospect, I was satisfied with the whole experience and enjoyed the empowering feeling of having some knowledge of the range in costs for a particular treatment. Because I am lucky to be amongst the privileged 55.2% of Australians (June 2022) who have private health insurance extras cover (45.2% of Australians have private hospital cover only), I also claimed a rebate of $1400 through my insurance provider.

Private Health Insurance

The funding of the Australian Healthcare system has evolved into a complex beast – with Medicare being at its foundation since 1984 – but there is also a private system. The arguments for and against taking out private health insurance are well covered by the consumer advocates CHOICE.

Medicare and the public hospital system provide free or low-cost access for all Australians to most of these health care services. Private health insurance gives you choice outside the public system.
The Australian Health System

As well as the Medicare Levy, 2% of your taxable income for most people, there is also the Medical Levy Surcharge which is an additional charge to encourage high earners to get private health insurance. Again, this is a bit complex, but if you are single with a taxable income (plus fringe benefits, super, etc) of greater than $90K, you are better off with private health insurance hospital cover.

The consumer body CHOICE has a calculator to answer if it financially makes sense to get private health insurance – but this is not just a financial issue, it depends on your circumstances and philosophy.

It is also important to know that there are a few areas that private medical insurance does not cover.

GP visits
Consultations with specialists in their rooms
Out-of-hospital diagnostic imaging and tests.

These services are under the umbrella of Medicare and their list of approved services and government subsidies available, the Medicare Benefits Schedule (MBS). If Medicare doesn’t cover the full cost of your treatment you will have to pay the difference, known as ‘the gap’ or “out of pocket expenses”.

Engaging with Medical Specialists

Again, I recognize my fortune in having private extras insurance cover and being in a large city (Melbourne) where there is choice in medical specialists.

Rather than getting a “big surprise” bill, I have resolved to be pro-active and informed when dealing with specialists.

It’s your right to get an estimate of costs from your doctor or hospital before you agree to have treatment. This helps you understand what you might have to pay.
Department of Health and Aged Care

If I think that I am in need of specialist’s attention, before I arrive at my GP asking for a referral, I get into research mode OR, if I haven’t had the chance to do any research, I will ask my GP for an open referral.

The reason for this is that my private health insurance provider has arrangements with some specialists to charge either a “No Gap” or a “Known Gap” arrangement. My insurance provider HCF have, on their member pages, a place where you can search for their preferred specialists in your area. They also have a good guide on questions to ask your doctor/specialist at your first consultation.

Medicare contributes a set amount for each treatment or procedure, as laid out in the Australian Government’s Medicare Benefits Schedule (MBS). For in-hospital treatment, Medicare pays 75% of the MBS fee; your insurer pays the other 25% (provided you’re covered for the service).
Department of Health and Aged Care

For in-hospital services, the Medical Cost Finder is an Australian Government site for estimating your out of pocket expenses for an operation. For example, the results below are for a Knee Replacement in a private hospital that indicate a typical $1600 out of pocket cost.

Output from Medical Cost Finder for Knee replacement in Melbourne

For “out of hospital” consultations with specialists in their rooms, where no private insurance claims can be made, get on the phone and ask the receptionist at a few places for typical “out of pocket” costs before you make an appointment. When you decide on a specialist and feel comfortable with him/her, ask for a written quote with any gap fees for any further work.

For a deeper dive, CHOICE have a number of tips on how to avoid out-of-pocket healthcare costs.

February 2023 – End of Month Update

Slack Investor remains IN for Australian index shares, the US Index S&P 500 and the FTSE 100. It was a mixed month for the Slack Investor followed markets. The FTSE 100 is powering on, but both the ASX 200 an S&P 500 drifting south (FTSE100 +1.4%; ASX 200 -2.9%; S&P500 -2.6%).

All Index pages and charts have been updated to reflect the monthly changes – (ASX Index, UK Index, US Index).

In full financial empowerment mode, Slack Investor set aside an hour and 10 minutes of his valuable time this month to get a better deal on some of his fixed costs. Good Results.

Task	Internet Research Time	Phone Time	Result
Home Loan	15 min	5 min	0.65% reduction in Interest rate – now 4.95%
Car Insurance (comprehensive)	40 min	10 min	Reduced annual payment from $1204 to $1031 ($173 saving p.a.)