All the big changes to Medicare, PBS and Aged Care from November 1 explained

Major changes are now being made to the way millions of Australians receive healthcare.

The changes affect Medicare and the Pharmaceutical Benefits Scheme (PBS), two pillars of the Australian healthcare system, as well as aged care.

Everything you need to know is here.

BULK BILLING

Bulk billing means the doctor visit is completely free.

Instead of you paying the doctor, the government pays the doctor a fee, called a Medicare rebate, for your visit.

However, many GP practices do not operate on full bulk billing, meaning Australians sometimes have to spend some money on a visit to the practice.

This is sometimes called a “gap fee” or “out-of-pocket” cost.

This is because clinics are businesses and some doctors do not receive enough revenue from government bulk billing fees to cover their costs.

But now the government is trying to change all that by increasing incentives for doctors to bulk bill.

This is called the Bulk Billing Application Incentive Program.

WHAT IS CHANGING?

Simply put, the government is increasing the Medicate discount it pays to doctors in the hope that more doctors will be encouraged to offer full bulk billing to patients.

Below is a table showing the current discount levels and the new total payments the bulk billing app will receive under the program.

Note that totals include the Medicare rebate, bulk billing incentive item discount, and 12.5 percent bulk billing practice incentive program payment.

The increases are quite serious. Payment for a standard consultation in one city rose 62 percent, from $42.85 to $69.56.

Standard consulting payments for a remote area rose 103 percent to $86.91.

Bulk Billing Incentive November 1

There is a second, related part of the government’s effort to expand bulk billing.

Includes expansion of eligibility for Medicare Benefits Schedule (MBS) bulk billing incentives (BBIs).

Currently MBS BBIs are reserved for children under 16 and Commonwealth concession card holders.

It now expands to include all Medicare-eligible patients.

BBIs are additional MBS payments that the government makes to a doctor when bulk billing a patient, in addition to the standard Medicare deductible.

What does this mean for you?

If GP clinics took up the offer to join and became full bulk billing clinics, this would mean more free doctor visits.

CONTRACEPTION COSTS HAVE BEEN HALF

Alongside changes to the GP environment, Australians will now benefit from better access to contraceptive healthcare.

NuvaRing is now listed on PBS.

The government subsidizes medicines listed on the PBS, making them more affordable.

NuvaRing is a flexible vaginal ring that comes in a pack of three. It secretes a combination of estrogen and progestogen to prevent ovulation and is used in a monthly cycle, offering an alternative to daily oral contraceptives.

Before the PBS listing, women could have been paying more than $270 a year for this option.

They will now pay $31.60 per script, or $7.70 in concessions.

Each scenario covers three months of birth control, so the listing essentially cuts the concept price in half.

Prices will drop to a maximum of $25 per scenario starting January 1.

“For too long, women’s healthcare needs have been sidelined, but the Albanian government is changing this and offering more choice, lower costs and better healthcare,” said Health Minister Mark Butler.

“Australia has one of the lowest uptake rates in the developed world of long-acting contraceptives, partly due to access and affordability.

“These changes to MBS and expanded options for PBS will eliminate cost and access barriers so more women can choose the birth control method that works best for them.”

ELDERLY CARE

Last year the government passed the Aged Care Act 2024, which changes how support for older people will be funded.

The government will fully fund all clinical care for people in aged care homes, but older people will be required to make means-tested co-contributions for non-clinical care and daily living services, according to the Older Persons Advocacy Network.

Daily services include cooking, cleaning and laundry, while non-clinical care includes personal care and mobility assistance.

Contributions for non-clinical care will be capped at $105.30 per day or $135,318 for life.

The support provided to seniors living at home is also changing.

The new Home Support program replaces the old Home Care Packages program and the Short-Term Restorative Care program.

The OPAN fact sheet notes that Home Support has eight funding classifications, ranging from approximately $11,000 to $78,000 per year.

Buyers receive a budget consistent with their evaluated financing classification.

“Recipients will work with their aged care providers to allocate their budgets across three broad categories of services tailored to their needs,” the fact sheet states.

• Clinical supports such as nursing and physiotherapy
• Independence services, including personal care, respite care, transportation and social support
• Daily living services such as cleaning, gardening and meal delivery

The government covers the costs of clinical supports, but older people will contribute to areas of “independence” and “everyday living”.

Contribution levels are based on income and asset assessments by Services Australia.

Alongside changes to funding models, the Act seeks to strengthen older people’s safety and decision-making authority.

Firstly, the legislation ensures the protection of whistleblowers, including older people, families or aged care workers who report a person or organization not complying with Aged Care legislation.

Reporters can report anonymously to the Aged Care Quality and Safety Commission, the federal health department, a registered provider or aged care worker, a police officer or an independent aged care advocate.

“If someone files a report, they will be protected from any negative consequences that may result from the preparation of the report,” the government says.

“(And) Ensure that their identity or identifying information is protected, with some exceptions – for example, where sharing information with the ACQSC or a lawyer is necessary or where it is necessary to prevent a serious threat to a person or persons.”