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Medicare rules are changing on 1 November – will you still be covered?

In the next few months there are big changes coming for Medicare rebates and health fund coverage for plastic surgery procedures. This article will help you understand if your plans are impacted.


Medicare changes on 1 November 2018

We were advised this week that Medicare will change many item numbers from 1 November 2018. Some are being abolished, while others are becoming much stricter in terms of eligibility. This is because the government believes that Medicare item numbers are currently being used by patients who have ‘cosmetic’ rather than functional needs. We have seen the draft of the new Medicare schedule which bring changes for:

  • breast reductions (will go up by $6,500 if you don’t satisfy the new rules),
  • breast lifts (up by $6,500 if you don’t satisfy the new rules),
  • removal and replacement of implants (will go up by $8,000 if you don’t satisfy the new rules) and
  • combinations of some surgery will be limited (for example, tummy tucks with other lift procedures).


New health fund tiers

You may also have seen media that health funds will be changing to a new standardised tiering model from 1 January 2019. This will likely impact the coverage that your fund may have for certain Medicare item numbers.


What does this mean for you?

Quotes we have issued which feature an item number and therefore attract a Medicare rebate and fund rebates (for insured patients) are only valid for surgery up to 31 October 2018.

After that date, we will have to provide new quotes based on the final version of the new Medicare item numbers which may mean you are not covered.


Should I book surgery before 31 October?

Only if it is the right time for you! While a Medicare rebate and fund coverage is a bonus, the timing still has to be right for you and your family.


What next?

Please contact us if you want to discuss the implications of these changes for your surgical plans by calling 4920 7700 or send us a message using the contact form below.