Varicose vein treatment costs can start at $750, depending on the type of treatment you’re receiving and whether you’re getting one leg done or two. Fortunately, Medicare can help cover the costs – so long as you are eligible. So, can your varicose vein treatment be covered by Medicare? Let’s go into the eligibility criteria and how much you can expect to receive.
Eligibility
1. Are you a Medicare cardholder?
First and foremost, you need to have Medicare to receive any Medicare coverage. To be eligible, you must be an Australian or New Zealand citizen, permanent resident, or have applied for permanent residency (some conditions apply.) You are also eligible if you are a citizen or permanent resident of an Australian territory, including Christmas Island, Norfolk Island, Cocos Island, or Lord Howe Island.
You may also be eligible if you are from a Reciprocal Health Care Agreement Country. Australia has reciprocal healthcare agreements with 11 countries: Finland, Italy, Malta, New Zealand, Norway, the Republic of Ireland, Sweden, the Netherlands, the United Kingdom, the Kingdom of Belgium and the Republic of Slovenia.
2. Is your varicose vein treatment medically necessary?
Varicose veins fall into two categories: symptomatic and asymptomatic. If your varicose veins cause symptoms such as pain, swelling, itching, skin discolouration, and/or limb fatigue, Medicare will cover you.
If your varicose veins are smaller and you do not experience uncomfortable symptoms, your case will likely be deemed cosmetic, and Medicare unfortunately will not cover it. Our doctors will do a thorough consultation with you and discuss if you would be eligible for rebates and we can give you a detailed estimate.
How much can you receive from Medicare for varicose vein treatment?
Medicare can cover over half of the treatment costs, provided you are eligible. The amount of coverage you receive depends on:
1. How much does your vein clinic charge?
At The Vein Institute, you can expect 50-60% coverage for treatment and ~$80 back for your consultation fee.
Medicare coverage depends on the schedule fee – which is essentially what Medicare estimates a service fee to be.
Unfortunately, Medicare’s schedule fees aren’t always accurate. Australian vein clinics often need to charge more than the schedule fee to account for practitioner and assistant pay, equipment, and clinic operation including overhead.
2. What is your safety net status?
Your gap amount counts toward your Medicare Safety Net Status. A gap amount is the difference between the schedule fee and the Medicare benefit you get.
When you reach the threshold, you’ll get a higher benefit back. You’ll get 100% of the schedule fee for out-of-hospital (private clinic) services for the rest of the calendar year.
If you’re an individual, you’ll automatically receive the higher Medicare benefit upon reaching the threshold. If you’re part of a registered family, you’ll need to confirm your family members.
You may be eligible for a lower threshold if you are:
- a Commonwealth Seniors Health Card holder
- a Health Care Card holder
- a Pensioner Concession Card holder
- eligible for Family Tax Benefit Part A.
Note: you don’t need to register for a Medicare Safety Net if you are an individual and already have a Medicare account. If you are part of a family or couple, you can combine your costs, meaning you all can reach your thresholds sooner – but you will need to register with Medicare as such.
For more information on how to check your Medicare Safety Net status, watch the following video:
For information on how to register as a family or couple, head to Service Australia.
Can Private Health help instead?
You should speak to your provider to see if you’re eligible for coverage. We will provide a quote with detailed item numbers after the consult, which you can use to check with your insurance provider.
Seek specialist advice
At The Vein Institute, we provide safe, effective, and minimally invasive varicose vein treatments. During your consultation, we’ll assess your vein condition to see if you need treatment, and if so, the best option for you. For any questions on our costs and services, please contact us on 04 2020 2637.