AKA out-of-pocket cost.
The amount you pay when your doctor or hospital charges more than what Medicare and your health fund can pay.
For example, as a private patient in a hospital or a day surgery centre your doctor and any specialists who treat you will each raise a bill for their services. The Australian Government sets a schedule of fees for all medical treatments called the Medicare Benefits Schedule (MBS).
For items on the MBS, Medicare covers 75 per cent, while your health cover picks up the remaining 25 per cent. However, some doctors and specialists charge more than the MBS fees, with the extra amount referred to as the ‘medical gap’ or your out-of-pocket cost.
We have Access Gap, a scheme to reduce your out-of-pocket doctor expenses. First you need to ask your doctor if they participate. If they do, we pay them more than the Medicare Benefit Schedule fee – resulting in lower or no out-of-pocket expenses for you.