The Medicare Benefits Schedule (MBS) is a list of fees for medical services set by the Government for eligible hospital treatment as a private patient. Medicare pays 75% of the MBS fee for in-hospital medical services and hospital cover pays the other 25% (sometimes more if the doctor agrees).
Doctors don’t have to stick to the MBS fee for their services, and if they charge above that amount, you’ll have an out-of-pocket cost (AKA ‘a gap’) to pay.
Lucky for you we take part in Access Gap, which is a program that aims to reduce the difference between the MBS fee and what doctors charge. Doctors can choose to take part in Access Gap on a case-by-case basis, and if they take part, you’ll either have no gap or they’ll tell you exactly what your out-of-pocket costs will be.
Health funds can’t pay benefits for medical services outside of hospital (things like going to your GP), but Medicare pays 85% of the MBS fee for these. For GP appointments, Medicare pays 100% of the MBS fee.