What is the 'Gap'?

What does 'Gap' actually mean? 

The government assigns an amount to be paid for every Medicare Benefits Scheme (MBS) item number. Providers are aware of the MBS and can decide to charge only the MBS amount, or they can add a Gap charge on top of the MBS amount. If they impose a Gap charge, then the patient is out of pocket.  

How do you avoid a gap charge?  

• Ask your referring doctor to direct you to a 'No Gap' specialist.  
• Search using our 'find a provider' tool on the Peoplecare website to discover what doctors are likely to offer 'No Gap' billing.  
• 'No Gap' can apply to some items, but not others. Discuss this with your doctor.  
• If the referred doctor doesn't offer 'No Gap' billing, get a second opinion.  

Your health fund and/or Medicare will only pay to the MBS amount, so it's important to understand any Gap charges before you wake up in recovery and have to sell a kidney. Ask your doctor for a full cost breakdown.  

So next time someone says 'Gap' in relation to your medical expenses, you know you need to research your options and ask questions.