What is a Hospital Gap?

A Hospital Gap is the difference between what a hospital charges you as a private patient for accommodation, meals, time in theatre, labour ward and other fees and what your health insurer pays for those services. It applies to private patients in a public or private hospital.

It does not apply to the difference between what your doctor charges to treat you and the amount Medicare pays for your treatment – this is known as a Medical Gap.

Often there is an agreement between your insurer and your private hospital so you have no out-of-pocket expenses (other than the excess or co-payment that may apply under your policy), or you know your out-of-pocket costs.

Public hospitals do not have agreements with specific insurers but are generally treated as Agreement Hospitals. If you are being treated as a private patient in a public hospital, you should check with the hospital to see whether out-of-pocket fees may apply.

If you are treated in a hospital that does not have an agreement with your health insurer, you could pay significant out-of-pocket costs for your treatment.

Always ask your hospital or health insurer for an estimate of the costs of your stay in hospital.