How much do private hospitals cost?

If you are a private hospital patient and the treatment you are receiving is listed on the Medicare Benefits Schedule (MBS), Medicare will cover 75% of the MBS fee for your doctors’ services.

You have to pay the rest of the hospital and medical fees, which could include:

• 25% of the MBS fee for your doctors’ services (including anaesthetist and assistant surgeons)
• any difference between your doctors’ fees and the MBS fee
• hospital accommodation
• operating theatre fees
• prostheses costs (for example, plates, screws, artificial joints) 
• medicines
• dressings and bandages
• medical imaging, pathology or other diagnostic tests
• costs for physiotherapy and other therapies in hospital.

If you have Hospital Cover for that treatment, you can claim back some of these from your private health insurer. If you have Hospital Cover for the medical service, your insurer must pay at least the remaining 25% of the MBS fee. 

Doctors set their own fees for private medical services. They can charge more than the MBS fee set by the Government.

If your doctor charges more than the MBS fee, you may have to pay the ‘gap’ out of your own pocket. If the doctor has a gap arrangement with your insurer, the doctor may choose to charge you under that arrangement with either ‘no gap’ or a ‘known gap’. However in some cases the doctor may not honour the gap arrangement with your insurer, and you may have significant out-of-pocket costs.