Going to Hospital

Going to hospital can be stressful, and the last thing you need is to worry about how much it’s going to cost. That’s why we’ve created a Going to Hospital guide; to give you a rundown of how it works, and what you can expect to pay out of your own pocket.

Once you’ve given it a good read, you’ll be better informed about your health insurance, so you can ask questions to make the right decisions.

Download the Going to Hospital guide

In the meantime, here’s a summary of the key points included.

What are my options? Public vs Private

If you’re an Australian resident with private health insurance, you can choose to be treated as a private patient at either a private or public hospital (provided the service is included in your cover), or a public patient at a public hospital.

Check out the government’s myHospitals website for information on public and private hospitals.

How does Hospital cover work?

Hospital cover can pay towards services you receive when you’re admitted to hospital and treated as a private patient. It can’t pay towards any services when you’re not admitted to hospital(e.g. seeing your GP or specialist).

Does my cover pay towards my treatment? Call us on 132 331 to check.

Before booking your treatment as a private patient, call us on 132 331 to find out what services we will pay towards, and any out-of-pocket expenses you might incur.

Ask your specialist for the MBS (Medicare Benefits Schedule) item number/s for your treatment and call us on 132 331 to check if it’s an Included, Limited (Restricted) or Excluded service under your cover. We’ll also let you know if you need to complete any relevant waiting periods.

How can I reduce my out-of-pocket expenses?

Your out-of-pocket expenses depend on things like the hospital you're admitted to and what services are Included or Limited under your cover.

Here are three ways to help keep costs down, and avoid any unwelcome fees.

  • Choose specialists who will participate in GapCover for your treatment

    GapCover is a scheme designed to help eliminate or reduce your out-of-pocket expenses for in-hospital charges. If your specialist decides to charge more than the MBS fee (the set government fee), you’ll be left with an out-of-pocket expense, commonly known as the ‘gap’. Learn more about GapCover on page 7 of the Going to Hospital brochure.

  • Find out where your specialist operates, and opt for a Members’ Choice hospital

    • We have arrangements with most private hospitals and day surgeries in Australia, so you generally get better value if you go to one of these providers.

    • If you’re treated in a non-Members’ Choice hospital, the amount we pay is generally lower than for a Members’ Choice hospital so you could be left with significant out-of-pocket expenses.

    • Find your nearest Members' Choice hospital at medibank.com.au/memberschoice

  • Ask for a full breakdown of costs
    • It’s your right to know the full cost of your in-hospital treatment and how much your out-of-pocket expenses could be. Knowing about potential costs not only saves you worrying - it can also save you money.

    • Before going to hospital, ask each of your specialists for a breakdown of all the costs in writing. This is known as Informed Financial Consent. It should list the fees for each specialist involved in your treatment – your surgeon, assistant surgeon, and anaesthetist – and any other related costs.

    • Tell your specialists if you’re worried about cost — there may be ways to cut down on expenses without compromising your care.

Going to hospital for a hip or knee replacement? Learn about our rehabilitation at home service

A rehabilitation program is sometimes required after you have undergone joint replacement surgery. To give you greater choice and flexibility after total hip or knee replacement surgery, Medibank offers a program that allows you to complete your rehabilitation at home. This can involve regular visits from a physiotherapist, occupational therapist, nurse, and/or personal carer.

If you hold Medibank hospital insurance that includes hip and knee replacements, you could be eligible for this program. We will also consult your treating doctor to determine whether it’s safe and appropriate for you. Call us on 1800 065 769 to find out more or download this brochure.

Clinicians can download the rehabilitation at home referral form here.

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