At a glance
- If you have private hospital cover, you can choose to be treated either as a public patient or a private one.
- As a private hospital patient, you can choose your specialist, hospital and treatment date, depending on availability.
- Ask your GP for their recommendation for a specialist. You can ask for an open referral if you want more options for choosing your specialist.
- You can often reduce out-of-pocket costs by choosing specialists who choose to participate in GapCover or No Gap1 arrangements for your procedure, and Medibank Members' Choice hospitals.
- Use our Find a provider tool to find specialists and hospitals. Look for the 'No Gap participating surgeon', 'GapCover' and 'Members’ Choice' tags.
What do I have choice over for my hospital treatment?
Your level of choice can depend on the type of treatment you need and how urgently you need it, where you live and whether you’re treated as a public or private patient.
There are three ways you can be treated in the Australian hospital system: as a public or private patient in a public hospital, or as a private patient in a private hospital.
Here’s what each of those scenarios means and how they can affect things like your out-of-pocket costs, your choice of specialist, and your wait times for treatment.
- Out-of-pocket costs: Generally no, if you’re eligible for Medicare
- Choice of specialist: No
- Wait times: Usually longer than private hospital wait times
- Private room: Not usually
- Out-of-pocket costs: Possibly, depending on your level of cover, whether you’ve served any relevant waiting periods, and whether your specialists charge above the MBS item fee
- Choice of specialist: Yes, unless you’re being treated in an emergency
- Wait times: Usually shorter than if you were treated as a public patient, subject to availability
- Private room: Depending on availability
- Out-of-pocket costs: Possibly, depending on your level of cover, whether you’ve served any relevant waiting periods, your excess or per-day payments if applicable, and whether your specialists charge above the MBS item fee
- Choice of specialist: Yes, unless you’re being treated in an emergency
- Wait times: Usually shorter than if you were treated as a public patient
- Private room: Depending on availability
There are many reasons why you might choose one specialist over another. You might decide based on a recommendation from your GP or from a friend or family member, or you might choose based on someone who understands your background or identity.
It’s important to find a specialist you feel comfortable with and whose location, availability, treatment plan and fees align with your needs.
Before you commit to a specialist, make sure you ask the following questions.
Will you particpate in GapCover for my treatment?
The GapCover scheme is designed to help reduce or eliminate gap payments. Each specialist involved in your care (for example, your surgeon and anaesthetist) can choose whether to use GapCover for your treatment, so ask each one whether they’ll participate in GapCover for your treatment.
Are you a participating surgeon in Medibank’s No Gap program?
Eligible Medibank members with hospital cover could pay no out-of-pocket costs1 for included treatments and medical services as part of their hospital admission for a range of elective surgeries at participating hospitals with participating surgeons.
Can I get a cost breakdown in writing?
Ask each specialist involved in your care for a written breakdown of their fees. This is known as Informed Financial Consent, and it can help you understand your out-of-pocket costs.
There are many reasons why you might choose one hospital over another.
To help try and reduce your out-of-pocket costs, ask these questions before you choose a hospital.
Is it a public or private hospital?
If you’re a public patient at a public hospital, you’ll generally have no out-of-pocket costs if you’re eligible for Medicare. You may have out-of-pocket costs if you choose to be treated as a private patient.
Is it a Members’ Choice hospital?
You can generally get better value at a Members’ Choice hospital than a non-Members’ Choice hospital. We have arrangements with most private hospitals and day surgeries in Australia.
Use our Find a provider tool to find specialists and hospitals. You can use these tags to narrow your search:
- No Gap participating surgeon: The surgeon particpates in Medibank’s No Gap1 program.
- GapCover: Ask each specialist involved in your care (for example, your surgeon and your anaesthetist) whether they'll participate in GapCover for your procedure.
- Members’ Choice: The hospital is a Medibank Member’s Choice Hospital.
Now that you've covered
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Things you should know
1 Eligible members participating in Medibank’s No Gap program could pay no out-of-pocket costs for your hospital stay, so long as your procedure is included in the program and your procedure is performed by a participating specialist at a participating hospital. An excess or co-payment may still be payable, depending on the product a member has chosen and whether they are claiming under their hospital cover for the first time in a calendar year. The Medibank Member Guide and Fund Rules set out hospital benefit exclusions, which apply to all hospital admissions for Medibank members. There may be out-of-pocket expenses associated with outpatient appointments, such as your initial visit with a participating surgeon in their consulting rooms.
While we hope you find this information helpful, please note that it is general in nature. It is not health advice, and is not tailored to meet your individual health needs. You should always consult a trusted health professional before making decisions about your health care. While we have prepared the information carefully, we can’t guarantee that it is accurate, complete or up-to-date. And while we may mention goods or services provided by others, we aren’t specifically endorsing them and can’t accept responsibility for them. For these reasons we are unable to accept responsibility for any loss that may be sustained from acting on this information (subject to applicable consumer guarantees).