Going to hospital can bring up lots of questions. We’ll help you understand your cover, choices and costs, and support you through your preparation, recovery and making a claim.
Check your cover
Make sure you understand what’s included in your cover and what your out-of-pocket costs might be.
Start by completing a hospital eligibility check. You’ll need the Medicare Benefits Schedule (MBS) item codes for your procedure.
Got your Medicare codes?
Get a personalised assessment on your upcoming hospital visit based on your admission details and what’s included in your cover.
Don’t have your Medicare codes?
You can still check which treatments we pay benefits towards by viewing your cover summary in My Medibank.
Alternatively, chat to us online or call 132 331.
Your choices can help reduce out-of-pocket costs
You can often reduce out-of-pocket costs by choosing Medibank Members’ Choice hospitals and specialists who choose to participate in GapCover or No Gap1 arrangements for your procedure.
Ask your specialist if they’re a No Gap program partipating surgeon
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.
Ask if a Members’ Choice hospital is right for you
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.
Common procedure costs
Find out the typical costs of more than 40 common hospital procedures.
Your hospital experience
No two hospital experiences look the same, but a planned private hospital admission usually follows similar steps. We can support you during all of them.
Visit your GP
In non-emergency cases, your GP will assess your condition and refer you to a specialist if needed.
See a specialist
A specialist can discuss your treatment options with you, including whether you need a hospital treatment or procedure.
Check your cover
Complete a hospital eligibility check to find out what’s included in your cover and what your out-of-pocket costs might be.
Prepare for and go to hospital
Your specialist will arrange your hospital admission and let you know how to prepare.
Recover at home
Follow your specialist’s discharge plan and use your cover to support your recovery.
Make a claim
Claim for in-hospital services included in your cover.
Explore your treatment options
Medibank at Home is a range of programs and services that gives eligible members the choice of whether they receive care or rehabilitation in a hospital or in the comfort of their own homes, when their doctor considers it clinically appropriate.
Speak to your GP or specialist about whether at-home care or rehabilitation could be appropriate for your needs.
Alternatively, contact our Customer Health Support Team to find out more. Call 1300 733 338 Monday to Friday 9am to 5pm AEST.
We're here to support you before, during and after hospital
Health Concierge
Health Concierge provides personalised, phone-based health support to help eligible Medibank members with hospital cover prepare for or recover from a hospital stay or treatment.10
Call 1800 789 414 to speak to Health Concierge, Monday to Friday 9am to 5pm AEST.
24/7 Medibank Nurse Support
Medibank health insurance members can chat to a registered nurse about their health questions or concerns and get guidance on what they can do next.11
Chat online or call 1800 644 325 anytime of the day or night, 7 days a week at no extra cost.12
Medibank After Hospital Home Care
We’re trialling13 a service where eligible members with resident hospital cover14 who have been admitted to hospital in the last 7 days, could receive the extra support they may need following their hospital stay, where clinically appropriate.15
Make a claim
Ready to make a claim for a hospital treatment or procedure? Claims made in the My Medibank app or online are generally processed faster than claims in store or by post.
Things you should know
1 Eligible members participating in Medibank’s No Gap program could pay no out-of-pocket costs for included services and treatments 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 cover 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.
2 Medibank members aged 18 and over. Members must, for the duration of the program, hold residential hospital cover with included Hospital Psychiatric Services, and have served any applicable waiting periods. Medibank Alcohol and Drug Detox at Home program is initially a 12 month trial that starts on 24 November 2025. Participation in the program is subject to Clean Slate Clinic’s eligibility criteria and may not be suitable for everyone.
3 Medibank members aged 18 and over with residential hospital cover that includes Chemotherapy, radiotherapy and immunotherapy for cancer and served the relevant waiting period. Treating doctor must consider it appropriate. Services are also subject to provider availability, and coverage may be limited in some regional and remote areas at the time of referral. Not available in ACT, NT and Tas.
4 Must have residential hospital cover that includes standard clinical category Dialysis for Chronic Kidney Failure and served the relevant waiting period. Must be clinically suitable.
5 Must have residential hospital cover. Treating doctor must consider it clinically appropriate.
6 Eligible members with bronze residential hospital cover or above and who have served any applicable waiting periods. Members must also be referred by a treating health professional, such as a GP or specialist, and meet the clinical criteria for at-home treatment.
7 Must have residential hospital cover with Palliative Care listed as Included or Restricted. Must have served the relevant waiting period. Must be considered clinically appropriate. Not available in all areas.
8 Available, where clinically appropriate, to Medibank members aged 18 and over with residential hospital cover with Restricted or Included Rehabilitation, who have been admitted and subsequently discharged from hospital in the last 90 days for a procedure or condition that is suitable for cardiac rehabilitation, can speak and read English and can access a telephone and internet. Must have served the relevant waiting period.
9 For eligible Medibank hospital members aged 18 and over with who have hospital cover with that includes Rehabilitation listed as Included or Restricted. and Must have served relevant waiting periods. Treating doctor must consider it appropriate. Services are subject to provider availability. Providers are not located in all areas and may change without notice. Additional treatment may incur out-of-pocket costs.
10 Excludes Overseas Visitor Health Cover, Working Visa Health Cover and Overseas Student Health Cover (OSHC).
11 This service is not suitable for medical emergencies and is not a substitute for a consultation with a doctor.
12 Some referred services may involve out-of-pocket costs and waiting periods may apply.
13 Medibank After Hospital Home Care is a 30-month trial service starting in May 2024. Service subject to provider availability. Available in most major metropolitan and regional areas. Not available in the Northern Territory.
14 Must hold Medibank resident hospital cover (excluding OSHC), be aged 18 years or over. Must have been admitted to hospital in the last 7 days and have a chronic health condition. Must be assessed by an Amplar Health clinician as having a risk factor for an unplanned hospital readmission and be assessed as clinically suitable for this program. No waiting periods apply to the After Hospital Home Care program, however standard waiting periods may apply to your hospital admission.
15 Clinical suitability is assessed by Amplar Health clinicians.
16 Other fees may include a facility fee, or fees for diagnostic services, other specialists, or take-home medication and equipment, depending on your circumstance.
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).
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