How to reduce your out-of-pocket costs

A few handy tips to help you keep your out-of-pocket costs down.

We’ve put together this little checklist to help you better manage any potential out-of-pocket costs for hospital admissions. More importantly, we hope it gives you the knowledge and confidence to know what to ask your doctor and specialist (or specialists) before your hospital admission.

How to reduce your out-of-pocket costs

You have a choice of specialist

If a hospital admission is on the horizon, it’s important to know that you can choose who treats you in the private system. Keep in mind that different specialists can charge differently for the same treatment or surgery, which can have an impact on your out-of-pocket costs. 

If your GP has a specialist in mind for your procedure, it’s perfectly okay to ask them why they recommend them or ask for an open referral so you can find the right specialist for you. If you change your mind, you can also use your referral with any doctor with the same speciality. 

Ask for a quote

You’re entitled to know the full cost of your in-hospital treatment and how much your out-of-pocket costs could be before you have your surgery. 

Ask each of the specialists involved in your treatment for a breakdown of all costs in writing. This is known as an Informed Financial Consent. It should list the fees for each specialist involved in your treatment – your surgeon, assistant surgeon and anaesthetist – along with the relevant Medicare Benefits Schedule item numbers related to your treatment.

Have a conversation with your specialist if you’re worried about cost, as there may be ways to cut down on expenses without compromising your quality of care, for example, through Medibank’s GapCover scheme.

And if you are looking for something to compare your quote with, you can get an idea of how much common procedures typically cost using our Procedure cost estimator tool.

Does your specialist participate in GapCover?^

GapCover is a scheme designed to help eliminate or reduce your out-of-pocket expenses for in-hospital specialist charges.

Your GP can help you find a specialist that participates in GapCover via an online health portal called Healthshare. Alternatively, you can find a specialist who has previously participated in GapCover using Medibank’s Find a Provider tool.

Please note that Terms and Conditions apply to GapCover – see below. 

Choose a Members’ Choice Hospital

We have agreements with Members’ Choice Hospitals to limit your out-of-pocket expenses, meaning you’ll generally get better value. Out-of-pocket expenses should be limited to things like:

  • Any excess you may have with your cover

  • Medical out-of-pocket costs
  • Any pharmaceuticals not covered by our agreement with the hospital. This includes the cost of any drugs issued on discharge from hospital
  • Any gap for surgically implanted prostheses and other items on the Federal Government's Prostheses Schedule list
  • Costs for services not covered, or not fully covered, by our agreement with the hospital or under your cover
  • Costs for treatment in an emergency department in a private hospital. Note, with Ultra Health Cover you can claim benefits on the facility fee charged (subject to annual limits).

It’s important to remember that if you choose a non-Members' Choice private hospital, you're likely to have significant out-of-pocket expenses. You can look up Members’ Choice Hospitals using our Find a Provider tool.

And finally, call us before your procedure

It’s always a good idea to get in touch before you commit to a procedure. We can confirm that your procedure is Included in your cover and help you get a better understanding of what out-of-pocket costs to expect. Just be sure to ask your GP or specialist for the specific Medicare Benefits Schedule (MBS) item numbers related to your treatment.

Want to find a specialist or Members' Choice Advantage Hospital?

Take the guesswork out of choosing a specialist with our Find a Provider tool. Find a provider

How much does my procedure cost?

See the costs involved in more than 40 common procedures like hip and knee replacements, ACL repair, and many more with our Procedure cost estimator .

Wondering about expenses for extras?

With the My Medibank app, you can now get an estimate of how much you could pay, and how much you could get back before your next visit to an extras provider. Go to “Cover” followed by "Health Insurance" section and tap on “Out of pocket estimator" to get started. Find out more about the My Medibank app here.


Looking for something else?

Visit our Hospital Assist homepage for a range of tools and advice to help you at every stage of your hospital journey.

No Gap Joint Replacement Program

Eligible members could pay no out-of-pocket costsfor a knee or hip joint replacement.

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Help the way you want it

Contact us 

Call us on 134 190 to speak to a consultant. Alternatively, chat to us 24/7 online.

Self-service options

Login to MyMedibank or Download the MyMedibank App for self service options.

Find a specialist

Find a specialist or Member's choice hospital using our find a provider tool.

Things you need to know

^    GapCover is a scheme designed to help eliminate or reduce your Out Of Pocket expenses for in hospital specialists’ charges. Doctors can choose to participate on a per claim, per treatment and per patient basis. You may be treated by more than one doctor (eg. surgeon and anaesthetist) and participation is at each individual doctor’s discretion. GapCover doesn’t apply to diagnostic services, out of hospital medical services and services not included under your policy. GapCover doesn’t apply to excesses and/or co-payments. Out of pocket costs may still apply. Please refer to the Going to Hospital Brochure or contact us on 132 331 for more information.

* There may be out-of-pocket expenses associated with outpatient appointments, such as your initial visit with a participating surgeon in their consulting rooms. An excess or per day 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.

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).