In the Australian health system, there are a few different ways in which in-hospital medical services are funded.
To begin with, the Medicare Benefit Schedule (MBS) lists all of the medical services subsidised by the Australian government through Medicare. These medical services include doctors’ services (eg. GPs and specialists), or diagnostic services (eg. blood tests, x-rays and ultrasounds provided by your pathologist and radiologist).
For each service listed in the MBS, the government has determined a set fee. Medibank pays benefits to Medibank health members towards their in-hospital medical services based on the MBS.
Doctors aren’t duty-bound to charge only the MBS fee for their services – they can choose to charge an amount above the MBS fee. This is where out-of-pocket costs can arise. But there are some scenarios where Medibank’s GapCover can help reduce your out-of-pocket medical expenses.*
If you receive in-hospital medical services for an MBS listed service (that is included in your Medibank hospital policy), and if your doctor charges no more than the MBS listed fee, then the cost will be covered by Medicare (75% of the MBS fee) and Medibank (25% of the MBS fee). This means that you won’t have an out of pocket expense for your in-hospital medical services.