No gap, no worries – 10,000 Medibank customers save $7 million in out-of-pocket fees
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More than 10,000 Medibank customers have gone through Medibank’s No Gap program, which has saved customers more than $7 million in out-of-pocket fees.
An out-of-pocket cost is an amount that is charged to a customer that is not covered by Medicare or their private health insurer. It is the “gap” between the total cost of the surgery and what health insurance and Medicare covers. In most cases, it is a separate cost that is charged directly to the customer.
Medibank launched its No Gap program in 2019, with the aim to improve transparency when it comes to surgery fees by reducing, and in many cases eliminating, these out-of-pocket costs.
Today, eligible customers can access the No Gap program for a range of specialist services at participating hospitals, including for knee and hip joint replacements, endoscopies, ACL surgery and some general surgery procedures. It is delivered by a range of surgeons and hospitals and follows a doctor-designed model of care.
Medibank Chief Customer Officer Milosh Milisavljevic said the program provides customers with affordable and high-quality surgery.
“At Medibank, we aim to make health care more affordable and accessible for our customers. With cost-of-living pressures still being felt in the community, we know every dollar counts, which is why this program is proving to be so popular with more than 10,000 customers choosing to go through it.
“It provides our customers with greater choice and control when it comes to how and where they access healthcare and what it will cost. For example, our customers are saving on average $2,240 in out-of-pocket fees for joint surgery, but in some cases, it is significantly more.
“It also helps minimise the time a patient spends in hospital, where clinically appropriate, by giving them the option to have rehabilitation in the comfort of their own home.
“Another benefit is that customers don’t have to worry about long surgery waitlists. The average length of time on a public hospital waitlist was 265 days in 20241, which is a long time to wait when you’re in pain. In most circumstances, Medibank customers can have their surgery soon after meeting with their surgeon.”
Orthopaedic surgeon Dr Daevyd Rodda - who played an important role when Medibank started the No Gap program six years ago - said: “The program has given patients access to high-quality, evidence-based care while saving them millions of dollars in out-of-pocket costs. It has fundamentally changed the way people experience private healthcare in Australia — making it more affordable, transparent and focused on outcomes that matter to patients.”
Medibank has been growing its No Gap network and the No Gap program is now offered at 36 hospitals across the country (full list below), including many regional locations.
Medibank is continuing to explore opportunities to add new services and specialists to the program.
