What's an out-of-pocket expense?

It's any expense for a hospital, medical or extras service or item for which you won't be reimbursed by us.

What's an out-of-pocket expense?

It's any expense for a hospital, medical or extras service or item for which you won't be reimbursed by us.

What out-of-pocket expenses can I expect if I receive an extras service and how can I reduce them?

The out-of-pocket expense will be the difference between the provider's charge and the benefit we pay. To help reduce your out-of-pocket expenses, visit a Members' Choice extras provider where you can access capped charges and/or discounts and generally receive higher benefits than you would with a non Members' Choice provider. 

What kinds of out-of-pocket expenses can I expect if I go to a hospital?

Although hospital cover helps reduce the cost of your hospital visit, you'll still have out-of-pocket expenses for things like your excess and any difference between what the hospital charges and the benefit we pay for the hospital services.

You can also expect to pay the difference between the charge for in-hospital medical services (eg. doctors' services, pathology and radiology) and what you receive from us. To explain it further, the benefits you're entitled to for the medical services you receive while you're in an overnight hospital or day hospital facility are based on the Medicare Benefits Schedule (MBS) fee. The MBS is a list of all the services Medicare pays benefits for and the rules that apply to payment of those benefits.

If you visit a doctor and they charge you more than the MBS fee, you may have out-of-pocket expenses. These can vary and may be significant, especially for doctors' visits when you're in hospital. 

You should confirm all likely out-of-pocket expenses with your doctor and/or hospital admission.

How can I reduce my private hospital out-of-pockets?

If possible, go to a Members' Choice hospital where our agreement with the hospital limits what you can be charged. This means your out-of-pockets for hospital charges should be limited to things like:

  • Any excess you may have with your cover 
  • Any difference between your doctors' charges (including pathology and radiology fees) and the benefits we pay you
  • Any difference between the amounts you are charged for pharmaceuticals (including drugs issued on discharge from hospital) that are not covered by our agreement with the hospital and the benefits available to you under the extras component of your cover for pharmaceutical prescriptions (if your cover includes extras except for Young Visitors)
  • Any Out-Of-Pocket Expenses for surgically implanted prostheses and other items on the Federal Government's Prostheses Schedule
  • 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.

If you go to a non Members' Choice private hospital, you're likely to have significant out-of-pocket expenses.

Going to hospital

Call us first on 1300 981 703 so we can help you understand what's involved and the types of questions you need to ask your doctor or specialist. 

Looking for something else?

Visit our Overseas Health Cover Guides homepage to find more information and advice.

Your guide to navigating Australian healthcare

Most visitors to Australia have no access to Medicare. Like most countries in the world, health care costs in Australia can be expensive.

Need some help?

We’re here to help you choose the health cover that matches your needs while you’re in Australia. Contact Medibank how it suits you; online 24/7, WeChat, in-store or by phone.

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Things you should know

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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