Costs For Services Outside Hospital
When it comes to out-of-hospital medical services, there are various types of treatments and appointments that fall into this category. These may include:
- GP or specialist appointments
- Diagnostic imaging
- Pathology
- Radiation or chemotherapy
- Dialysis
- Rehabilitation
If a particular out-of-hospital service is listed on the Medicare Benefits Schedule (MBS), Medicare will contribute towards the cost as follows:
- For most services, Medicare will pay 85% of the MBS fee.
- For GP appointments, Medicare covers 100% of the MBS fee.
It's important to note that Medicare generally doesn't provide benefits for out-of-hospital services that are not listed on the MBS, such as physiotherapy and podiatry.
When you receive an out-of-hospital service covered by the MBS, your out-of-pocket costs will depend on the difference between the fee charged by your doctor and the Medicare benefit provided by the government.
In most cases, doctors directly bill Medicare for the Medicare benefit. If the service is not bulk-billed, you will be responsible for paying the difference between the Medicare benefit and the total fee. Typically, this involves paying the entire fee upfront and subsequently claiming the Medicare benefit.
It's worth noting that private health insurers cannot cover out-of-hospital Medicare services. However, they may offer coverage for services that Medicare doesn't, such as physiotherapy and other allied health services not included in the MBS.
Costs for in-Hospital Services
When it comes to in-hospital services, the cost structure varies depending on your patient status. Here's what you need to know:
Public Patient in a Public Hospital:
If you have a Medicare card and receive treatment as a public patient in a public hospital, you won't incur any out-of-pocket costs. This means that the hospital services are covered by Medicare, ensuring you receive the necessary care without having to pay directly.
Private Patient in a Public or Private Hospital:
However, if you choose to be treated as a private patient in either a public or private hospital, there may be out-of-pocket costs involved. As a private patient, you have the option to access additional services and benefits but may be responsible for certain expenses not covered by Medicare or your private health insurance.
It's essential to carefully review your health insurance policy and consult with the hospital and health insurer to understand the specific costs you may be responsible for as a private patient.
Remember, as a public patient in a public hospital with a Medicare card, you can receive treatment without incurring any out-of-pocket costs. However, if you opt for private treatment, it's important to be aware of potential expenses that may arise.
