What does an MRI scan really cost, and how does insurance coverage come into play? From private health insurance policies to Medicare & out-of-pocket expenses, we help you understand what to expect when it comes to the cost of an MRI in Australia.
Summary
- The cost of an MRI (magnetic resonance imaging) scan varies and depends on whether it’s covered by Medicare
- It can cost anywhere from $100 to $1,000
- Both Medicare and private health cover may cover the cost of an MRI scan
- MRI services can be costly, but it’s often a bulk-billed service for Medicare-eligible Australians
Navigating the world of healthcare can be daunting, especially when it comes to understanding the costs involved. MRI scans are a common and critical diagnostic tool in Australia, but the costs can vary widely, leaving many patients confused. From Medicare coverage to private health insurance policies and out-of-pocket expenses, the factors influencing the cost of an MRI are numerous.
In this comprehensive guide, we’re here to help you understand what to expect when it comes to the cost of an MRI in Australia. Whether you’re looking for information on Medicare rebates, private health coverage, or just want to know what an MRI might cost you, we’ll break it down for you.
In this comprehensive guide, we’re here to help you understand what to expect when it comes to the cost of an MRI in Australia. Whether you’re looking for information on Medicare rebates, private health coverage, or just want to know what an MRI might cost you, we’ll break it down for you.
How Much Does an MRI Cost?
An MRI scan in Australia can cost anywhere from $100 to $1,000. The price will depend on the part of the body being imaged.
Medicare and private health insurance can help cover the cost of an MRI scan, as long as it’s on the Medicare Benefit Schedule (MBS). The MRI machine must be fully or partially licensed as well.
CHI TIP: If you’re being treated in a public hospital as an inpatient (a patient who stays in the hospital while under treatment) and you are bulk-billed, you may not have to pay any out of pocket expenses, meaning the MRI is completely free.
If you’re treated in a public hospital as an inpatient and they bulk-bill, you might not have any out of pocket expenses.
However, you need to ask your treating health professional if you’re entitled to a Medicare rebate to avoid any surprising out of pocket costs.
Not Eligible for a Medicare Rebate?
If your MRI or treatment isn’t covered under the Medicare Benefit Schedule, a top-level (Gold hospital cover) health insurance policy will help cover some if not all of the costs.
Remember: When taking out private health, waiting periods apply, and you’ll need to have held private health cover for a certain amount of time before you’re eligible to claim.
Does Private Health Insurance Cover MRIs?
It’s a bit more nuanced than a simple yes or no. First, it’s important to know that diagnostic imaging/MRI scans aren’t categorised by illness; they’re a type of treatment. So if you need an MRI for something specific, like cancer, your insurance might help with the expenses – but only if your policy covers that particular illness.
So, why won’t private health cover a scan that’s for general healthcare screening? Since there’s a Medicare rebate available and MRIs fall under ‘outpatient’ services, these policies often don’t include coverage. Even if you’re an inpatient at a private hospital, this rule still usually applies.
However, some insurance funds might offer coverage for non-MBS item scans, like MRIs used for general health screenings. Also, if you’re admitted to a private hospital and need an MRI, your insurance might chip in to cover any out-of-pocket costs or gap fees. That all depends on the type of policy you’ve got.
If you find yourself needing to head to a private hospital for treatment, it’s always wise to have a chat with your health fund. They can fill you in on exactly what’s covered and what expenses might be left for you to handle when it comes to MRIs and other imaging services.
Cost of MRI: Medicare vs Private Health Insurance
Whether you’re leaning on Medicare or health insurance, the coverage of an MRI scan can vary. Here’s a simple guide to the different upfront costs:
- Public Patient in a Public Hospital (No Health Insurance): Medicare’s got you covered, taking care of 100% of the MBS fee.
- Private Patient in a Public Hospital: Medicare will cover 75% of the cost, and your health insurer will pick up the remaining gap.
- Private Patient in a Private Hospital: Medicare will cover 75%, and your health insurance will handle the rest.
- Out of Hospital MRI Scan with Specialist Referral: Medicare will cover 85% of the cost.
Just remember: if you want your health insurance to cover your MRI scan, you’ll need the right hospital cover. Not all hospital insurance tiers are created equal, so make sure you’ve got the one that fits your particular medical condition and needs.
Does Medicare Cover MRI scans in Australia?
The good news is Medicare will cover the cost of some types of MRI scans – but it depends on the reason for the scan. The Medicare Benefits Schedule lists item numbers (conditions) for which benefits can be claimed. We’ve put it in a table below:
| Type of scan | Cost | Medicare Rebate |
| Head scan for a patient over 16 to investigate:
• Unexplained seizures • Unexplained chronic headaches with suspected intracranial pathology |
$403.20 | 75%: $302.40
85%: $342.75 |
| Spinal scan for a patient over 16 for suspected cervical radiculopathy | $358.40 | 75%: $268.80
85%: $304.65 |
| Spinal scan for a patient over 16 for suspected cervical spine trauma | $492.80 | 75%: $369.60
85%: $418.90 |
| Knee scan for a patient over 16 following acute knee trauma with:
• Inability to extend the knee suggesting the possibility of acute meniscal tear • Clinical findings suggesting acute anterior cruciate ligament tear |
$403.20 | 75%: $302.40
85%: $342.75 |
What is the Best Health Insurance for MRI Scans?
Finding the “best” health insurance for MRI scans isn’t as simple as picking one out of a hat. Why? Because MRI scans aren’t considered a treatment category on their own; they’re just a type of treatment.
So, when you’re dealing with an MRI scan, what you need to think about is what injury or illness you’re getting treated for. If your health insurance policy covers that specific issue, then they’ll usually help with some of the MRI scan cost.
The key is to look at your private health insurance policy carefully and understand what kinds of injuries or illnesses it covers. That way, you’ll know if an MRI scan for your specific situation is something they’ll help pay for.
COMPARE PRIVATE HEALTH POLICIES
What is an MRI?
An MRI is a type of scan that uses powerful magnetic and radio-frequency pulses to collect information about what’s going on inside your body. This information creates a detailed view of the body’s soft tissues such as muscles, ligaments, brain tissue, discs and blood vessels.
Known as the ‘gold standard’ in radiology, MRI delivers very detailed imaging and gives health care professionals a more accurate diagnosis of certain diseases and conditions that might not show up on other imaging services.
Unlike X-Rays or CT scans, there is no radiation involved in MRI scans.
What to Expect During an MRI
During an MRI, you’ll be asked to lie on a movable bed that goes inside the MRI scanner, which looks like a smooth, white tube. The bed might move a bit during the scan to get the right images.
When the scan starts, you’ll need to lie really still, and you might have to hold your breath briefly. It might sound strange, but you’ll likely hear vibrating or knocking noises.
That’s just the machine doing its job, flipping between different settings to take the pictures. What’s happening is that radio waves are causing the hydrogen atoms in your body to move in a certain way, and the machine reads this movement to create images of what’s inside you.
After the scan, the radiologist will look at the images. They’re experts at understanding these pictures, and they’ll help figure out what’s going on inside your body. From there, they’ll chat with your treating doctor to figure out what’s going on inside your body and how to move forward if some kind of treatment is necessary.
Frequently asked questions
How much is an MRI scan in Australia?
MRI scans can cost anywhere between $100 and $1,000, depending on what part of the body needs to be scanned, and your specific medical condition.
Is an MRI Scan Safe? What Should I Expect?
MRI scans are widely considered safe, as they don’t use any radiation like X-rays or CT scans do.
Will My Health Insurance Cover the Cost of an MRI Scan?
Health insurance coverage for MRI scans isn’t always straightforward, as it depends on your specific policy and the reason for the scan. If your insurance policy covers the particular injury or illness you’re being treated for, it will likely cover some of the cost for the MRI. It’s essential to check with your insurance provider to understand what’s covered and what you might have to pay out of pocket.
