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Reducing Medical Expenses

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Reducing your medical expenses when admitted to hospital

Understanding medical expenses and how you can eliminate or reduce them when you go to hospital.

How medical fees and Health Insurance work

Medicare sets a standard fee for all medical and hospital charges, called the Medicare Benefits Schedule (MBS) fee. The MBS fee is a predetermined fee the government considers appropriate for the procedure you’re having.

When admitted to a private hospital, Medicare will reimburse 75% of the scheduled MBS fee they have set for each item number, and Private Health Insurance pays the remaining 25% back. Specialist and other medical fees may be higher than the MBS fee, the difference being referred to as the ‘medical gap’.

Certain things are not covered, such as outpatient services (specialist appointments prior and post admission). Please refer to the Health Partners Member Guide for more details.

Reducing your medical expenses when admitted to hospital

You can reduce or eliminate the gap you pay by taking advantage of the Health Partners’ Access Gap Scheme.

Access Gap is an arrangement we have with participating specialists to limit your medical expenses. This arrangement ensures that when you’re treated in hospital, you will either:

  • have no gap to pay, or
  • know your exact gap before treatment.

How does Access Gap work?

Calculating your ‘medical gap’ when admitted to hospital:

75% of the MBS fee for your procedure is paid by Medicare.

25% of the MBS fee for your procedure is paid by Health Partners

If your specialist uses Access Gap there will be a $0 medical gap OR a reduced gap is disclosed to you upfront, in advance. Health Partners is billed directly, making claiming easier than ever.

If your specialist doesn’t use Access Gap, you pay the medical gap. This is the amount your specialist(s) charges above the MBS fee.

Ask your specialist if they use Access Gap before you’re admitted to hospital

Go to our Doctor Search to see if your doctor/specialist(s) participates in Access Gap.

If they’re not listed, it doesn’t mean that they won’t use Access Gap. It’s your doctor/specialist(s) choice to use it on a patient-by-patient basis. You should ask them directly if they (and any assisting doctor/specialist) will use if for your procedure.

Going to hospital?

By knowing the right questions to ask those involved in your treatment i.e. your doctor, the hospital, Medicare, you’ll be best prepared. For more information, read our  flyer.

For full details on Waiting Periods and more information refer to the Health Partners Member Guide.