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.