The health system can be confusing so it’s hard to be sure who pays for what. We make it clear in one table.
Please remember that this is only an overview. Benefits depend on your level of cover and any restrictions, exclusions or waiting periods you have.
For more information, including out-of-pocket costs and what's not covered, please refer to your cover description.
Medicare Benefit Schedule
The Medicare Benefit Schedule (MBS) is a list of fees for medical services issued by the Australian Government. If you have private health cover and are admitted to hospital as a private patient, Medicare pays a benefit of 75% of the MBS and the remaining 25% is paid by the RBHS.
Between Medicare, private health insurance and out-of-pocket costs, it’s important to understand who pays for what. Benefits depend on your level of cover and any restrictions, exclusions or waiting periods you have. You can check what you’re covered for and your waiting periods using our app, or by calling us on 1800 027 299.
Medicare covers a portion of the fees charged by doctors, general practitioners and specialists, whether for treatment in surgery, in hospitals or on house calls. Medicare also covers such items as anaesthesia, pathology and optometry charges. Items covered by Medicare cannot be covered by private health funds, except when a patient is admitted to a hospital, in which case, the RBHS may pay benefits towards the hospital and medical fees.
Medicare |
RBHS | You | ||
|---|---|---|---|---|
| Hospital | Extras | |||
Ambulance (state-based providers only). |
No | Yes | Yes | No |
| Outside of hospital (outpatient) Things like specialist fees, radiology and pathology. |
Yes | No | No | Yes |
| Private Hospital (inpatient) Remember that your waiting periods need to be served before you go into hospital and we can only pay for the services you’re covered for. If you have an excess or use things that hospitals can charge you for like TV access or newspapers, those will be at your own cost. |
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| Medical Things like specialist fees, radiology and pathology. |
Yes | Yes | No | Yes |
| Hospital Things like accommodation fees, theatre fees, and medical devices and human tissue products. |
No | Yes | No | No |
| Public Hospital (inpatient) as a Private patient If you have an excess or use things that hospitals can charge you for like TV access or newspapers, those will be at your own cost. Your hospital might ask you to pay additional charges for your admission. |
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| Medical Things like specialist fees, radiology and pathology. |
Yes | Yes | No | Yes |
| Hospital Things like accommodation fees, theatre fees, and medical devices and human tissue products. |
Yes | Yes | No | No |
| Public Hospital (inpatient) as a Public patient You may have out of pocket costs from your doctor or specialist even if you’re a public patient in a public hospital. If you have an excess or use things that hospitals can charge you for like TV access or newspapers, those will be at your own cost. |
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| Medical Things like specialist fees, radiology and pathology. |
Yes | No | No | Yes |
| Hospital Things like accommodation fees, theatre fees, and medical devices and human tissue products. |
Yes | No | No | Yes |
| Other services Things like dental, optical & physio. (There are some interesting items on Medicare like dental for kids and some free consults for chronic conditions you could get after seeing your GP). |
Yes | No | Yes | Yes |