What is the Medical Gap Cover Scheme?

A Medical Gap Cover Scheme is when a health insurer has a Gap Cover Agreement with a particular doctor or healthcare provider.

The agreement allows health insurers to cover all or some of the gap fees for your treatment in hospital. The idea is to reduce or eliminate out-of-pocket costs for you as the patient.

If you receive treatment from a doctor or healthcare provider who charges above the Medicare Benefits Scheme (MBS) fee and does not have a Gap Cover Agreement with your health insurer, you could have high out-of-pocket expenses.

There is no requirement for any doctor to participate in an insurer’s Gap Cover Agreement.

Doctors and healthcare providers are free to decide on a case-by-case basis whether to use an insurer’s Gap Cover Agreement.