How much do private hospitals cost?

If you are a private hospital patient and the treatment you are receiving is listed on the Medicare Benefits Schedule (MBS), Medicare will cover 75% of your hospital and medical fees.

You have to pay the rest of the hospital and medical fees, which could include:

• 25% of the MBS fee for your doctor’s services
• any difference between your doctor’s fees and the MBS fee
• other doctors’ fees (for example, an anaesthetist and/or an assistant surgeon)
• hospital accommodation
• operating theatre fees
• prostheses costs (for example, plates, screws, artificial joints) 
• medicines
• dressings and bandages
• medical imaging, pathology or other diagnostic tests
• costs for physiotherapy and other therapies in hospital.

If you have Hospital Cover, you can claim back some of these from your private health insurer. If you have Hospital Cover for the medical service, your insurer must pay at least the remaining 25% of the MBS fee. 

Doctors set their own fees for private medical services. They can charge more than the MBS fee set by the Government.

If your doctor charges more than the MBS fee, you may have to pay the ‘gap’ out of your own pocket. However, if the doctor has a gap arrangement with your insurer, the doctor charges you under that arrangement.