ACT residents paying high Gaps, as premiums set to rise 

Some ACT residents are being hit with shock bills for public hospital treatment, new figures show.  

Following news this week that health insurance premiums for ACT residents may rise by at least $180 next year, an analysis of billing records has revealed the high Gaps being paid for Canberra hospital treatment. Data from Private Healthcare Australia – peak body for the health insurance industry – found 30% of those treated as private patients in public ACT hospitals in 2022-23 paid Gaps ranging from $50 to more than $9,000. 

“It’s very concerning that 3 in 10 private patients in public hospitals are paying out-of-pocket costs when they could have attended the hospital free of charge under Medicare – a system we all pay taxes for,” said Dr Rachel David, CEO of Private Healthcare Australia.  

When people are treated in a public hospital, they can choose to use health insurance and be treated as a private patient. However they may receive bills for out-of-pocket expenses from the specialists who treat them. 

“Charging private patients out-of-pocket fees for the same services provided to public patients is unfair and should not be happening,” Dr David said.  

Earlier this week it was revealed the ACT Government will increase its ambulance levy – a weekly charge included in health insurance premiums in the territory. From 1 January 2026, the levy could increase to $180 a year for single adult policies and $360 for family policies. 

Private Healthcare Australia criticised the levy, which it called a “health insurance tax by stealth”. It said the additional cost could force ACT residents to downgrade or cancel private cover and rely on the public hospital system, which is already under strain.  

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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