Guide to fees and costs

Australians have access to a world class healthcare system through Medicare. It is free to get treatment at a public hospital as a public patient. Australians also have subsidised access to private health care for a range of treatments.

Many Australians have private health insurance. This helps reduce waiting times for a service and allows people to choose their treating specialist. However, some people experience unexpected or significant out-of-pocket medical costs. Understanding your options will help inform your decisions when seeking medical specialist services.

Learn more about medical fees, out-of-pocket costs and how to avoid unexpected bills below.

What we mean by fees and costs

On the Medical Costs Finder website, a medical ‘fee’ refers to the amount charged for a medical service.

The amount you must pay for the medical fee is called an ‘out-of-pocket cost’. This also can be called an ‘out-of-pocket’, ‘patient payment’, ‘gap payment’ or a ‘cost’. Out-of-pocket costs are expected in many situations.

An out-of-pocket amount depends on your individual circumstances. Your out-of-pocket cost could be the same as your medical fee. If Medicare and your private health insurer contribute to your medical fee, your out-of-pocket cost is reduced.

See the glossary of terms for more definitions of the terms on the website.

Your treatment options and who contributes

Medical specialist treatments and procedures are provided in both the public and private health systems. Your out-of-pocket cost depends on where and how you are treated.

Public patient in hospital – There are no out-of-pocket costs for treatments for public patients enrolled in Medicare.

Hospital treatment for insured private patients – Patients pay the difference between the doctors’ fees and the combined amount paid by Medicare and their insurer.

Out-of-hospital treatment – Patients pay the difference between the doctors’ fees and any Medicare payment. Out-of-hospital procedures are not generally covered by private health insurance.