Many private health insurers make gap cover agreements with particular doctors. This might reduce your gap payment or mean you have no gap to pay at all. If your doctor doesn't have a gap cover agreement, or they don't agree to charge you under the agreement, you must pay the gap yourself.
If you have private health cover, contact your health fund for a list of healthcare professionals with gap cover arrangements. If you're treated by anyone on the list and they agree to participate, there'll either be low or no medical gap cost involved.
By law, private health insurance does not offer cover for out-of-hospital medical services including: GP visits. consultations with specialists in their rooms. out-of-hospital diagnostic imaging and tests.
A gap payment is the difference between what a doctor charges you and how much Medicare or your health fund will give you back. If you have private health insurance, contact your health fund to check that your treatment in hospital is covered and to ask about your gap cover.
The 'gap payment' or 'out of pocket' cost refers to the difference between the amount the doctor charges, and the amount that is paid by Medicare.
A gap payment is an out-of-pocket expense you have to pay when you receive medical treatment that costs more than what you can claim back from both Medicare and your private health insurance.
Unless you go to a public hospital or are bulk-billed by the GP or specialist, you will have to pay the 'gap' costs.
The Bupa Medical Gap Scheme is all about reducing the medical costs you need to pay for treatment when you're admitted to hospital. If your doctor uses our scheme, you'll never pay more than $500 per doctor.
Gap cover serves to cover shortfalls where doctors charge above medical aid rate, and where medical aid pays up to their specified rate from the Risk or hospital benefit. Gap cover cannot provide cover where medical aid does not pay towards a procedure or covers the full amount for a procedure.
One in 10 doctors' clinics surveyed in NSW said their books were full. Bulk-billed doctor's visits are sharply declining for several reasons: the government froze the rebate for almost a decade while the costs of running a clinic rose, and fewer medical graduates are choosing general practice as a career.
Most Australians pay a Medicare levy of 2% of their taxable income. Taxpayers who have taxable income above a specific amount must pay a Medicare Levy Surcharge of up to 1.5% on top of the Medicare levy. These taxpayers can save money on the surcharge by purchasing suitable private health insurance.
Medical services costs
Under the MBS, Medicare pays 85% of the schedule fee for a specialist and 100% for general practitioners. If your health practitioner bulk bills for medical services, Medicare pays the cost straight to them (they accept the schedule fee as full payment), and you don't pay anything.
If you are privately or directly billed, you are paying the GP's fee in full. You will then receive the relevant patient rebate from Medicare for the service you received, subsidising part of the fee you were charged. Remember that the Medicare rebate may not cover the total cost of the health service.
Specialists that participate in the Bupa Known Gap Scheme, can charge a Known Gap of up to $500 per doctor for each episode of treatment.
Medicare covers
We help to cover the costs for part or all of the following services: seeing a GP or specialist. tests and scans, like x-rays.
Doctors can decide to participate in GapCover on a per claim, per treatment, and per patient basis. GapCover doesn't apply to diagnostic services, out of hospital medical services and services not included under your policy. GapCover doesn't apply to excesses and/or co-payments.
All gap cover providers impose a 9 to 12 month waiting period for any pre-existing medical conditions. Make sure you understand what the waiting periods are so that you know when you can start claiming benefits. Exclusions: Exclusions are the conditions and treatments that are not covered by the policy.
GAP Insurance is a type of insurance policy attached to your car loan that will cover you in the event of total loss. It will essentially pay-out the difference between what your comprehensive car insurer pays and the remaining finance amount in the event of total loss.
GapCover aims to reduce or eliminate our members' out-of-pocket medical expenses for a hospital stay. In return, we pay providers higher rates for most MBS item numbers.
You'll know exactly what we'll pay, and what will be left over for you to pay. Depending on your cover, we pay 60% to 100% of the cost on most dental, physio, chiro, and podiatry consultations. For some services, you'll pay nothing at all. You'll usually be able to claim on the spot by swiping your Bupa card.
To get a copy of your Statement of Medicare Benefits, contact Medicare on 132 011 or visit your nearest Medicare Service Centre.
If you're being charged out-of-pocket costs – or a “gap fee” – it means you are being asked to subsidise the cost of your doctor's visit, on top of the Medicare rebate. In these circumstances, the patient pays the GP clinic the full fee and Medicare sends the rebate to the individual.
If you're not covered by a health fund, or if you have a large bill to pay, some doctors may offer a payment plan. The average cost of an appointment with a GP (general practitioner) in Australia is around $50, while the average cost of a specialist appointment is around $130.
If you have Medicare, there will typically be a gap fee that will need to be paid by you. However, if you also have private health insurance, depending on your cover, most or all the cost may be covered.