Australians paying more for hospital fees despite fewer visits

Peter Terlato 18 May 2016

Gap payments are highest in the ACT.

The nationwide proportion of in-hospital medical services with no gap payments has dropped 3.5% over the last year.

According to the latest data from the Australian Prudential Regulation Authority (APRA), the proportion of services with no gap decreased from 88.4% in March 2015 to 85.9% in March 2016.

A medical gap is the out of pocket cost you pay for medical charges over what Medicare and your private health insurance cover.

Despite there being less gap-free services, average gap payments increased slightly.

The average gap payment across all services rose from $18.59 in March 2015 to $19.23 in March 2016.

StateServices with no gapAverage gap
across all services
Average gap
when gap was paid

Average gap payments across all services was highest for those in the Australian Capital Territory, with patients approximately $60 out of pocket, more than 200% higher than the national figure.

Patients in the Northern Territory forked out an average of $34.72, followed by New South Wales at $25.96.

For non-GP services Medicare covers 85% of the Medicare Benefits Schedule (MBS) fee, the baseline price for medical services, as a rebate.

If you have private hospital cover and are admitted to hospital for a procedure, your doctor can choose to bill more than the Federal Government scheduled fee. This can result in out of pocket expenses not covered by Medicare or health insurers.

Picture: Shutterstock

Compare health insurance on

Ask a Question

You are about to post a question on

  • Do not enter personal information (eg. surname, phone number, bank details) as your question will be made public
  • is a financial comparison and information service, not a bank or product provider
  • We cannot provide you with personal advice or recommendations
  • Your answer might already be waiting – check previous questions below to see if yours has already been asked

Disclaimer: At we provide factual information and general advice. Before you make any decision about a product read the Product Disclosure Statement and consider your own circumstances to decide whether it is appropriate for you.
Rates and fees mentioned in comments are correct at the time of publication.
By submitting this question you agree to the privacy policy, receive follow up emails related to and to create a user account where further replies to your questions will be sent.

Ask a question