The Medicare Benefits Schedule (MBS) is a list of medical services the Australian government will pay a rebate towards when you need medical treatment.
Each service has a schedule fee – this is the amount that the Australian government deems as a fair fee.
Doctors and specialists do not need to adhere to the Medicare schedule fee if you are treated in a private hospital – this is where out of pocket expenses can occur.
What is the MBS?
The Medicare Benefits Schedule (MBS) is a list of medical services which are covered (subsidised) by the Australian government.
Each medical service is given a schedule fee (sometimes referred to as the MBS fee) by the Australian government based on what it thinks is a fair fee. The Medicare schedule fee rebates are as follows:
100% for consultations with a GP
85% for non-GP services from Medicare when the services are provided out of hospital
75% for in-hospital services you receive as a private patient (private health insurance covers the remaining 25%)
Out of pocket fees
If you are treated in a private hospital and have private health insurance, the MBS fee does not guarantee you will have no out of pocket expenses. The Medicare schedule fee is only a recommendation – doctors and specialists have the freedom to set their own fees for the services they provide and may charge more than the MBS fee.
What benefits are covered under the MBS?
The MBS provides benefits for an extensive range of medical services, procedures and consultations, including:
Consultation fees for doctors and specialists
Tests and examinations doctors require to diagnose and treat illnesses, for example X-rays, ultrasounds and pathology tests
Most surgical and therapeutic procedures carried out by doctors
Eye tests performed by optometrists
Some surgical dental procedures carried out by approved dentists
Some specified dental items listed under the Cleft Lip and Palate Scheme
Psychologist consultations
Some specified items for allied health services, for example items to help manage chronic diseases, and services for patients with a terminal medical condition and complex care requirements
Finder survey: How many Australians in different states worry that Medicare will not be enough?
Response
WA
VIC
SA
QLD
NSW
Yes
54.72%
47.78%
48%
48.73%
56.87%
No
25.47%
25.93%
33.33%
27.92%
23%
Not sure
19.81%
26.3%
18.67%
23.35%
20.13%
Source: Finder survey by Pure Profile of 1006 Australians, December 2023 Data for ACT, NT, TAS not shown due to insufficient sample size. Some other states may also be excluded for this reason.
What doesn’t the MBS cover?
There are also plenty of medical services that are not included in the MBS, such as:
Treatment as a private patient in a public hospital (there is no charge for care and treatment as a public patient in a public hospital)
Hospital costs incurred as a private patient, such as hospital accommodation and operating theatre charges
Dental examinations and treatment
Home nursing services
Acupuncture (unless it is provided as part of a doctor’s consultation)
Emergency or non-emergency ambulance services
Prescription glasses, frames or contact lenses
Hearing aids and other medical appliances
The cost of prostheses (except approved external breast prostheses covered as part of the External Breast Prostheses Reimbursement Program)
Medications (these are covered under the Pharmaceutical Benefits Scheme)
Any medical and hospital costs incurred overseas (these can be covered by international travel insurance)
Medical costs which a third party is responsible for paying (for example, a service you receive may be covered by compensation insurance or by your employer)
Medical services that are not clinically necessary
Cosmetic surgery
Medical examinations you are required to undergo when applying for life insurance or in order to access superannuation benefits
Eye therapy
How private health insurance can help
Private health insurance can cover treatment in a private hospital and out of hospital costs such as dental, optical and physio which Medicare doesn't cover. This is called extras cover. Make sure you're aware of which services are covered by a hospital policy and which services fall under the auspices of extras cover before choosing a health fund.
Why compare health insurance with Finder?
We don't ask for your phone or email to see prices.
With 1 click, you can open your results to nearly every fund in Australia.
You pay the same price as going direct – we charge no fees.
Depending on your age, you may be eligible for an
aged-based discount. This is used to estimate your
rebate.
Under 65
65 - 69
70 or older
What's your household's taxable income?
This is the combined income you and your spouse earn before tax. It's needed to calculate the correct Australian government rebate.
$93,000 and under
$93,001 to $108,000
$108,001 to $144,000
$144,001 and over
What kind of health insurance do you need?
Combined (Extras + Hospitals)
Extras
Hospital
What level of hospital coverage would you like?
You can change this at any time later.
Legend
Covered
Restricted cover, You may be partially covered for
this category.
Not covered. Optional for insurer to include.
*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
What extras cover do you need? (Optional)
Select as many as you want or move to the next step
Preventative & general dental
Major dental & implants
Optical
Physiotherapy
Podiatry
Non-PBS pharmaceuticals
Chiropractic
Emergency ambulance
Remedial massage
Email me my results (optional)
To get a copy of your results for later, add your email below
You'll pay the same price as going direct - we don't
charge fees
We don't ask for your phone number to see prices
Hang tight - we're fetching policies just for you!
Comparing quotes from 30+ funds...
What are gap cover schemes?
To help reduce and even eliminate out of pocket medical expenses, many private health funds run gap cover schemes. These schemes provide additional benefits to cover some or all of the gap between what your doctor charges and the MBS fee.
Doctors or specialists must agree to participate in a fund’s gap cover scheme in order for you to be able to claim benefits for their services. If your fund has a gap cover scheme in place, it will be able to provide you with a list of doctors or specialists that participate in the scheme.
Although gap cover arrangements vary, in most cases your doctor will be required to bill your health fund directly rather than impose any additional charge on you. The scheme will also only apply to certain medical services, so check with your health fund to find out exactly what’s covered and how to find a participating doctor.
Why you can trust Finder's health insurance experts
You pay nothing. Finder is free to use. And you pay the same as going direct. No markups, no hidden fees.
You save time. We spend 100s of hours researching health insurance so you can sort the gold from the junk faster.
You can trust us. We say it like it is. We aren't owned by an insurer and our opinions are our own.
Frequently asked questions about the MBS
The MBS ensures that you receive free treatment in a public hospital as a public patient (Medicare). It's also integral to how private health insurance works. It covers 75% of services you receive in a private hospital. If you get private health insurance, that covers the remaining 25% of the MBS fee.
No. If you attend a public hospital as a public patient, you won't be charged for care or treatment. According to the Department of Health, "Public hospital services are to be provided free of charge to eligible persons who choose to be treated as public patients in accordance with the 2020-2025 Addendum to the National Health Reform Agreement."
The Pharmaceutical Benefits Scheme (PBS) is a list of all government-subsidised medicines in Australia. This is designed to ensure prescription medication is affordable. The PBS is separate from the MBS which focuses primarily on medical services.
Gary Ross Hunter was an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146). See full bio
Gary Ross's expertise
Gary Ross has written 729 Finder guides across topics including:
This guide looks at how the PBS works, who is eligible and what you’re likely to pay at the prescription counter.
Feedback
How likely would you be to recommend Finder to a friend or colleague?
0
1
2
3
4
5
6
7
8
9
10
Very UnlikelyExtremely Likely
Required
Thank you for your feedback.
Our goal is to create the best possible product, and your thoughts, ideas and suggestions play a major role in helping us identify opportunities to improve.
Important information about this website
finder.com.au is one of Australia's leading comparison websites. We are committed to our readers and stands by our editorial principles
We try to take an open and transparent approach and provide a broad-based comparison service. However, you should be aware that while we are an independently owned service, our comparison service does not include all providers or all products available in the market.
Some product issuers may provide products or offer services through multiple brands, associated companies or different labeling arrangements. This can make it difficult for consumers to compare alternatives or identify the companies behind the products. However, we aim to provide information to enable consumers to understand these issues.
We make money by featuring products on our site. Compensation received from the providers featured on our site can influence which products we write about as well as where and how products appear on our page, but the order or placement of these products does not influence our assessment or opinions of them, nor is it an endorsement or recommendation for them.
Products marked as 'Top Pick', 'Promoted' or 'Advertisement' are prominently displayed either as a result of a commercial advertising arrangement or to highlight a particular product, provider or feature. Finder may receive remuneration from the Provider if you click on the related link, purchase or enquire about the product. Finder's decision to show a 'promoted' product is neither a recommendation that the product is appropriate for you nor an indication that the product is the best in its category. We encourage you to use the tools and information we provide to compare your options.
Where our site links to particular products or displays 'Go to site' buttons, we may receive a commission, referral fee or payment when you click on those buttons or apply for a product. You can learn more about how we make money.
When products are grouped in a table or list, the order in which they are initially sorted may be influenced by a range of factors including price, fees and discounts; commercial partnerships; product features; and brand popularity. We provide tools so you can sort and filter these lists to highlight features that matter to you.
Please read our website terms of use and privacy policy for more information about our services and our approach to privacy.
We update our data regularly, but information can change between updates. Confirm details with the provider you're interested in before making a decision.
You pay nothing. Finder is free to use. And you pay the same as going direct. No markups, no hidden fees.
You save time. We spend 100s of hours researching health insurance so you can sort the gold from the junk faster.
You can trust us. We say it like it is. We aren't owned by an insurer and our opinions are our own.
