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The Medicare Benefits Schedule (MBS) outlines the benefit amounts you are eligible to receive from Medicare for a wide range of health services. This schedule of fees is maintained by the Australian Government and defines a fair charge for all Medicare-covered services.
So what exactly is included in the MBS and what doesn’t it cover? Let’s take a closer look.
Medicare forms the basis of Australia’s universal healthcare system. It allows Australians to access an extensive range of health services at little or no cost, providing benefits for everything from GP visits to complicated surgical procedures. These benefits are known as Medicare rebates, and the maximum rebate amount payable varies depending on the medical service you receive.
The MBS is a schedule of fees for medical services set by the Australian Government. It lists a range of medical consultations, tests and procedures covered by Medicare, and the schedule fee for each of those services.
The schedule fee is the amount defined by the government as a fair fee for each of these services. The Medicare rebate you receive is calculated as a percentage of the Medicare Schedule Fee as follows:
However, it’s worth pointing out that the Medicare Schedule Fee does not reflect the amount a medical practitioner must charge for providing a service. Doctors and specialists have the freedom to set their own fees for the services they provide and may charge more than the Schedule Fee. As a result, you may have to pay “the gap” to cover the cost of medical treatment.
The MBS provides benefits for an extensive range of medical services, procedures and consultations, including:
There are also plenty of medical services that are not included in the MBS, including:
Some of the services listed above, including private hospital costs, dental, ambulance costs and optical services, are covered by health insurance from private health funds. Private hospital accommodation and theatre fees, for example, are included in hospital cover while dental and optical services are included in 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.
Doctors and specialists are under no obligation to charge the same amount as the fee listed in the MBS for the services they provide. In many cases, medical professionals charge more than the MBS fee, so you will need to cover “the gap” between the schedule fee and the amount your doctor charges.
For example, Tony is sick and decides to visit his GP for an examination. The MBS fee for this service is $37.05, for which Tony is entitled to receive a 100% Medicare rebate under the MBS. However, the doctor charges $65 for the consultation, so Tony has to cover the remaining $27.95 out of his own pocket.
To help reduce and even eliminate your out-of-pocket medical expenses, many private health funds run what are known as 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 – this means that your choice of doctor may be restricted to those providers registered with the health fund, though in some cases doctors may have the flexibility to participate in a fund’s gap program on a case-by-case basis.
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.
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Is the safety net an annual benefit from January to December of each year. Does the process begin every January?
Hello Irene,
Thank you for your comment.
If you’re referring to the Medicare Safety Net, the tally starts on January 1 each year and runs to December 31.
Should you wish to have real-time answers to your questions, try our chatbox on the lower right corner of our page.
Regards,
Jhezelyn