What is the MBS? (Medicare Benefits Schedule)

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

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.

Compare health insurance for free

Compare prices from 30+ Aussie funds in under 30 seconds.

Get started

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

We're free

Our health insurance engine is completely free to use. You pay the same as buying directly from the health insurer. Better still, we regularly run exclusive deals that you won't find on any other site.

We're experts

We've researched and rated hundreds of policies as part of our Finder Awards. We've published 250+ guides and our in-house experts regularly appear on Sunrise, 7News and SBS News.

We're independent

Unlike other comparison sites, we're not owned by an insurer. That means our opinions are our own and you can compare nearly every health fund in Australia on the site (and find a better deal).

We're here to help

Since 2014, we've helped 350,000+ people find health insurance by explaining your options simply. We'll never ask for your number or email to see prices. We're here to help you make a decision.

Frequently asked questions about the MBS

• How does the MBS work?

  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.

• Will I have out of pocket costs for treatment in a public hospital?

  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."

• What is the MBS and PBS?

  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.