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.
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 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.
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.
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 has over 6 years of expertise writing about insurance, including life, health, home, and car insurance. Having reviewed hundreds of product disclosure statements and published over 800 articles, he loves simplifying complex insurance topics for everyday readers. Gary has contributed to major outlets like Yahoo Finance, The Sydney Morning Herald, and news.com.au, and holds a Bachelor of Arts (Honours) in English Literature from the University of Glasgow, along with a Tier 2 General Advice certification, ensuring his work adheres to ASIC’s RG146 standards. See full bio
Gary Ross's expertise
Gary Ross has written 615 Finder guides across topics including:
This guide looks at what our public health system actually covers and why you may need to have some level of private health cover as well.
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