Who pays for what with private health care?

The answer depends on what you have done, where you have it done and who does it

At public hospitals

If you go into a public hospital as a public patient, you are fully covered under Medicare. That’s the good news. The not so good news is that you’ll have little or no say over who treats you, or when.
If you go into a public hospital as a private patient, your HBA hospital cover will pay for some of the private health care costs associated with your treatment. So you get to choose your doctor but you’ll still have little or no control over where or when you get treated.

At private hospitals

If you go to a private hospital, Medicare will cover a portion of your medical treatment costs, but not a cent of your accommodation and theatre expenses. The only way to cover yourself for those bills – and they usually have plenty of zeros – is with private hospital insurance.

Our hospital cover also contributes to the portion of treatment costs not covered by Medicare. It works like this:

The Government sets a dollar amount for every conceivable type of in-hospital medical treatment, known as the “Schedule Fee”
Medicare pays 75% of the Schedule Fee
HBA private health care pays the remaining 25%

Sounds simple? Unfortunately it’s not!

Some doctors and specialists charge more than the Schedule Fee. The difference between the two is the “Gap” that everyone bangs on about – us included – and it’s normally up to you to pay it, unless you have private health care and your doctor uses our Ezyclaim system.

With Ezyclaim, your specialist agrees with HBA on the fee charged for services and bills us directly, so most often there’s no bill and no Gap! So it really pays to include private health care in your health insurance plans.

For other health services

Unless you’ve spent your life in a bubble and never been to a doctor, you’ll know Medicare helps pay for a visit to a General Practitioner. But that’s where it ends. Medicare does not cover other day-to-day stuff like dental work, physiotherapy and so on. Only extras cover through private health care will do that.

Include extras cover with HBA in your health insurance plans, and you can claim back up to 60% of the cost of your treatment up to a set annual limit, and each year we increase that limit on most services until it’s doubled, at no extra charge.

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