Using your private health insurance

You may need to pay extra if you use your private health insurance in a public hospital.

Your private health insurance and Medicare will cover the Medicare fee (MBS fee) for your doctor or specialist. You may need to pay the insurance excess if you use your private health cover.

Sometimes your insurance pays hospital charges like accommodation and theatre fees. You'll need to check your policy to see what they'll cover. If they don't cover items, you'll need to pay for them yourself.

Your doctor might also charge you a higher fee for being a private patient. Medicare won't pay this fee. Check if your health insurer will pay this for you. If they won't, you'll need to pay it yourself.

If you use Medicare, all your clinical hospital costs as an inpatient get paid by Medicare as long as your treatment is clinically needed. Medicare does not cover accommodation.

Things to consider

When you're thinking about using your private health insurance in a public hospital, these questions might help you decide what's best for your care:

  • Will I have any out of pocket costs or invoices?
  • Can I choose which doctor treats me?
  • Can you guarantee that I'll get a private room?
  • What are the benefits of using my private health insurance?

Last updated: March 2022