Understanding an out of pocket cost in Australia.

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OSHCglobal - An out-of-pocket cost is the difference between the amount a doctor charges for a medical service and what Medicare and any private health insurer pays. Out of pocket costs are also called gap or patient payments.



What you might pay out of pocket costs for

If you have treatment as a public patient at a public hospital you do not pay anything for your medical treatments.

Costs for many private treatments are also fully covered by Medicare and private health insurers. However, you may have to pay out of pocket costs if you have medical treatment as a private patient in a private or public hospital. This can include costs for:

  • doctors or other health care providers
  • hospital charges like accommodation and theatre fees

You might also have to pay out of pocket costs for medical services:

  • outside a hospital, for example for appointments or diagnostic tests
  • at a private hospital accident and emergency department


Bulk billed services

If you are bulk billed for a medical service you will pay no out of pocket costs. The health professional bills Medicare and accepts the Medicare benefit as full payment for the service.


What out of pocket costs you might pay?

Any out of pocket costs you pay will vary depending on:

  • how much you are charged
  • whether you have treatment in hospital or outside hospital
  • whether your treatment is covered by Medicare and how much Medicare pays
  • if you are treated at a hospital, whether you are a public or private patient
  • whether you have private cover for the treatment and if so, your level of cover

Doctor’s fees can only be covered by private health insurance for treatment in hospital. Different insurers might pay a different amount for the same service. Talk to your doctor, hospital and health insurer about:

  • what your costs might be
  • when you must pay them


If you want renew OSHC, OVHC, you can check out the prices and purchase insurance please contact OSHCglobal Team for further information and assistance at info@oshcglobal.com and info@ovhcglobal.com.


OSHCglobal (source:healthgov)