‘The gap’ is common term to describe the difference between the total cost of a medical treatment (not including hospital accommodation) and the Medicare Benefits Schedule (MBS) fee for that treatment, which is set by the government. Your out-of-pocket expenses may be required
to cover the gap.
How ‘the gap’ occurs
When you receive in-hospital treatment, the benefit we pay towards medical services is based on the Medicare Benefits Schedule (MBS), which is set by the government. If a service is listed on the MBS and included on your cover, Medicare will pay 75% of the MBS fee and we’ll pay 25% of the MBS fee.
A doctor may choose to charge more than the MBS fee. This may leave you with an out-of-pocket expense commonly referred to as ‘the gap’.
GapCover can help
The good news is many doctors participate in a scheme called GapCover, which is designed to help eliminate or reduce your out-of-pocket expenses for in-hospital doctors’ charges. Find a doctor that participates in GapCover here.