Medicare Gap Payments in Australia

Australia's Medicare system provides universal coverage for doctor visits and public hospital treatment, but patients frequently face 'gap payments' when providers charge above the Medicare Benefits Schedule (MBS) fee. The MBS sets the benchmark fee for each medical service, and Medicare typically rebates 85% of this fee for out-of-hospital services and 75% for in-hospital services. When a doctor charges more than the MBS fee, the difference is the gap.

The average gap payment for specialist consultations in Australia is approximately A$87, though this varies enormously by specialty and location. Orthopaedic surgeons and obstetricians tend to have the highest gap charges, often A$500–A$2,000 or more for procedures. In contrast, about 88% of GP visits are bulk-billed (no gap), meaning the GP accepts the Medicare rebate as full payment.

Gap payments represent a significant equity issue in Australian healthcare. Patients in metropolitan areas, particularly Sydney and Melbourne, face higher gaps due to greater demand and higher operating costs. The Australian government has periodically increased MBS rebates, but these increases have generally not kept pace with actual fee growth, widening the gap over time.