Medicare benefits schedule & access gap

The Medicare Benefit Schedule (MBS) is a list of fees for medical services issued by the Commonwealth Government. If you have private health cover and are admitted to hospital as a private patient, Medicare pays a benefit of 75% of the MBS and the remaining 25% is paid by onemedifund.

If a doctor raises a charge that is above the MBS, this amount is known as a ‘medical gap’. onemedifund has arrangements with more than 35,000 doctors Australia wide where additional benefits are payable by the fund to reduce or eliminate ‘medical gaps’ faced by contributors. This scheme is known as ‘Access Gap’.

Before admission to hospital you should ask your doctor/s to inform you of all medical fees that may be charged and whether he/she participates in our ‘Access Gap’ scheme. If the doctor/s elects not to participate in the ‘Access Gap’ scheme and charges a fee above the MBS, this additional amount will need to be paid by you. Before any hospital treatment you should confirm all charges with your doctor/s. We can help you identify whether your doctor participates in the ‘Access Gap’ scheme. Call us on 1800 148 626.