Using your private health insurance

If you're eligible for Medicare 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, prosthetics 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.

If you can't use Medicare, you may need to pay for your care. Health insurance does not always cover 100% of the hospital costs for Medicare ineligible patients.

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?

Moving to a Private Hospital as a Private Patient from a Queensland Health Public Hospital

When you choose to move to a private hospital for treatment as a private patient you will need your own private health insurance or other funding to meet the costs of treatment. You need to check if you will have extra costs if you transfer to a private facility.

Sunshine Coast Hospital and Health Service staff cannot give advice about treatment costs in a private hospital or facility. You must ask your health insurance provider as they will only give details about your cover to you.

Your Private Health Insurance provider will tell you:

  • the costs that your insurance covers
  • the costs that your insurance does not cover
  • whether you must pay an up-front fee (excess) to use your insurance.

Last updated: June 2022