What Medicare Pays
The Medicare Benefits Schedule determines what Medicare pays or the rebate you receive from Medicare if eligible. The Medicare Benefits Schedule (MBS) is a list of medical fees that acts as a guide for rebates.
You can claim 75% of the schedule fee (from Medicare) for inpatient doctor's services and a minimum of 25% of the schedule fee from CBHS Corporate Health. For doctor’s services provided as a non-admitted patient in a hospital, you can claim 85% of the schedule fee as a rebate from Medicare only. Health funds are not allowed to cover outpatient costs. These rates apply whether you are treated in a private or public hospital.
The MBS is a guide only, doctors and specialists are free to charge above the MBS amounts. This means you may be required to pay the gap.
All CBHS Corporate Health hospital covers provide a minimum benefit of 25% of the schedule fee (subject to Medicare’s assessment) for services received in private and public hospital when you are an admitted patient. The benefits that CBHS Corporate Health pays you will depend on your coverage level and choice of hospital.
CBHS Corporate Health has agreements with most private hospitals and day surgeries in Australia to keep the costs of hospitalisation lower and more predictable for members. If you stay at an agreement hospital, then depending on your level of cover, you might be covered for everything from bed fees and intensive care to coronary care fees and theatre and labour ward fees. If you choose to stay at a non-agreement hospital, you will be covered only up to pre-set limits that are set by the Government and will need to pay large out-of-pocket costs.
Disclaimer: Note also that the MBS does not cover medications; the Pharmaceutical Benefits scheme looks after subsidies for prescription medications. Medicare does not cover private patient hospital costs (this is covered by CBHS Corporate Health subject to your level of cover) or medical and hospital costs incurred outside Australia. Additionally, Medicare does not cover ambulance services and services that it considers are unnecessary. This includes surgery that is carried out for cosmetic reasons.