Using your private health insurance

You may have to pay extra if you use your private health insurance in a public hospital.

The costs will depend on who your doctor is.

  • If your admission is unplanned and you choose to see a hospital doctor, your insurance and Medicare will cover your private hospital costs.
  • If you’ve planned to see your private doctor you’ll have to pay any costs not covered by your insurance before you go to hospital.

Your private health insurance and Medicare will cover the Medicare recommended fee (MBS fee) for your doctor or specialist. You may have to pay the insurance excess.

Other hospital charges like accommodation and theatre fees are usually covered by your insurance, but you'll need to check your policy.

Your doctor might also charge a higher fee for being a private patient. This won't be covered by Medicare and may not be covered by your health insurer.

If you use Medicare, all your hospital costs as an inpatient will be covered as long as they’re clinically necessary.

Things to consider

When you’re considering whether to use your private health insurance in a public hospital, there are a few questions you can ask the hospital. These might help you decide what's best for your circumstances.

  • Will there be 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 for using my private health insurance?

Last updated: May 2024