What is the cost of staying in a public hospital?
Australian public hospital treatment is free to Australian and New Zealand citizens, as well as most permanent residents and people from countries with reciprocal agreements, thanks to the Medicare scheme. As long as you hold a Medicare card and the treatment is deemed clinically necessary, you are unlikely to face any out-of-pocket expenses during your stay as a public patient. This is no small benefit when you consider that in 2019-2020 the average cost across public hospitals to treat an admitted patient was $5,205, according to the Australian Institute of Health and Welfare (AIHW). Admitted patients are people who go through a hospital’s formal admission process to receive treatment.
According to the Victorian Department of Health, Medicare covers costs of public hospital services for public patients in Australia, including:
- Clinical services
- Doctor and specialist fees
- Accommodation and food
- Medication prescribed in hospital
- Operating theatre fees
There are some hospital-related costs that Medicare may not cover. For example, Medicare will not cover the cost of ambulance services. Depending on where you live, your state or territory government may cover this. For example, the ambulance service in Queensland is fully subsidised by the Queensland Government, making it free for local residents, whereas in Victoria, residents who use the service may be out of pocket unless they have an Ambulance Victoria membership, a concession entitlement or a health insurance policy that provides cover for ambulance services.
During your stay as a public patient in a public hospital you will generally be in shared accommodation, though sometimes there may be a single room available.
What is the cost of staying in a private hospital?
The cost of staying in a private hospital can depend on a few factors, including the specific fees set by the hospital and the doctors and specialists who treat you.
As a private hospital patient, you can still access Medicare benefits, which can cover 75% of your hospital and medical fees as long as the treatment is listed on the Medicare Benefits Schedule (MBS), which outlines which medical services are eligible for a rebate. However, note Medicare will only pay 75% of the Schedule fee (the amount the government assigns to each service), so you will be required to foot the remaining 25%, plus any additional fees if your doctors and other health professionals charge more than the MBS fee.
If you have private health insurance, you can check how much you can claim back for a hospital stay and treatment by health professionals, which may vary depending on the level of cover and any excess (the amount you pay your insurer when making a claim) you have.
Patients in a private hospital may also have to pay for:
- intensive care
- hospital accommodation
- operating theatre fees
- dressings and bandages
- blood tests, x-rays or CT scans
- specialists’ fees.
Additionally, if you spend time as a patient in an emergency department in a private hospital, you may have to pay extra fees for some services not covered by Medicare.
If you have private health cover, it can be important to contact your health insurer and check your product disclosure statement (PDS) to clarify which tier of hospital cover you have, as this will determine your minimum coverage for hospital treatments. As an example, if you are admitted for surgery on your tonsils, your treatment will generally be covered by a policy that offers at least the Bronze tier of cover, although you may have to pay an excess and/or serve a waiting period before you can claim. On the other hand, if you have a Basic-tier policy that doesn’t cover this treatment, you could be out of pocket for the total difference between the MBS-listed price for it and what the hospital charges.
Staying in a public hospital as a private patient
If you are admitted to a public hospital, you may still be asked if you would like to be registered as a private or public patient. If you choose to be a private patient, you may receive additional benefits such as access to a single room and your choice of doctor (provided they are available), depending on the hospital.
The cost of staying in a public hospital as a private patient follows the same structure as the costs listed above for a private hospital, where Medicare will generally cover 75% of the MBS fee for eligible treatments and your health insurance policy could potentially cover the rest, usually minus an excess (depending on your policy). Again, it can pay to clarify the extent of your cover with your health insurance provider, and the costs charged by the hospital for a private patient, to help you determine whether you will be out of pocket.
How to prepare for the costs of staying in hospital
If you are planning an admission to hospital, it can be a good idea to check with your doctor, specialist or the hospital administration staff about the costs involved with your stay. If you choose to stay in a private hospital, you may want to ask about their fees per day and what they include.
You could also check what private health cover you have and if any waiting periods (an amount of time set by your insurer between when you take out a policy and when you can claim for certain services), exclusions, benefit limits or excesses may apply. It could also pay to understand what you are covered for with your private health insurance policy, so you can make an informed decision if you are offered the choice between being admitted to a public or private hospital.
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Article originally published on 23 December 2019, updated with additional reporting by Tamika Seeto.
Cover image source: Tyler Olson/Shutterstock.com