What is Access Gap cover?

Access Gap cover is one way to eliminate or reduce your out-of-pocket medical costs (gap) while you are an admitted patient of any contracted hospital or day procedure hospital.

Medicare pays 75% of the Medicare Benefits Schedule (MBS) services while you’re in hospital; we cover the rest up to the MBS schedule fee. Where the charge exceeds the MBS fee, we’ll pay an additional benefit that will eliminate or reduce any out-of-pocket medical gap expenses if the doctor participates in our Access Gap Cover Scheme.

Doctors can choose whether they take part in this scheme on a case-by-case basis. You should ask your doctor to explain the costs of your hospital admission including any prostheses gap amount, their own fees, any fees for other doctors involved (such as assistant surgeons and anaesthetists) and any other expenses involved. If there are any out-of-pocket costs for you to pay, ask for a written cost estimate.