Access Gap Cover

How Access Gap Cover works

When you receive treatment in a private hospital, Medicare covers 75% of the Medicare Benefit Schedule (MBS) fee set by the Government for doctors’ charges and TUH will cover the remaining 25%. 

Some doctors charge above the MBS fee, which is an out-of-pocket cost that you have to pay. If your doctor uses the Access Gap Cover scheme, you will either: 

  • have lower out-of-pocket costs; or
  • have no out-of-pocket costs 

Prior to treatment, you can request an estimate of costs from your doctor. See Informed Financial Consent.

Access Gap Cover is available with any hospital cover. Participation in this scheme is the personal choice of your medical practitioner for each procedure. If your doctor participates in the scheme, in most cases, you will not receive an account as TUH receives the bill and makes any claims on your behalf from Medicare.

Before accepting treatment, ask your doctor: 

  1. Would you treat me under my fund's Access Gap Cover arrangements?
  2. Will I incur any personal out of pocket expenses for my treatment and if so, can you give me a written estimate of how much?
  3. Will any assisting doctors also use Access Gap Cover?
  4. Will you send the bill to my fund directly, so that they can claim my Medicare benefit on my behalf and send the payment back to you? 

Find a specialist

Use the search below to find out if your specialist has participated in the Access Gap Scheme.

TUH does not recommend or endorse any doctors. This list has no bearing on skill or experience of any doctors listed. TUH reserves the right to refuse Access Gap Cover benefits to providers who do not adhere to the Business Guidelines.