Your questions answered

Welcome to Your questions answered, practical information on the most frequently asked questions by consumers and links to multiple guides and checklists on the Health and external agency websites.

Page last updated: 21 March 2014

Your health costs

  1. What questions should I ask about my healthcare costs?
  2. What does Medicare pay for?
  3. How are doctors' fees set and what am I covered for?
  4. What out of pocket costs can I expect when I use my private health insurance?
  5. What is Lifetime Health Cover?
  6. How do I ensure I am informed about all costs before I start treatment?
  7. What health expenses can I claim as a tax refund?

Your access to services

  1. Who can access the breast screening program?
  2. Where can I access magnetic resonance imaging (MRI) services?
  3. Am I eligible for breast screening services under Medicare?
  4. Where can I access radiotherapy services?
  5. What information is available on radiation oncology and radiotherapy?
  6. Where can I go to get cancer information and support?
  7. How is access to services being improved?
  8. How are new technologies and services assessed for a rebate through Medicare?
  9. What can I do if the service my specialist has recommended is not funded under Medicare?

Your rights

  1. What are my healthcare rights?
  2. What are my rights and responsibilities as a patient in a private hospital?

Your health costs

  1. What questions should I ask about my healthcare costs?
  • Talk to your doctor about whether the services you need are available in the public and private systems and the implications for transfer between these two sectors. Compare what you will have to pay after the Medicare contribution.
  • If you have a private specialist, ask what his/her fees will be.
  • Obtain and agree to a written quote from all treating professionals before treatment. This may be provided in person, emailed, posted, or in short timeframes given verbally.
  • Request that an estimate of additional services/tests that may be required if complications arise, also be included.
  • Ask when to expect bills for your treatment, and when and how they will need to be paid.
  • Check what you will pay for privately conducted pathology tests and diagnostic imaging, whether these services are done in the public system and how much is subsidised by Medicare.
  • If the service your specialist recommends is not funded under Medicare, ask your specialist about the comparative safety, clinical and cost effectiveness of alternative treatment options.
  • Ask your doctor whether it would be appropriate to hold consultations with interstate treating professionals by video conference to reduce the travel required.
  • If you live in a rural or remote area and need to travel to treatment, enquire whether you are eligible for financial assistance through the Patient Assistance Transport scheme run by your state or territory government.
  • If eligible, claim out-of-pocket costs on your tax return through the Australian Taxation Office (conditions apply).
  • If you chose to go private, ask your private health insurer what the benefit will be under your level of cover and whether any gap cover schemes are available.
  • The Private Health Insurance Ombudsman (PHIO) hosted website, has a search engine that enables you to browse Standard Information Statements (SIS) for each private health insurance product available in Australia. Each SIS shows important price and benefit information on each private health insurance product. The website also provides information on medical practitioners and hospitals that have gap cover arrangements with insurers. The PHIO can also be contacted by telephone on 1800 640 695.
  • You can transfer between insurers to a similar level of cover for hospital treatment without having to serve waiting periods. However, you should check carefully as normal waiting periods apply for higher benefit levels or benefits for additional services which were not available under a previous policy.
  1. What does Medicare pay for?

MBS Online website at http://www.mbsonline.gov.au
MBS Online website

MBS Online contains the Medicare Benefits Schedule (MBS), a listing of the Medicare services subsidised by the Australian Government. The schedule may be searched by key word or item number to identify the types of services covered, and the benefit available.

  1. How are doctors' fees set and what am I covered for?

Doctors' Bills, a Private Health Insurance Ombudsman brochure provides information on:

  • how doctors’ fees are set
  • how much you will pay for doctors' fees in and out of hospital
  • the operation of private health insurance gap cover schemes
  • how to avoid unexpected medical costs.

Your treating doctor should provide you with information on likely costs.

  1. What out of pocket costs can I expect when I use my private health insurance?
  • Private health insurers offer gap cover arrangements which may cover some or all of the fees charged by doctors.  This is a commercial decision for the insurer and access to gap cover arrangements will depend on the private health insurance policy you have purchased. You should contact your insurer to get details on the applicability of these arrangements to your policy.
  • The Out of Pocket Expenses (Gap Cover) web page explains the ‘gap’, the amount you pay for medical or hospital charges, or surgically implanted prostheses, over and above what you get back from Medicare or your private health insurer.
  • It also provides advice on the steps you can take to access gap cover arrangements, or obtain estimates of costs before proceeding with treatment.
  1. What is Lifetime Health Cover?

What you need to know about Lifetime Health Cover booklet
Lifetime Health Cover


  • Lifetime Health Cover (LHC) encourages more people to join private health insurance at a younger age and maintain their membership, which helps contain the cost of private health insurance.
  • LHC involves a financial loading that is payable on top of the hospital cover premiums of policyholders who do not commence hospital cover until after their LHC deadline (known as their LHC base day). People who delay taking out hospital cover until after their LHC base day pay a two per cent LHC loading on top of their premium for every year they are over 30 years of age when they take out hospital cover, up to a maximum 70 per cent loading.
  • Private health insurance membership held prior to 1 July 2000 is not considered when calculating a person’s LHC loading. After payment for ten years, the LHC loading is removed.
  • Frequently asked questions
  1. How do I ensure I am informed about all costs before I start treatment?

Knowing how much your treatment will cost will assist you to provide Informed Financial Consent (IFC).  See Your Right to Know
You are entitled to ask your doctor, private health insurance fund and hospital about the out of pocket costs that you may have to pay as a result of treatment.  SeeMedical and Hospital Bills

The IFC Checklisthas been developed for easy printing to help you ask the questions that will enable you to provide IFC before you go to hospital for treatment, reducing the likelihood of surprise bills afterwards.

  1. What health expenses can I claim as a tax refund?

Links to the Australian Taxation Office website have been provided to assist you to claim eligible out of pocket expenses (conditions apply):

Your access to services

  1. Who can access the breast screening program?

Mammography screening
Mammography screening

If you are a woman between the age of 50 and 74 years you may be eligible for a free screening mammogram every two years. The BreastScreen Australia program operates in over 600 locations nationwide and while the program targets women aged 50-74 years without symptoms, other women aged 40-49 and 75 years and older may also be screened.

  1. Where can I access magnetic resonance imaging (MRI) services?

The Department of Health website provides information to assist you in location of your closest Medicare eligible MRI facility.

  1. Am I eligible for breast screening services under Medicare?

This web page provides information on access to Medicare for breast scanning services, including:

  • eligibility for rebate of MRI breast scans
  • access to mammography and ultrasound scans.
  1. Where can I access radiotherapy services?

A list of treatment facility locations in each state and territory is available on the Department of Health website.

  1. What information is available on radiation oncology and radiotherapy?

This web page provides information on:

  • radiation oncology and radiotherapy services
  • cancer treatment options links to services sand who to contact for access to accommodation and the Patient Assistance Transport  schemes.
  1. Where can I go to get cancer information and support?

Cancer Australia is Australia’s national authority in cancer control, established to benefit all Australians affected by cancer and their families and carers. 
The Cancer Australia website provides a central source of evidence-based information, resources and data for people affected by cancer, health professionals, researchers, educators, decision makers and the wider community.

A breast prosthesis
A breast prosthesis

The National External Breast Prostheses Reimbursement Program aims to improve the quality of life of women who have undergone mastectomy as a result of breast cancer.
It provides reimbursements of up to $400 for both new and replacement external breast prostheses for eligible women who have had a mastectomy as a result of breast cancer.
Reimbursement Claim Form

  1. How is access to services being improved?

Victorian Comprehensive Cancer Centre project
Victorian Comprehensive Cancer Centre project

Comprehensive Cancer Centres
Quality cancer services that are accessible to all Australians, including those living in rural and regional areas, are a priority.

Integrated Cancer Centres is a major initiative that includes building two state-of-the-art integrated cancer centres – The Chris O’Brien Lifehouse at Royal Prince Alfred Hospital in Sydney and the Victorian Comprehensive Cancer Centre (VCCC) in Melbourne.

The VCCC project is delivering a new $1 billion facility purpose built for cancer research, treatment and care in Melbourne. It is jointly funded by the Victorian and Australian Governments and will include the Peter McCallum Cancer Centre. Construction commenced in 2011 and service delivery will commence in 2016.

Regional Cancer Centres
The establishment of a network of best practice regional cancer centres will help improve access and support for cancer patients in rural, regional and remote Australia, and to help close the gap in cancer outcomes between the city and the country.

Telehealth
People in Telehealth eligible areas of Australia have access to specialist video consultations under Medicare. This provides many patients with easier access to specialists, without the time and expense involved in travelling to major cities.
Medicare rebates for specialist video consultations

  1. How are new technologies and services assessed for a rebate through Medicare?

Classic double helix
Classic double helix

Medicare aims to ensure that all Australians have access to free or low-cost medical, optometry, midwifery and hospital care and, in special circumstances, allied health services.
In 2012-13, Medicare rebates were provided for 343.6 million services in Australia, an average of 14.8 services per person.
New medical technologies and procedures are not necessarily more effective and safer than existing health services.
The comparative safety, clinical effectiveness and cost-effectiveness of new, amended and reviewed medical services are assessed by the Medical Services Advisory Committee (MSAC).
MSAC provides advice to the Minister for Health for decision.
The Department of Health is required to consider the financial impact, submit the proposed changes for consideration by government, and draft and implement legislative change before an item is included or amended on the Medicare Benefits Schedule (MBS).

  1. What can I do if the service my specialist has recommended is not funded under Medicare?

Talk to your specialist to discuss treatment options and fees, including co-payments (the part of the bill that you pay).

Your rights

  1. What are my healthcare rights?

The Australian Charter of Healthcare Rights
The Australian Charter
of Healthcare Rights

The Australian Charter of Healthcare Rights was developed by the Australian Commission on Safety and Quality in Healthcare.The Charter specifies the key rights of patients and consumers when seeking or receiving healthcare services.

  1. What are my rights and responsibilities as a patient in a private hospital?

The Private Patients' Hospital Charter outlines your rights and responsibilities as a private patient in a public or private hospital.
Translations of the Charter in 19 languages