changes to MBS

As your personal health insurance fund, we’re always here to keep you up to date with industry news and updates and answer any questions you might have.

The Australian Government recently announced changes to the Medicare Benefit Schedule, or MBS, from 1 July 2021. With several articles in the media commenting on the changes, we wanted to answer some common questions, so you have all the facts.

What is the Medicare Benefit Schedule?

The Medicare Benefit Schedule, or MBS, is a list of services for which the Australian Government will pay a rebate, and for each service listed on the MBS, there is a Medicare Schedule Fee.

So when you claim on a service listed on the MBS as an inpatient, Medicare will pay a portion of the cost and your Phoenix Health hospital cover will pay the remainder of the Schedule Fee. If you doctor chooses to charge over this fee you may end up with out of pocket expenses.

What’s changing from 1 July?

The schedule of fees set by the Australian Government for doctors and patients is being improved from 1 July. The changes to the MBS reflect the recommendations of the expert members of the MBS taskforce to improve health outcomes for patients and should not result in any increased out of pocket bills for consumers.

These changes include adding new services and removing any that are no longer being used while other items will remain unchanged which means treatments and procedures covered under the MBS will better align with the care patients are needing.

Will there be changes to my cover?

There will be no changes to your Phoenix Health hospital cover at this time. Should we need to make changes to the levels of cover we offer, we will always write to you with plenty of notice to communicate the pending changes.

What about if I go to hospital, will anything be different?

You will continue to be able to claim for hospital as you have been previously with your Phoenix Health hospital cover. Your doctor may mention a change to the Medicare Schedule Fee for your procedure or treatment but unless they are charging over the set fee this won’t impact you.

How do I avoid out of pocket expenses should I have to go to hospital?

We always recommend you ask your Doctor or Surgeon for a quote (or informed financial consent) prior to your hospital admission, for any services they will be providing to you, as well as getting a quote from any assisting surgeons or specialists. If they choose to charge over the Medicare Schedule Fee, you’ll know what out of pocket expenses to expect to receive and you can ask if they’ll participate in the Phoenix Health Access Gap Scheme to minimise your out of pocket expenses. Either way you’ll have all of the information, but it’s important that you know that  you are within your rights to find a doctor who will participate in Access Gap, or even shop around to find a surgeon who is the right fit for you and your budget.

Let us help you! As soon as you find out you have an upcoming hospital admission give us a call and we can confirm your benefits and level of cover, any excess or co-payments you’re required to pay on your level of cover and guide you on the questions to ask your doctor.

I already have a hospital admission planned, how do I know if my treatment or procedure will be changing?

When asking your Doctor or surgeon for a quote prior to your hospital admission ask them to confirm if their quote takes into consideration any changes from 1 July. Remember the changes only affect some items on the MBS and your Doctor or surgeon will know if the fees for your procedure or treatment is being changed.

If you’re still not sure about the financial information your doctor has provided, give us a call and we can guide you to find out all the information you need so you can focus on your recovery rather any possible out of pocket costs.

Still have questions?

We’d love to chat! Sometimes just talking things through can help you feel more relaxed about a planned hospital admission. We want you to be confident in your cover so invite you to reach out to our Member Service team by emailing [email protected] or calling us on 1800 028 817we’re always here to help.

If you’d like to learn more about the Medicare Benefit Schedule and the governments review of Medicare Services click here. The information provided above is current as at 10 June 2021.