Short answer: As a private patient in an Australian hospital, Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee and your insurer pays at least the remaining 25% for covered services. If your doctor charges more than the schedule fee, you usually pay the difference, called the gap, unless there’s a gap-cover arrangement (privatehealth.gov.au (opens official site)). None of this applies to treatment overseas. Many people compare an overseas price with an Australian price, so it helps to know what you’d actually pay here.
Risks and limitations to understand first
- Overseas treatment isn’t covered. Medicare doesn’t cover you overseas (Smartraveller (opens official site)), and Australian health insurance generally doesn’t cover treatment received overseas. One fund’s FAQ says so directly (Union Health (opens official site)).
- Cosmetic surgery isn’t covered in Australia either. Medicare doesn’t pay benefits for surgery done mainly for cosmetic reasons (MBS TN.8.4 (opens official site)), and insurers don’t pay benefits for it (Commonwealth Ombudsman (opens official site)).
- A cheap headline price isn’t the whole cost. Fixing a problem can cost more than the original procedure (Smartraveller (opens official site)).
How gaps work in Australia
| Cost | Who pays |
|---|---|
| MBS fee for a covered in-hospital service | Medicare 75%, insurer at least 25% (privatehealth.gov.au (opens official site)) |
| Doctor’s fee above the MBS fee | You, unless a gap-cover arrangement applies |
| Excess or co-payment on your policy | You |
| Services your hospital tier excludes | You (Department of Health (opens official site)) |
Ask your surgeon for the MBS item numbers and a written estimate, then ask your insurer what they’ll pay (Department of Health (opens official site)).
What isn’t covered
- Cosmetic surgery, in Australia or overseas
- Treatment received overseas
- Revision of cosmetic surgery done overseas. See revision surgery in Australia.
- Services excluded by your hospital tier
As a public patient in a public hospital, you aren’t charged for treatment if you’re eligible for Medicare (privatehealth.gov.au (opens official site)).
Comparing with overseas costs
When you compare, include:
- the Australian out-of-pocket cost after Medicare and insurance (for medically necessary procedures)
- flights, accommodation, time off work and a support person
- travel insurance for surgery and medical tourism insurance
- aftercare in Australia and possible revision
- a buffer for complications. See what to do if something goes wrong
Australian cost guides: dental implants (AU typical complete single implant about AUD 3,000 to 7,000 in our sourced table), veneers, hair transplants and gastric sleeve in Thailand. Other procedure prices: Price on request, get quotes from clinics until verified. Trip costs: trip budget planner.
Procedure guides: hip replacement, knee replacement, gastric sleeve and dental implants. For orthopaedic procedures, ask about the public waiting list and your insurer’s cover before you compare.
Destinations: Thailand, Bali and Turkey.
Waiting periods, tiers and known-gap arrangements
Before you treat an Australian quote as “the full price”:
- Hospital product tiers (basic, bronze, silver, gold) exclude different clinical categories (Department of Health (opens official site))
- Waiting periods can apply for new policies or upgraded cover
- Some specialists participate in known-gap or no-gap schemes; others do not
- Anaesthetist and assistant fees can create separate gaps even when the surgeon is covered
Get every provider’s item numbers in writing. An estimate that only lists the surgeon’s fee is incomplete for comparison with an overseas package.
Extras cover vs hospital cover
Extras (ancillary) cover may contribute to dental, optical or physio up to annual limits. Hospital cover is what usually matters for inpatient surgery. Mixing the two in a comparison with overseas dental tourism is a common mistake: an extras rebate for a crown at home is not comparable with a full-arch implant package abroad (Department of Health extras (opens official site); ADA overseas dental policy (opens official site)).
Sourced Australian single-implant private fees commonly fall around AUD 3,000 to 7,000 per typical complete implant case on our costs table (dental implant costs). Overseas lines must still be verified separately; do not assume extras cover pays for foreign treatment.
Sister site disclosure
Our sister site surgeryloans.com.au publishes general information about financing medical and dental treatment. Disclosure: surgeryloans.com.au shares ownership with medicaltourism.com.au. See how we make money. This page does not place a URL to that site. Gap education is not a reason to borrow.
Frequently asked questions
What is a health insurance gap?
It’s the difference between what your doctor charges and what Medicare and your insurer pay. You usually pay it unless there’s a gap-cover arrangement.
Does private health insurance cover surgery overseas?
Generally not. Check your policy.
Is cosmetic surgery covered by Medicare or health insurance?
No. Medicare doesn’t pay benefits for surgery done mainly for cosmetic reasons, and insurers don’t pay benefits for cosmetic surgery.
How do I find out my out-of-pocket cost in Australia?
Ask your surgeon for item numbers and a written estimate, then ask your insurer what they’ll pay.
Can I claim overseas surgery on my Australian extras policy?
Generally no. Confirm with your fund in writing. Treatment location and item eligibility both matter.
Should I cancel Australian cover because I plan to travel for surgery?
Do not cancel cover based on this page. Speak to your insurer and a trusted adviser; returning patients still need Australian care for complications.
Does Medicare cover anything overseas?
Only limited urgent care in 11 reciprocal agreement countries. See does Medicare cover treatment overseas?
Sources
All accessed 24 October 2026.
- privatehealth.gov.au, Out of pocket costs: https://www.privatehealth.gov.au/health_insurance/howitworks/out_of_pocket.htm
- Department of Health, Disability and Ageing, Out of pocket costs: https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs
- Department of Health, Disability and Ageing, Hospital cover and product tiers: https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/hospital-cover-and-product-tiers
- privatehealth.gov.au, What is covered by private health insurance?: https://www.privatehealth.gov.au/health_insurance/what_is_covered/
- Smartraveller, Going overseas for a medical procedure: https://www.smartraveller.gov.au/travel-essentials/travel-health/medical-tourism
- Union Health, Am I covered whilst travelling overseas?: https://unionhealth.com.au/faqs/manage-my-cover/travelling-overseas
- Medicare Benefits Schedule, Note TN.8.4: https://www9.health.gov.au/mbs/fullDisplay.cfm?q=TN.8.4&qt=noteID&type=note
- Commonwealth Ombudsman, Plastic and reconstructive surgery: https://www.ombudsman.gov.au/publications-and-news-pages/publication-pages/brochures-and-factsheets/factsheets/private-health-insurance/plastic-and-reconstructive-surgery
Disclaimer: The information on medicaltourism.com.au is general in nature. It isn’t medical, financial or insurance advice and doesn’t take your personal circumstances into account. See our editorial policy, medical disclaimer and how we make money.