6 ways to reduce your hospital costs

Published March 2025 | 6 min read
Words by Andrea Downey

Getting the most out of your private hospital cover is more important than ever. So if you have a hospital stay coming up, here’s how to reduce your out-of-pocket costs.

We’re all feeling the pinch as the cost of living rises. That’s why getting the most out of your private hospital cover is essential right now.

Here are six ways to make the most of your hospital cover and lower your out-of-pocket expenses.

1. Check you’re on the right level of hospital cover

Checking exactly what your policy covers will help you be more prepared if you're planning a hospital stay.

If you’ve got hospital cover, you’ll have a greater choice when it to comes to picking your specialist and hospital.

All hospital cover needs to fit into the Gold, Silver, Bronze or Basic categories as defined by the Australian Government. The treatments you can claim on will depend on your level of cover or 'tier'.

With HCF Hospital Silver Plus, you'll be covered for things like cancer treatments, eye problems including cataracts, joint reconstructions and heart and vascular issues, while HCF Hospital Gold is designed to provide additional benefits for items like psychiatric care, pregnancy, IVF and weight loss surgery.

With cover like HCF Basic Hospital Plus, you can still claim on things like joint reconstructions, eye problems (excluding cataracts) and dental surgery.

When choosing your hospital cover, it’s important to think about what you need now and what you might need in the future. For example, do you need to be covered for the things like cataracts, pregnancy and birth or heart surgery?

You should also know the waiting periods if you switch or upgrade your policy, as changing to a higher cover may require you to wait 12 months before you can claim for things you weren't covered for on your previous level of cover.

2. Understand what Medicare covers

Medicare is available to all Aussie citizens and most permanent residents. It helps with the costs of a wide range of health and hospital services, however understanding what’s covered by Medicare and your hospital cover can be confusing. Medicare and private health insurance pay for different aspects of your care. Find out more about out-of-pocket costs or speak to your health fund.

Medicare contributes a set amount charged by doctors for each treatment or procedure, as laid out in the Medicare Benefits Schedule (MBS). For doctors’ services in hospital, Medicare pays 75% of the MBS fee and your fund may pay the other 25% (if you’re covered for the service).

You can still use Medicare even if you have private health cover, for example, you can choose to go to a public hospital as a public patient or elect to be a private patient in a public hospital.

3. Closing the gap

Before any planned hospital admission, it’s a good idea to find out how much your treatment will cost and whether you’re covered for the full amount. This can help you avoid bill shock and understand if you’ll need to pay any ‘gap’ payments.

You can go to any hospital you choose for treatment, but to save our members money, we have agreements in place with many private hospitals (known as participating hospitals) to help you avoid a gap for services you’re covered for.

Our cost indicator gives you an idea of the average costs for some of the most common hospital procedures. You can see the average total costs and the out-of-pocket costs incurred by HCF members.

You can also see how your choice of doctor and hospital affect that cost.

When you speak to your specialist about a procedure, ask key questions like ‘what are the total fees for the procedure?’ and ‘do you offer no-gap or known-gap options?’. Remember to ask for costs for other health professionals like the anaesthetist, too.

Try not to feel awkward discussing money – your doctors understand how out-of-pocket costs work and that you’re keen to reduce them as much as possible.

If you need a joint replacement, our No-Gap Joints program for hip and knee replacements gives eligible members peace of mind with no out-of-pocket costs^* from hospital admission through to discharge and post-surgery rehab, with participating private hospitals and clinicians.

As with all bills, always make sure you read the breakdown of any specialist bills before you arrange payment.

If something looks out of place, you should query this with your doctor, specialist or hospital, or you can also check the fees by calling us on 13 13 34.

4. Find a participating specialist or hospital

Our Find a Provider tool helps you find a specialist who’s more likely to charge a no-gap or known-gap (capped at $500 per specialist) fee.

If your GP has recommended a specialist and you’d like to find out more about their fees, you can find all this information by searching the specialist’s name on the Find a Provider tool.

If you're not sure, you can do your own research by searching for the speciality and a location that suits you.

To find a participating hospital, use our directory of partner hospitals around Australia.

If you need a referral from a GP, our partnership with GP2U helps eligible members^{^} get a 10-minute telehealth consult for $50. Eligible members who live in rural or remote Australia can access one 15-minute online GP consult free⁺ per year.

5. Know how to prepare for hospital

If you’re planning a trip to hospital, our Preparing for Hospital online guides have all the information you need for common procedures, including helpful videos featuring members who've been to hospital for the same procedures.

Speak to your health professional or ask at your pre-admission clinic appointment to find out how long your hospital stay might be and what considerations you might need to think about after surgery. If it’s a day procedure, make sure you have someone who can drive you if you need help or who can help with aftercare.

If you have an overnight stay, make sure you pack a hospital bag with all your essentials to make your stay as comfortable as possible.

Second opinions can help you make informed decisions about your care. You might want to consult another doctor for more support or reassurance or have more time to ask questions you may not have at the time.

Eligible HCF members can get a second opinion^# at no extra cost. You’ll get peace of mind, and another opportunity to understand your treatment plan, ask questions about your diagnosis and make the best decision about your health.

Before your hospital stay, it’s a good idea to ask your specialist which recovery services (if any) you’ll need after your treatment so you’re prepared for any expenses. If you need help understanding what your recovery costs might be, speak to our team on 13 13 34.

6. Explore our range of at-home hospital treatments

You may be able to enjoy flexible care with our treatment at home options.

Treatments at home aren’t actually covered by our policies like treatment in hospital is. But we’ve chosen to pay for some treatments you can have in the comfort of your own home when we can make sure the treatment can be given safely and at the same, or better, quality than in hospital.

This may include IV antibiotics, complex wound care, IV chemotherapy, reconditioning rehabilitation and rehabilitation after hip or knee replacements. Ask your doctor or hospital if there’s an option to be treated at home in your case and they may be able to refer you to an HCF contracted provider before you leave hospital.

To help reduce your cost of selected medical devices for ageing, post-surgery, rehab and home-based care, members can also get up to 15% off selected Cabrini Technology Group (CTG) devices^**.

Have a hospital visit coming up?

We know going to hospital can be stressful. Our Preparing for Hospital tool gives you peace of mind with information and videos on common procedures, like knee and hip replacements, IVF and cataracts. This resource helps you make informed decisions, ask the right questions and find out what you need to know and do before heading to hospital.