Should you be a private patient in a public hospital?

Published August 2024 | 4 min read  
Words by Sally Bathgate 

Should you use your private health cover if you find yourself in a public hospital? Here are some important points to consider before deciding. 

If you have hospital cover as part of your private health insurance, you already know you can use it to help with the costs of a private hospital stay. But what about public hospitals?  
 
Should you elect to be treated as a private patient when admitted to a public hospital? Before making the choice, there are some factors you need to think about.  

Public versus private hospitals

First, it’s important to understand the differences between public and private hospitals in Australia.

In a public hospital, most treatment is free for anyone with a Medicare card – including costs for doctors’ and specialists’ fees and for hospital accommodation and clinical services. In general, public hospitals are usually the first choice for emergencies and, in most cases, are well equipped to handle complex cases.

Private hospitals are often seen as a more ‘comfortable’ choice. There are generally shorter waiting times for elective surgeries, you can choose your doctor, and amenities like private rooms are more readily available. Medicare will partially cover treatment costs in a private hospital, but there will most likely be additional costs related to your treatment and stay.

Types of private health cover

To cover these costs, you may be able to claim against your private health policy, depending on the insurer and your type of cover.

• Hospital cover helps pay for treatment and hospital costs in both public and private hospitals. This can be a big help, especially if you want to avoid out-of-pocket expenses or prefer a private hospital.
• Extras cover helps reduce out-of-pocket expenses associated with managing or improving your health, like dental, optical, physio and chiro.
• Ambulance cover can pay for ambulance rides, which Medicare doesn’t cover.

To understand your HCF cover, give our team a call on 13 13 34 to discuss your options and to make sure you know what you're covered for. You can also log in to online member services and go to ‘cover details’, or use the My Membership app to access the details of your cover.

Using private insurance in a public hospital

When you're admitted to a public hospital, you can choose to be treated as a public or private patient if you have hospital cover. If you opt for private, you’ll need to provide your private health insurance details – but before you decide, it’s best to know what your policy covers and what the hospital will charge you as a private patient.

If you’re unsure what your policy covers, you’re not alone. Fewer than three in 10 respondents in a recent Consumers Health Forum of Australia survey fully understood what their health insurance policy covered.

As a private patient in a public hospital, you may be able to choose your doctor or specialist (if they work at that particular hospital), and this can provide continuity of care. You may also get a private room if one is available – this is not guaranteed, especially in a busy public hospital, and you’ll need to check whether your policy includes cover for this.

Usually, being a private patient in a public hospital will not shorten the wait time for elective (planned) procedures. This is an advantage of using a private hospital, where wait times are generally shorter for elective procedures.

Understanding gap payments and out-of-pocket expenses

It's important to remember that being a private patient can come with extra charges and out-of-pocket expenses on top of what Medicare covers. As a private patient (in either a public or private hospital), Medicare covers you for 75% of the Medicare Benefits Schedule (MBS) fee for doctors’ services while you’re in hospital.

The hospital may charge you the remaining costs. This can include:

• any amount the doctors charge above the MBS fee (known as ‘the gap’)
• expenses related to your treatment, such as room and theatre fees, medicines and diagnostic tests.

Your private health insurance may cover some of these costs. At HCF, we offer our members a number of ways to reduce out-of-pocket-expenses (closing the gap), including our Find a Provider tool (where you can find a participating specialist), as well as options for choosing the right excess for your situation. HCF members can also get an idea of typical hospital procedure costs with our cost indicator tool, which can be extremely useful for making any decisions about your hospital care.  

Questions to ask your doctor, insurer and hospital admissions

Before deciding whether to be treated as a private patient or a public patient, it can be helpful to ask your doctor, insurer and hospital admissions a range of fact-finding questions.

How much extra will I have to pay?

Start by asking your specialists about any potential gap fees or out-of-pocket costs associated with your treatment in the public hospital. A specialist should provide you with information in writing about the costs of your treatment so that you can give your informed financial consent (IFC). Check with your hospital for any extra costs, like diagnostics and admin fees, which you may be asked to pay once discharged. Finally, check with your insurer to make sure you understand how much they will cover.

How does being treated as a private patient benefit me?

This may include asking if a private room is available, asking if you can choose your specialist and how long the wait may be. Some insurers may not cover the cost of a private room in a public hospital, so before accepting one, check with your health fund

How much would it cost if I was a public patient?

This will help you weigh up the pros and cons of each choice.

Transferring hospitals and pregnancy

In some situations, you can ask to transfer from a public to a private hospital after you’ve been admitted. This usually depends on the medical reasons for the transfer and the specific provisions of your insurance policy. Depending on your insurer and policy, your ambulance transfer charges may not be covered. If you do decide to transfer from public to private, it’s best to ask your health fund, doctor and hospital admission department early on in your treatment process.

If you're visiting Australia and have Overseas Visitors Health Cover (OVHC), double check your policy details. While OVHC is a form of private health insurance, it might only cover some of what a standard Australian private health insurance policy covers. You should ask hospital admissions to confirm what extra costs you may have to pay early in your treatment.

If you're pregnant, it’s best to decide early on in your pregnancy whether you want public or private healthcare. This can affect your choice of hospital and the nature of your maternity experience. Many public hospitals have maternity wards, but a private hospital might offer more choices for doctors or birthing suites.

Preparing for hospital

Going to hospital can be a source of anxiety for our members. That’s where our Preparing for Hospital guide can provide peace of mind, with information and explainer videos on 47 common procedures, like knee and hip replacements, IVF and cataracts. This resource helps members make informed decisions, ask the right questions and find out what they need to know and do – before they head to hospital.