Skip to content

PREV PAGE nib MediGap

Public vs Private

If you need to go to hospital, you have the option of going through the public system or the private system. nib Hospital covers pay benefits toward the cost of treatment as a private patient in an nib Agreement Private Hospital or any public hospital for services included in your hospital cover.

If you choose to be treated in a public hospital as a public patient Medicare will cover the cost of the hospital stay, including doctors, specialists and pathologists. You will also:

  • Be put on the public hospital waiting list for anything that isn’t an emergency
  • Be more likely to stay in a shared room with other patients
  • Have limited or no choice of doctor, hospital and when your treatment is performed
  • Your procedure may be postponed once or multiple times for more urgent cases

You can choose to stay at a public hospital as a private patient. This often happens in the case of an emergency if you have private health insurance but have been transported to the nearest hospital by ambulance. As a private patient in a public hospital, Medicare will cover some of your hospital costs and your private health insurance will cover some or all of the remaining costs of your accommodation, theatre, doctors and specialists fees – however some out of pocket expenses may apply. You will also:

  • Be treated as soon as a spot becomes available for anything that isn’t an emergency, so you may experience wait times
  • Stay in a private room if the procedure is included on your level of Hospital cover (if available)
  • Choose your doctor and hospital (where possible)

Remember, your ability to be treated at a public hospital will depend on where your surgeon performs the procedure.

As a private patient in a private hospital, Medicare will cover some of your hospital costs and your private health insurance will cover some or all of the remaining costs of your accommodation, theatre, doctors and specialists fees – however some out of pocket expenses may apply. You will also:

  • Avoid public hospital waiting lists
  • Stay in a private room (if available)
  • Choose your doctor, hospital and when your treatment is performed

What’s an nib Agreement hospital?

If you choose to go to a private hospital, we recommend you use an nib Agreement Private Hospital. nib has agreements with most of Australia’s private hospitals and day facilities to ensure you pay as few out of pockets as possible.

nib may not have agreements with some hospitals. If you choose to be admitted to a private hospital that is not contracted with nib you may have significant out-of-pocket expenses to pay. The hospital has a responsibility to explain, in writing, any of the potential additional fees you may be charged before you are admitted. You should also provide your written consent to these charges. This is called written estimate of fees (or Informed Financial Consent).

Your surgeon's charges for the procedure are different from the hospital costs. This is where nib's MediGap may be able to help.

Continue to the next page