Gap fee

A gap fee refers to the difference between a healthcare provider’s total charge and the rebate provided by Medicare for a specific health service. 

How the gap fee is determined 

• The provider establishes their consultation fee. 

• Medicare provides a set rebate. 

• The patient is responsible for paying the remaining balance. 

Payment options and rebates 

• Payment can be made either in advance or after the doctor consultation 

• Patients can claim the Medicare rebate through Easyclaim or online 

• The rebate is issued to the patient, not the practice 

Effect on the Medicare safety net 

• Gap fees contribute to the Medicare safety net thresholds 

• Once these thresholds are met, higher rebate amounts may be available 

• This can lower out-of-pocket expenses in the future 

Being aware of gap fees assists Australians in budgeting for healthcare costs and helps prevent surprise expenses when consulting with privately billing providers. 

Medical Disclaimer: The content on this page is for informational purposes only.