The Medicare Rebate for around 800 procedures has been reduced following clinical advise to the Australian Government.
In one of dozens of documents released as part of last year’s budget 2024-25, the Australian Government announced a change to the Medicare Benefits Schedule (MBS) that will see many older people paying more for some out-patient medical procedures. These changes came into effect on March 1 this year.
What is the Medicare Benefits Schedule?
The Medicare Benefits Schedule is the list of medical services that are subsidised by the Australian Government through Medicare. These subsidies can occur through bulk-billing, where a medical professional such as a GP bills the government directly for a service that they offer to a patient. They can also occur through a Medicare rebate, where a patient pays out of pocket for a service then claims some or all of the cost back through Medicare.
There are more than 2,500 categories of service currently on the MBS, with multiple different services within most categories.
Different services listed on the schedule are subsidised by different amounts, meaning that the Medicare rebate for some services can be as high as 100%, while for others it may only be 50% or less.
If you are a public patient in a public hospital, all of your medical expenses are covered by Medicare. However, you may be put on a waiting list to receive non-emergency services. If you are a private patient in a public hospital, or a patient in a private hospital, Medicare will only partially cover your medical expenses.
What has changed?
Different services receive different subsidies depending on whether they are provided in a hospital or hospital equivalent setting, or in a non-hospital setting (such as a private clinic). For example, a hip replacement performed in a private hospital is subsidised by a 75% Medicare rebate. On the other hand, kidney dialysis performed at home receives an 85% Medicare rebate.
Before March 1, there were numerous services that were originally performed in a non-hospital setting that are now performed in a hospital setting in keeping with clinical advice to the Australian Government. However, some of the Medicare rebates for these services had not been updated to reflect this change in practice. This meant that the 85% Medicare rebate for some procedures could still be claimed even though these procedures were being conducted in a hospital. The change put in place on March 1 lowers the Medicare rebate for these services from 85% down to 75%, in keeping with the standard for other services provided to private patients through a hospital setting.
Waitlists could get even longer
It is difficult to translate the medical jargon in the MBS to determine exactly which procedures are affected. However, CPSA has heard from a constituent that recently had to cancel cataract surgery due to increased costs, suggesting that this might be one of the procedures that will become more expensive for private patients.
Recent waitlist data shows that by 31 December 2024, more than 1,700 patients in NSW had been waiting longer than clinically recommended for cataract surgery through the public healthcare system, so for a person in need of cataract surgery, the choice is to either sit on this growing waitlist, or pay out of pocket for private surgery and receive a smaller rebate than they were previously eligible for. This will put important surgeries even further out of reach for many people.
While this change makes the rebate consistent with the Australian Government’s policy to offer different subsidies for hospital and non-hospital treatments, it will also raise costs for many people, and put greater pressure on the already long waitlists for many surgeries in the public health system.
It’s also worth noting that this decision was made by the Australian Government, but it is the state governments that run our hospitals, so maybe the Australian Government needs to provide more support to the states to get waiting lists down.
If you are planning to have elective surgery through a private hospital or as a private patient in a public hospital, we recommend that you contact your specialist to see if your surgery has been affected by this change. We also encourage people to get in touch with us to let us know if their surgery costs will increase.
