Out-of-pocket expenses:
How to avoid surprise hospital costs

Updated October 2026 | 5 min read
Words by Angela Tufvesson

Key takeaways

• It’s important to understand the out-of-pocket expenses that can arise when you go to hospital.
• Checking what you’re covered for, your excess and the typical cost of your procedure can help you know what you might need to pay.
• Using our Find a Provider tool can help you find specialists who are more likely to charge no-gap or known-gap fees.

Find out how to reduce out-of-pocket expenses in hospital, from checking your cover to using our No-Gap provider network. 

We’re fortunate in Australia that Medicare and public hospitals provide access to healthcare at low or no cost. But there are also many benefits to having private health cover, particularly when the time comes for a hospital visit.

For starters, private health cover gives you the option to be treated in a private or public hospital and choose your doctor. Plus, by using private care, you’re helping to reduce demand on the public hospital system.

The waiting list for elective surgeries is often shorter than going through the public system, too. In 2024–25, for example, the median waiting time for public hospital patients needing knee replacement or cataract surgery was 255 and 106 days respectively. When you go through the private system, you can generally get in sooner.

Private health cover can also protect you from large, unexpected hospital costs if you want to use the private system. Last financial year, HCF paid $3.8 billion for members’ hospital and medical services, including 757,500 hospital admissions and 806,275 hospital services.

But having private hospital cover doesn’t always mean you’ll have no out-of-pocket expenses. Understanding what your policy covers, what you may need to pay and how hospital costs are calculated can help you avoid unwelcome surprises.

These practical strategies can help you make the most of your hospital cover and keep out-of-pocket costs down.

How to avoid or lower out-of-pocket expenses in hospital

1. Check what’s included in your hospital cover

First things first: checking exactly what your policy covers will help you make informed choices, especially when it comes to non-emergency procedures.

Talk to us about whether your level of cover is right for you and your life stage. Are you covered for the things you might need, like cataract surgery or joint health programs? Are there waiting times or coverage limits to be aware of? It’s worth reviewing your cover regularly to make sure it still suits your circumstances – and you’re not paying for services you don’t need.

Give our friendly team a call on 13 13 34 to chat through your options and 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 policy.

2. Understand your excess

If you’re admitted to a private hospital, you may need to pay an excess. Check what your excess is through online member services or the My Membership app, so you know what to expect. You’ll usually pay it directly to the hospital when you book your treatment or when you’re admitted.

Generally, choosing a lower (or nil) excess means paying more in premiums but less up-front when you’re admitted to hospital. A higher excess, on the other hand – up to $750 for singles and $1,500 for families – can help lower your monthly premiums, but you’ll pay more when you need to use your hospital cover. The amount and circumstances in which you pay an excess depend on your policy, so check your cover before you need treatment.

3. Use our No-Gap provider network

The specialists you choose can affect how much you pay when you go to hospital. A gap payment is the difference between the benefits your private health cover pays and the overall cost of your treatment.

So, what does no gap mean? It means there is zero cost to you for the medical service provided by the specialist in hospital, as long as you're covered by your policy. What about a known-gap payment? This is a fixed, out-of-pocket cost for the specialist's in-hospital service (capped at $500 per specialist). You can use our Find a Provider tool to find doctors or surgeons who are more likely to charge no-gap or known-gap fees.

Your GP can also recommend specialists who are suitable for your health condition. Ask if they can give you two or three recommendations, so you can compare their fees and choose a specialist who’s right for you. A higher fee doesn’t necessarily mean a specialist is more qualified or provides better care.

If your GP has recommended a particular specialist, you can search for them by name in the Find a Provider tool. Or search by specialty and location to find other specialists who may charge no-gap or known-gap fees. You can see the percentage of hospital admissions where a specialist has charged no-gap or known-gap fees and get an idea of potential out-of-pocket expenses.

Last financial year, for 97%^* of hospital admissions involving a specialist in our network, HCF members paid nothing or a maximum of $500 per specialist for their in-hospital medical services, like surgeon’s fees, through our network, which is made up of more than 48,000 specialists.

Eligible members^{^} can also use our Second Opinion service, which connects you with an independent, Australia-based medical specialist for a second opinion, so you can ask questions and feel more informed about your treatment options. 

4. Research typical costs for your procedure

If you’re planning to have a hospital procedure, it’s worth doing your research. A great place to start is our Preparing for Hospital guides, which have been curated with the input of specialists and offer support for over 47 common procedures. They tell you what you need to know about your procedure, what to ask your doctors and typical medical costs.

No idea how much out-of-pocket costs you’ll pay for a lumpectomy, colonoscopy, hysterectomy or skin graft? Hospital treatment can be expensive and our cost indicator tool gives you an idea of the typical 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, which can help you to make decisions that benefit your hip pocket as well as your health.

When you speak to your specialist about a procedure, ask these key questions:

• What are the total fees for the procedure – including fees that might be charged by an anaesthetist and assistant surgeon? Specialists should provide a breakdown in writing beforehand, known as informed financial consent.
• Is your fee an estimate only?
• Are you a participating provider with HCF who charges no-gap or known-gap?
• Which hospital do you provide services at?
• Are there any other doctors involved in my treatment?

You don’t need to feel awkward discussing out-of-pocket costs with your doctor. They understand that medical expenses can add up and can help you explore ways to minimise them.

5. Find a participating hospital

HCF members can avoid out-of-pocket costs by going to an HCF-participating hospital, which you can check with our Find a Participating Hospital tool. 

Once you’ve chosen a hospital for your procedure, ask them about any extra fees. This could include hospital services like meals, wi-fi, TV, partner accommodation or rehabilitation. 

6. Ask about treatment at home

We offer eligible members⁺ a wide range of treatment at home options, including chemo, rehab after knee or hip surgery, IV antibiotics, palliative care and complex wound care. This means you can get the care you need in the comfort, convenience and security of your own home – and reduce or avoid the associated costs of going to hospital or extending your stay there.

Get in touch

Do you have questions about your cover? Don’t hesitate to contact us and we can talk through your options. Either chat with us online or call 13 13 34 and speak to our team.