5 ways to reduce out-of-pocket medical expenses

Research & Insights

5 ways to reduce out-of-pocket medical expenses

Updated September 2023 | 5 min read
Expert contributor Dr Andrew Cottrill, HCF’s Chief Medical Offer

Getting the most out of your private hospital cover is more important than ever. We show you five ways to reduce your out-of-pocket costs.

With the cost of living on the rise across many areas, from housing to food and utilities, we’re all looking for ways to streamline the family budget and make careful financial decisions.

We’re here for our members to help you understand and manage your health costs. We have a range of tools to help and can advise you on what information you need from your doctors.

Here are some simple, practical strategies to help you maximise your hospital cover and lower your out-of-pocket expenses.

1. Compare your hospital cover

Checking exactly what your policy covers will help you make informed choices, especially when it comes to non-emergency procedures.

If you’ve got hospital cover, you’ll get more choice with your specialist and hospital. You may also have a shorter waiting time for elective surgery like knee replacements or endoscopies.

Talk to us about whether your level of cover is right for you and your life stage. Are you covered for the things you need, like cataracts, pregnancy and birth, and dental surgery? Are there waiting times or coverage limits to be aware of? It’s worth reviewing your cover regularly, as you might be covered for conditions or hospital treatments that no longer benefit you and your family.

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. You can also find out more about what’s covered by Medicare.

Give our friendly team a call on 13 13 34 to chat through 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.

2. What is covered by Medicare

With private hospital cover, understanding what’s covered by Medicare and who to pay can be confusing. Medicare and private health insurance pay for different aspects of your care. Find out more about out-of-pocket costs here.

Talking through your options with your GP can help you avoid some out-of-pocket costs. When your GP refers you to a specialist, ask for two or three recommendations so you can compare costs before choosing the right one for you.

When you go to hospital, the specialists you choose may enable you to lower, or perhaps even avoid, a gap payment – the difference between the benefits your private health insurance hospital cover pays and the overall cost of your treatment. Remember, you may still be required to pay an excess for your hospital admission.

Just because one specialist is more expensive, it doesn’t mean they’re better or more qualified than a specialist with lower fees.

3. Find a participating specialist

HCF was one of the first health funds to share its insights with members about costs of major treatments. We launched our Find a Provider tool to help you find a specialist who’s more likely to charge no-gap or a known-gap (capped at $500 per specialist) fee.

"HCF is a leader in providing members with information about out-of-pocket costs for specific procedures by a specialist. The out-of-pocket costs other HCF members have experienced for that procedure are shown in an easy-to-understand bar chart," explains HCF’s Chief Medical Offer, Dr Andrew Cottrill. "We also show which specialists use our gap arrangements and how often."

If your GP has recommended a specialist and you’d to like to find out more about their fees, you can search by entering the specialist’s name or do your own research by searching for the speciality and a location of the specialist that suits you.

You’ll be able to see the percentage of hospital admissions where the specialist charged no-gap or known-gap fees, and get an idea of out-of-pocket costs for your procedure. For tips using the tool, watch the video below.

4. Out-of-pocket expenses

No idea of the out-of-pocket costs you’ll pay for a lumpectomy, colonoscopy, hysterectomy or skin graft? Hospital treatment can be expensive and our cost indicator gives you an idea of the average 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.

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

  • What are the total fees for the procedure? Specialists should provide a breakdown in writing and get your consent to any gaps, 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 and will they charge a fee or any gaps?

Try not to feel awkward discussing money – your doctors understand how out-of-pocket costs work and that you’re keen to reduce them as much as possible.

If you need a joint replacement, our No-Gap Joints program for primary hip and knee replacements gives eligible members peace of mind with no out-of-pocket costs (excluding excess) from hospital admission through to discharge and post-surgery rehab, with participating private hospitals and clinicians*.

5. Find a participating hospital

We’re here to help you understand which hospital you choose. We can help eligible members get no-gap treatment and avoid out-of-pocket costs (excluding excess and for services they’re covered for) at participating hospitals, which are located in capital cities and regional centres across Australia.

Once you’ve chosen which hospital you’re going to for your procedure, ask them about any extra fees. This could include hospital services like meals, wifi, TV, partner accommodation or rehabilitation.

We also want to give you more choice in how and where you’re treated. You may be able to reduce or avoid the associated costs of going to hospital, and enjoy flexible care, with our treatment at home options.

Your hospital cover provides benefits for your stay in hospital which normally doesn’t include treatments that occur at home. At HCF, we choose to cover the cost for some treatments, using our contracted providers (called hospital-substitute treatment or HST providers), because we know you might prefer to be treated in the comfort and convenience of your home.

We only cover treatments when they can be provided safely and at the same, or better, quality than in hospital. We choose to cover the cost of some at-home treatments, including IV antibiotics, complex wound care, IV chemotherapy, and prehabilitation before surgery and rehabilitation after hip or knee replacements^.

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Important Information

* Eligible members will need to have HCF hospital cover including primary hip and knee replacements for 12 months (excluding Overseas Visitors Health Cover). Members will be accepted into the program in line with clinical criteria by the participating clinician and hospital on a patient-by-patient basis. Must be admitted at Macquarie University Hospital, East Sydney Private Hospital, Hurstville Private Hospital or Vermont Private Hospital. You must undergo your joint replacement surgery before the proposed trial program end date. The No-Gap Joints program is proposed to end on 31 March 2024 at Hurstville Private Hospital, 31 March 2024 at East Sydney Private Hospital, 30 April 2024 at Vermont Private Hospital and 30 September 2024 at Macquarie University Hospital.

^ Available with HCF contracted providers, subject to member location and hospital cover. Waiting periods apply. You must have a suitable home environment to be treated in.

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