Gap fees explained — what Medicare covers, what you pay, and how to reduce your costs
Your doctor charged more than Medicare will pay back. The difference — the amount Medicare doesn't cover — is called a gap fee (or out-of-pocket cost). You pay it directly to the doctor.
If your doctor bulk bills, you pay nothing — they accept the Medicare payment as the full fee. Not all doctors bulk bill, and even those that do may only bulk bill certain patients (pensioners, children under 16).
Enter what your GP charges and how long the consult was. We'll show what Medicare pays back and what you're out-of-pocket.
Medicare rebate amounts are the MBS schedule fees as at July 2026 (items 3, 23, 36, 44). Fees are indexed 1 July annually. For GP consultations the Medicare rebate is 100% of the schedule fee — the "85% rule" applies to specialists, not GPs. Source: MBS Online (mbsonline.gov.au).
Every Medicare-covered service has a schedule fee — the government's benchmark price. Medicare then pays a percentage of that fee. Your doctor can charge any amount they like; the gap is what's left over.
When a doctor bulk bills, they accept the Medicare benefit as their full payment. You sign a form assigning your Medicare benefit to the doctor, and that's it — no payment from you.
Doctors receive a small extra payment (bulk billing incentive) for bulk billing concession card holders and children under 16. This is why many practices bulk bill those groups even if they charge gaps for everyone else.
Bulk billing rates vary widely by area. Finding a bulk billing GP is one of the most effective ways to avoid out-of-pocket costs entirely.
Find a bulk billing GP near you →The RACGP surveyed 2,416 practising GPs in April–May 2025. The results show gap fees have risen sharply and more Australians are delaying care because of cost.
The RACGP notes that per-person government funding for general practice was $452 in 2023–24 — the same in real terms as 2015–16 — while hospital funding per person increased by 30% over the same period. This funding gap is the primary reason practice fees have risen faster than the Medicare rebate.
People aged 15–34 are most likely to delay GP care due to cost, with 15.4% in that age group having delayed care in 2023–24 according to the ABS.
If your out-of-pocket costs add up over a calendar year, the Medicare Safety Net kicks in to reduce future gaps. Thresholds reset on 1 January each year.
No — not for GP or out-of-hospital specialist visits. This surprises many people. Private health insurance hospital cover only applies when you're admitted to hospital as a private patient. It does not cover:
Extras cover (optical, dental, physio, chiro) does not cover GP or specialist fees either. The only way to avoid a GP gap fee is to find a bulk billing doctor. Learn what private health insurance actually covers →
| Service | Bulk billed | Typical gap |
|---|---|---|
| Standard GP visit (6–20 min) | $0 | $20–$40 |
| Long GP visit (20–40 min) | $0 | $30–$60 |
| Specialist consultation (referred) | Rare | $80–$250+ |
| Pathology (blood tests) | Almost always $0 | Rarely charged |
| Diagnostic imaging (X-ray, ultrasound) | Often bulk billed | $0–$100+ |
| After-hours GP (urgent) | Variable | $50–$150+ |
Gap fees vary widely by practice, location, and doctor. These are indicative ranges only. Always ask your practice for their current fees.
Yes. There is no legal maximum fee. However, your doctor must inform you of the fee before providing the service. You can choose to go elsewhere if the fee is too high.
Speak to your practice about a payment plan, or look for a bulk billing alternative. Community health centres and Aboriginal Medical Services often provide free or low-cost care. After-hours services like 13 SICK (13 74 25) or Healthdirect 1800 022 222 can also provide guidance.
Some private health funds have agreements with specialists where the fund covers the gap for admitted hospital procedures. "No gap" means you pay nothing beyond Medicare. "Known gap" means the fund covers a set amount, leaving a predictable capped out-of-pocket cost. These arrangements only apply to admitted hospital procedures — not outpatient specialist visits.
If your doctor doesn't bulk bill, you'll pay upfront and claim the rebate back from Medicare. Your doctor can process this electronically at the time of your visit (easiest), or you can claim via the myGov app or website, or a Medicare service centre. The rebate is usually back in your bank account within 24–48 hours.