Important clarification about Bupa's Medical Gap Scheme changes

Bupa has reassured health insurance customers they will still be able to use the Medical Gap Scheme in public hospitals under the new changes, if they pre-book their treatment as a private patient at least two working days before admission. 

This information has been updated.


The Bupa Medical Gap Scheme is all about reducing the medical costs you need to pay for treatment in hospital. If your doctor uses our scheme, you’ll never pay more than $500 per specialist for your treatment. Currently, 96% of all private hospital beds in Australia ARE in hospitals which are contracted to Bupa.

Bupa recently announced changes to the scheme which were designed to make the system more transparent, and ensure our customers were never left with surprise out-of-pocket costs.


To clarify, customers who want to be treated by specialists who work in public hospitals CAN still use the Medical Gap Scheme for elective, pre-booked procedures. This is as long as the hospital follows the same process as the private system, and that they don’t charge anything extra for hospital costs, like accommodation or theatre fees.

Bupa is happy to work with public hospitals to make this a simple process and deliver a good outcome for customers.

But, we firmly believe patients shouldn’t be forced to use their private cover if they’re not given a choice of doctor or other benefits they are paying to get from their cover. For instance, if they’re asked to use their private cover AFTER they’ve finished receiving treatment in a public hospital.

We also believe that public hospitals shouldn’t choose to prioritise patients with private cover ahead of patients who don’t, considering all Australians should have fair access to medical treatment, regardless of their ability to pay for it.

Dr Dwayne Crombie, Managing Director of Bupa Health Insurance, said he always supported maintaining the Medical Gap Scheme, as long as Bupa could confirm that the hospital admission really was a pre-booked private admission. He has also welcomed the opportunity to work with public hospitals to help make this happen.

He acknowledged the need to make sure our patients are given a choice of doctor in a public hospital for pre-booked procedures, especially in regional Australia. He believes a process designed to support this would benefit everyone.

“We’ve always recognised that a patient should be able to make the choice to receive a private experience in a public hospital, and in fact a public hospital may be the best setting to do so. So, we support patients and doctors and we believe that making sure any Bupa customer receives the private experience they are being billed for, is a good thing for all involved.

“When a patient is admitted to a public hospital as an emergency or acute patient and treated as a public patient, they should use Medicare to fund that treatment as it is designed to do so,” Dr Crombie said.

Bupa has and will continue to work to remove (or reduce) out-of-pocket costs for its customers, while at the same time tackling unnecessary waste in the system which is one of the many factors driving up private health insurance premiums.

Find out answers to some of the other most frequently asked questions about the Medical Gap Scheme changes here, including claims about 'Managed Care', claims about becoming a 'US style' system and why not all doctors are happy about the changes Bupa is making.