MBS updates  1 July 2021

MBS updates – 1 July 2021

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Upcoming changes to the Medicare Benefits Schedule

From 1 July 2021, the Federal Government is making changes to the Medicare Benefits Schedule (MBS). Here’s what you need to know.


What are the changes?

The MBS is a list of health services subsidised through Medicare rebates. From 1 July 2021 around 900 procedures and services on the MBS will change, affecting cardiac surgery, general surgery, and orthopaedic surgery services.

The details of specific changes won’t be released until closer to 1 July 2021, due to the complex work involved.


Why are the changes happening?

The MBS Review Taskforce has been reviewing the MBS for five years, to make sure procedures are up-to-date, evidence-based and cost effective.

The taskforce was made up of a large group of independent medical experts, in consultation with patients and GPs. The changes follow the recommendations outlined in the Taskforce’s final report.


Will out-of-pocket costs increase?

The CEO of Private Healthcare Australia, Rachel David has said that most people won’t be worse off or pay increased out-of-pocket costs but for some items, in the minority, the benefit will go down*.

As always, it’s important to get a complete itemised list of costs from your surgeon or specialist before any surgery or procedure.


Does this affect you?

If you already have surgery booked for 1 July onward, contact your surgeon or specialist to ask if the costs will be changing, including any Access Gap Cover payments.

We’ll continue to pay benefits towards inpatient specialist services (25% of the MBS fee).


Do the changes affect Access Gap Cover?

Yes, the Australian Health Service Alliance (AHSA) is working on the revised AGC schedules and we expect to have them on 28 June 2021. The AHSA will notify AGC participating medical providers of the changes to AGC on 29 June 2021.

If you already have surgery booked for 1 July onward (and have an Access Gap Cover agreement), contact your surgeon or specialist to ask if the ACG payments will be changing.