The Albanese government has introduced legislation that would change how specialist medical fees and private health insurance product changes are disclosed, with implications for health funds’ pricing, product design, and data reporting. The Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026 would permit the government to publish information on what individual specialists charge for particular Medicare services, using Medicare, hospital, and private health insurer billing data already held by government and displaying it on the Medical Costs Finder website.
The bill follows criticism of the existing Medical Costs Finder, established under the former Morrison government at a cost of $24 million. The tool was configured to show typical costs for common services and, on a voluntary basis, fees charged by individual specialists. Of approximately 6,300 eligible specialists across 11 specialties, only six had opted to display their fees by the end of 2022, increasing to about 88 doctors three years later. Health Minister Mark Butler said the proposed changes are intended to give patients clearer information about potential costs before acting on a referral. “Specialists and private health funds have been given the opportunity to be upfront about patient costs and out of pocket expenses but frankly, have failed to do so. We know an increasing number of Australians are not taking up referrals from their GP to see a specialist due to concern about cost, but this legislation will give hard working Australians the clarity they deserve about costs and more choice in their health care,” Butler said.
For insurers, a central provision of the bill is a prohibition on “product phoenixing,” where a health fund closes a product and then launches an essentially equivalent product at a higher premium or with reduced benefits. Under the reforms, insurers would be required to obtain ministerial approval for premiums on new products and for certain changes that reduce cover or value in existing products. The government has framed these measures as increasing regulatory oversight of benefit design, repricing, and communication with policyholders. “I also warned insurers that product phoenixing had to stop, and yet insurers continued to do so. This bill legislates wider scrutiny of premiums so consumers can be more confident in the value of private health insurance,” Butler said.
The Australian Medical Association (AMA) has expressed support for the government’s plan to expand the range of data published on the Medical Costs Finder, including Medicare rebates and private health insurer contributions alongside typical specialist charges. The AMA said it had “pushed very hard for Medicare rebates and insurer benefits to be included on the Medical Costs Finder so that patients get the full picture of why they may face an out-of-pocket cost.” Under the envisaged model, patients would see what specialists commonly charge for specified services, the Medicare rebate, and the contribution from their health fund, with the remaining balance indicating likely out-of-pocket costs.
AMA president Dr Danielle McMullen said the association had worked with the Department of Health, Disability, and Ageing to change the site’s functionality for practices and doctors after early versions were difficult to use. She said further engagement would be required to maintain data accuracy and integration with clinical and billing workflows. “Access to insurer data is crucial for patients, alongside clear information on Medicare rebates, which have failed to keep pace with inflation for decades and remain a major driver of out‑of‑pocket costs,” she said.
Private Healthcare Australia (PHA), representing private health insurers, has stated its support for the legislation as a transparency measure in the context of rising specialist costs. PHA chief executive Dr Rachel David said many patients do not know what they will be charged before seeing a specialist or avoid appointments because of concerns about potential bills. “Greater visibility of specialist fees will help patients compare options, avoid bill shock, and make informed choices about their healthcare,” David said.
David said health funds are prepared to provide additional data to the upgraded Medical Costs Finder to help consumers understand typical charges and expected gaps. “Health funds want their members to be able to compare fees and know what they are signing up for so they can access private healthcare with confidence. This legislation is an important first step in restoring affordable access to specialist care and ensuring the private health system remains accessible and sustainable to take pressure off the public health system,” David said. PHA has indicated it intends to work with the government on the operation of the portal for consumers and general practitioners.
The legislative package is being advanced amid affordability concerns outlined in PHA’s report, “Restoring affordable access to specialist care in Australia,” based on a national survey of more than 4,000 adults. According to the survey, about 30% of Australians had delayed or cancelled specialist care due to cost in the previous three years, with the proportion rising to around half among families with multiple children managing long-term health conditions. One in two respondents reported they did not know the fee before attending a specialist appointment.
The findings indicated frequent reports of unexpected or larger‑than‑anticipated bills. The survey found 38% received a bill they were not expecting and 55% paid more than they anticipated. Twenty‑nine percent said they were charged illegal administration or booking fees that do not appear in Medicare data, and 18% reported being asked to pay non‑refundable deposits before their appointment. The report stated that median in‑hospital specialist gap fees have increased 22% since 2022, from $222 to $270. Some community‑based specialists, such as psychiatrists and surgeons, were reported to charge $500 to $1,000 upfront for an initial consultation. The survey also reported geographic variation, with patients in the ACT facing median out‑of‑pocket costs of $605 per hospital service, $335 higher than the national average.
Utilisation patterns have shifted over recent years. Between 2019 and 2024, GP attendances increased by 4%, while initial specialist consultations fell by 8%, suggesting some patients may remain in primary care for longer or move into public hospital pathways rather than accessing private specialists. Early access to superannuation for medical treatment nearly doubled over two years, reaching $1.04 billion in 2023–24. “These are not luxury services people are skipping. People are delaying care they have been told they need because they are worried about the cost, can’t afford the fees, or cannot find a specialist near home,” David said.
For health insurers, the reforms would mean additional regulatory oversight of product closures, launches and benefit downgrades, more detailed public visibility of benefits and gaps, and heightened expectations around contributing accurate, current data to a national transparency platform. The AMA and PHA have both indicated they expect close consultation on implementation of the Medical Costs Finder changes, including data definitions, presentation of insurer contributions, and operational impacts for providers and policyholders.
“If we don’t act, Australians will continue to forgo care, people will get sicker, and the health system will face higher long-term costs from preventable illness,” David said. As the bill progresses, insurers are likely to focus on how the ban on product phoenixing is framed in regulation, how premium approval processes for new and varied products will operate, and how expanded fee and benefit data on the Medical Costs Finder may influence member behaviour, contracting strategies, and product design across Australia’s mixed public–private health system.
