Medibank’s No Gap program has resulted in more than $7 million in out-of-pocket savings for over 10,000 of its customers since its introduction in 2019.
The initiative was developed to reduce the financial impact of medical procedures not fully covered by Medicare or private health insurance, commonly referred to as the “gap” payment.
Out-of-pocket expenses occur when there is a difference between the total cost of a medical procedure and the combined contributions from Medicare and private health insurance. These costs are typically paid directly by the patient.
Medibank’s No Gap program was designed to improve transparency and predictability for customers by reducing or eliminating these additional charges for a range of elective surgeries.
Eligible Medibank members can access the No Gap program for various specialist procedures, including knee and hip replacements, endoscopies, ACL repairs, and selected general surgeries.
The program is available at 36 hospitals across Australia, including both metropolitan and regional facilities.
The model is based on a doctor-led approach and involves collaboration with a network of surgeons and hospitals.
According to Medibank chief customer officer Milosh Milisavljevic, the program is intended to provide customers with more affordable healthcare options and greater certainty about their medical expenses.
“It provides our customers with greater choice and control when it comes to how and where they access healthcare and what it will cost. For example, our customers are saving on average $2,240 in out-of-pocket fees for joint surgery, but in some cases, it is significantly more,” he said.
He also noted that the program can reduce hospital stays when clinically appropriate, as some patients can opt for rehabilitation at home.
Another advantage is that customers can avoid extended public hospital waitlists, which averaged 265 days in 2024. In most cases, eligible Medibank customers can proceed with their surgery soon after consulting with their surgeon.
Orthopaedic surgeon Dr Daevyd Rodda, who contributed to the program’s development, said the initiative has changed how many Australians experience private healthcare by focusing on affordability and transparency.
“The program has given patients access to high-quality, evidence-based care while saving them millions of dollars in out-of-pocket costs. It has fundamentally changed the way people experience private healthcare in Australia – making it more affordable, transparent, and focused on outcomes that matter to patients,” he said.
Medibank reported that the No Gap program has seen increasing uptake, with more than 10,000 customers participating since its launch.
The network of participating hospitals continues to expand, with Medibank seeking to add more services and specialists.
The list of hospitals offering the program includes facilities such as Adeney Private Hospital, Ballarat Day Procedure Centre, and Bondi Junction Endoscopy Centre, among others.
Recent survey data from Money.com.au indicated that Australian consumers perceive health insurance, especially extras cover, as offering the best value among insurance products.
In the survey, 20% of respondents identified extras policies as providing the most savings, while 19% pointed to hospital insurance.
Medibank has also introduced a new health service for employees navigating perimenopause and menopause.
The program, delivered in partnership with Viv Health, provides access to specialist doctors, personalised treatment plans, and mental health support through telehealth and at-home services.
Kylie Bishop, Medibank group lead – people, spaces & sustainability, said the initiative addresses a significant need within the company’s workforce.
“The research shows that 60% of people who are going through perimenopause or menopause don’t feel supported at work. And when symptoms are severe, nearly 1 in 2 people experiencing menopause consider retiring or taking a break from work,” she said.
The menopause support service complements Medibank’s existing employee health offerings, including a virtual GP, 24/7 nurse triage, and mental health services.
