Private Health Insurance for MRI Scans

This depends on how you receive your MRI. Whether you’re able to get it done while you’re a hospital impatient can make a big difference to your costs.

Is there a MRI rebate?

For services listed on the Medicare Benefits Schedule (MBS), Medicare covers some or all of the costs of:

• CT scans 

• nuclear medicine scans 

• MRI scans 

• ultrasounds 

• X-rays. 

Only accredited practices can provide Medicare-eligible services.*   Some MRI units have partial Medicare eligibility and can only perform a small set of specific services listed on the MBS. Diagnostic imaging providers set their own fees. Ask about costs before you finalise your appointment. If your provider chooses to bulk bill you, you won’t pay any out-of-pocket costs. 

Does private health cover MRI scans?

If you’re admitted to hospital and you need an MRI scan during your treatment, your private health policy will cover all or part of the gap between what Medicare pays, and the total cost of your MRI scan. 

This is providing your scan is part of a treatment covered by your policy and Medicare. Generally though, an MRI is considered an outpatient procedure, which isn't covered by Medicare or private hospital cover. This can mean you'll likely end up paying for your MRI yourself.

Who pays for MRI scans?

Medicare usually covers your MRI scan if it’s ordered by your GP or another recognised medical specialist (like a cardiologist), and your MRI is completed while you’re a hospital inpatient. 

What does an MRI scan cost?

The cost of MRI in Australia varies widely between $200-$1000, but it can be bulk billed and may cost you nothing. Here’s a short summary:

• Public patient in a public hospital: Medicare can cover 100% of the MBS fee.

• Private patient in a public hospital: Medicare covers 75% with some or all of the remaining "gap" covered by your health insurer.

• Private patient in a private hospital: Medicare once again covers 75% with some or all of the remainder paid by your health insurer.

• Out of hospital MRI scan with specialist referral: Generally not covered. Medicare may cover 85% of the cost if the service is listed in the MBS.

To have your MRI scan covered by health insurance, you'll need hospital cover. Each hospital insurance tier will cover a different set of conditions, so you'll need to have a product that covers your particular issue to be covered.

What to look for re: MRI private health cover:

Sections that include MRI: Look for joint investigation, gastroscopy, diagnostic imaging, health screenings and similar terms. Depending on your particular health issues, you might be able to claim the MRI costs against these treatments. The top level health cover policies often include health screening tests (which can include MRI's).

Exclusions: These are the conditions under which your claim will not be paid. Common exclusions include: 

• overseas treatment.

• medically unnecessary scans.

• scans performed without a doctor's referral.

• scans not covered by Medicare

Pre-existing conditions: Pre-existing conditions are generally not covered during the first 12 months of holding hospital cover

Frequently Asked Questions:

What is an MRI scan?

MRI machines pass radio waves through your body, some of which are absorbed by your body’s tissue before being retransmitted. By turning the large magnet in a MRI machine on and off, the machine picks up the radio waves you are giving off and uses these to generate a picture of a particular part of your body.

Metallic objects in the vicinity of the machine’s magnetic field can become magnetised  and can be pulled towards the MRI magnet. This can be unsafe.

For example: Wearing a ring into your MRI machine means it will be pulled towards the MRI magnet with such force, you could damage your finger.

Are MRI covered by Medicare?

Medicare and health insurance typically provide coverage for MRI scans when they’re administered within a hospital setting to admitted patients. These are known as inpatient procedures. Conversely, outpatient MRI services may not be covered by Medicare or your private health insurance. Nevertheless, if you’re admitted to a hospital and an MRI scan is deemed necessary, both Medicare and your private health fund may cover your MRI scan cost. 

Are MRI covered by private health insurance?

As long as the specific reason for your scan aligns with items listed on the Medicare Benefits Schedule (MBS), even a basic hospital policy may minimise or eliminate your out-of-pocket expenses for this procedure.

If you undergo an MRI scan as a patient in a public hospital within the public healthcare system, you're eligible to request a reimbursement, provided this component of your treatment is approved by Medicare. Alternatively, if you have health cover and choose to be treated as a private patient in either a public or private hospital, Medicare may covers 75-85% of the MBS fee, with part or all of the remainder being covered by your health insurer.

What hospital treatments may require an MRI scan?

Joint investigations (often done pre-surgery).

• Gastroscopy

• Diagnostic imaging

• Health screenings

Health screenings are preventative measures used to identify potential health issues. Some extras cover includes MRI health screening benefits.

What is the best health insurance for MRI scans?

There is no best health insurance that specifically covers MRI scans. This is because MRI scans are not a treatment category, they're an investigative procedure. If you need an Medicare approved MRI scan for a particular treatment, then your private health insurance may cover some of the cost if your policy covers the particular type of injuries or illness that you're receiving treatment for. Learn more about health insurance for MRI scans.

Sources

health.gov.au

Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

• 1

  Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.

• 2

  An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.

• 3

  Family health cover means your children are covered under the same policy as you.

• 4

  Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).