What is the 'gap' in relation to Private Health Insurance?

• A. The Difference Between Private and Public Hospital Charges
• B. The Annual Out-Of-Pocket Cap For PHI
• C. The Maximum Coverage Amount Per Year
• D. The Amount A Patient Has To Pay For Treatment In A Private Hospital Once The Medicare And PHI Contributions Have Been Paid

Answer: (D)

The gap is the portion of private hospital treatment you end up paying out of pocket after Medicare and your private health insurance have contributed. In private care, Medicare provides a set benefit and your PHI rebate covers part of the bill; the hospital or doctor may charge more than what Medicare and PHI pay, and the difference is the gap. For example, if the total bill is $5,000, Medicare pays $4,000 and PHI covers $600, the remaining $400 is the gap you would pay unless your policy includes gap cover. This isn’t the same as the difference between private and public hospital charges, a yearly out-of-pocket cap, or a maximum annual coverage amount.