How much does an MRI cost in Australia?

A magnetic resonance imaging scan (MRI scan) is a type of diagnostic imaging that uses strong magnetic fields and radio waves to create a detailed image of your body’s soft tissue, ligaments and musculoskeletal system.¹

MRI services are typically performed by an MRI radiographer at a radiology clinic or in a hospital. Your MRI results can then be analysed by a radiologist, who’ll report to your referring doctor. An MRI scan can take anywhere from 10 minutes to 2 hours, depending on the body parts being scanned.

While an MRI is considered a very safe procedure, you’ll be required to complete a safety questionnaire at the time of booking, which you should fill out carefully. This is to make sure you don’t have any metal objects or implants that could be affected by the MRI machine’s magnetic field, such as a pacemaker or aneurysm clips.

MRI scan costs can vary a lot depending on where you’re treated, the body part being scanned and your provider’s billing policy. However, if your scan was required as part of a hospital admission as a public patient, or you go to an outpatient clinic that bulk bills, you should have no out-of-pocket-costs.

When you’re treated as a private hospital inpatient, your health fund will likely pay for any required diagnostic imaging, although you may still have an out-of-pocket expense such the gap fee, excess or co-payment.

When you get a medically necessary MRI as an outpatient, Medicare will pay 85% of the Medicare Benefits Schedule (MBS) fee if your provider doesn’t bulk bill. The table below will take you through some of the different types of MRIs, the amount Medicare will pay and the average out-of-pocket cost.

Your private health insurance will only be able to pay towards the cost of an MRI when it’s completed in hospital as a private inpatient. For MRIs out of hospital or as a public patient, only Medicare can pay a benefit.

When you’re treated as a private inpatient, you’ll receive a Medicare rebate for 75% of the MBS fee for your treating doctors, including any required diagnostic imaging. Your private health fund will then pay the remaining 25% for your doctors’ fees and some or all the hospital fees, assuming the treatment you’re receiving is included on your policy and you’ve served your waiting periods.

If your doctors charge above the MBS fee, you may be responsible for paying the difference between the MBS fee and what you’re charged, which is known as ‘the gap’. Depending on your health fund’s gap cover scheme, this amount could be reduced or paid in full, which is why it can pay to compare health insurance policies.

“There can still be gap fees for those with private health insurance, but many health funds have a list of doctors and hospitals that they have agreements with where you can have your treatment with no gap fees at all, or a lower gap fee that is set before your treatment.” – Steven Spicer.²

A recent survey by our team at Compare the Market has found that 12% of Australians have gone into debt for medical expenses, either for themselves or their loved ones.³ Depending on your policy, having health insurance can pay benefits towards your MRI if you’re admitted as a private inpatient in a hospital and greatly reduce your out-of-pocket costs.

Provided it’s listed on the MBS, Medicare can cover all of the cost of an MRI when you’re an inpatient in a public hospital. Medicare will also pay a partial benefit towards medically necessary MRIs as an outpatient or a private inpatient.

When an outpatient radiology clinic chooses to charge the exact amount Medicare will pay, this is referred to as bulk billing, meaning you won’t have to pay anything. To encourage health service providers to offer bulk-billed diagnostic imaging, Medicare will pay an increased benefit of 95% of the MBS to providers that bulk bill for select MBS item numbers.

If you want an MRI or another diagnostic imaging procedure due to an elective cosmetic procedure or for life insurance underwriting purposes, it will not be covered under Medicare, and no benefit will be paid.

Typically, for Medicare to pay a benefit for an MRI, you’ll need a diagnostic imaging request from a medical professional. This request is often called a referral, although there are a few differences, the main difference being that there’s no time limit on the validity of a diagnostic imaging request.

Depending on the diagnostic imaging provider, you may still be able to get an MRI without a referral; however, Medicare is unlikely to pay a benefit in these cases, so you’ll be responsible for the full cost.

Besides MRIs, there are a few other common types of diagnostic imaging services you might want to be aware of. These services all work similarly to MRIs regarding Medicare and private health insurance.¹

•  X-rays. Uses radiation to create an image of the inside of the body
• CT scans. A type of X-ray that makes high quality 2D or 3D images of the inside of your body using computed tomography.
• PET scans. A scan used to detect how an injected tracker fluid moves through the body. Used to identify medical conditions like tumours, heart disease and brain disorders.
• Ultrasounds. Creates a live image of the inside of your body using sound waves.

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