Gap Fees and Out-of-Pocket Costs
Whether NDIS providers can charge gap or out-of-pocket costs, what price limits mean for you, and how to avoid surprise charges on your supports.
Being handed an unexpected bill for a support you thought was covered is stressful and confusing. It helps to understand the rules around what providers can and can't charge, so you can spot a surprise charge and question it with confidence. This guide explains how price limits work, whether you can be charged a gap, where out-of-pocket costs can crop up, and how to keep charges predictable.
How price limits work
Can a provider charge you a gap?
Where out-of-pocket costs can arise
Cancellation fees and other charges
Avoiding surprise charges
If you're charged too much
Frequently asked questions
Can an NDIS provider charge me a gap fee?
For supports covered by a price limit, registered providers can't charge above that limit, so the funding is meant to cover the full agreed cost and you shouldn't be paying a gap out of pocket for the NDIS support itself. If you're being asked to, it's worth questioning and checking against your…
What are the price limits?
They're maximum amounts set out in the NDIS pricing arrangements each year for many supports. A provider can charge up to the limit but not above it for those supports. They protect participants from overcharging. They're maximums, not fixed prices, so a provider can charge less, and it's fair to…
Why am I being asked to pay out of pocket?
Some costs sit outside NDIS funding, such as the everyday portion of a cost like the ordinary price of a meal, items that aren't NDIS supports, or general community costs everyone pays. The NDIS funds the disability-related support, not everyday costs. Check whether the charge is genuinely outside…
Can providers charge cancellation fees?
Yes, within the rules set out in the pricing arrangements. A provider can charge for a short-notice cancellation or no-show, and this comes out of your funding rather than your own pocket. Knowing the cancellation terms in your service agreement upfront, and giving notice where you can, helps you…
How can I avoid surprise charges?
Get a clear service agreement before supports begin, setting out what you're paying for, how it compares to the price limit, any costs not covered, cancellation terms, and how you'll be billed. If you're plan-managed, your plan manager checks invoices against your funding and can flag anything that…
What if I think I've been overcharged?
Raise it with the provider first, pointing to your service agreement and the relevant price limit, as it may be a simple error. If it isn't resolved, a plan manager, support coordinator, LAC or disability advocate can help, and the NDIS Quality and Safeguards Commission handles concerns about…