Wondering if your health insurance cover will pay for your cataract surgery? The good news is private health insurance covers a range of health services – with cataract surgery being one of them. However, it’s important you have the right level of cover. Below, we’ll dive into everything you need to know so you can make an informed decision for your health needs.
- Cataract surgery is typically covered under gold-tier health cover
- Without private health insurance, cataract surgery as a private patient can cost anywhere between $1,500 to $4,500 per eye
- Medicare will cover medically necessary cataract surgery, but you’re in for a long wait – usually 6 months or longer
If you’re dealing with cataracts, you’re probably wondering how much surgery will cost you and if insurance will cover it. Let’s cut to the chase: private health will cover some of the costs of cataract surgery – but only under gold tier hospital cover – or sometimes top-level silver hospital policies.
So, if you already have private health cover and need to upgrade, or are looking at taking out private health to get your eyes sorted, read on. We’ll cover everything you need to know about private health insurance and cataract surgery, including surgeon fees, anaesthetist fees, health insurance rebates and more.
Got your eye drops ready? Let’s get to the important stuff.
How Private Health Insurance Covers Cataract Surgery?
If you’re contemplating cataract surgery, you might be wondering how private health insurance can assist you. Here’s the deal: most gold-tier hospital policies and some silver plus policies will cover cataract surgery.
The advantage of using private insurance is that you often avoid long waiting periods that are typical in the public system. Plus, you have the choice of your own specialist, as well as when and where you’d like the surgery to happen.
Health Insurance Premium
Cost-wise, a gold-tier policy is usually around $35 to $50 per week. These policies are comprehensive, covering a wide range of 38 clinical services. This could be particularly useful if you have other healthcare needs, such as joint replacements or insulin pumps.
However, it’s important to note that if you have a pre-existing condition, there’s a 12-month waiting period before your insurance will cover the cataract surgery.
How Much Does Private Health Pay?
There are a lot of fees that go into cataract surgery, from eye surgeon fees to anaesthesia and anaesthetist fees, theatre fees and more. With private health, you won’t be going at it alone, you’ll have some of the costs covered (but there are still some out of pocket costs to pay).
EXAMPLE: HCF Hospital Premium Gold From $51.30p/w
With HCF Hospital Premium Gold cover, if you’re a single that’s living in Victoria, aged 65-69 on less than $93,000 per year, you could pay just $623 for your cataract surgery. Here’s a cost breakdown.
TOTAL SERVICE COST: $5,779
YOUR COST: $623
Who Pays What?
- HCF pays 67%
- Medicare pays 22%
- You pay 11%
Cost based on: participating private hospital; Nil excess; doctors participating in an HCF gap arrangement.
How Much is Cataract Surgery?
The cost of cataract surgery varies based on several factors, including the healthcare system you opt for (private system or public system) and whether you have private health insurance.
Public Hospital Under Medicare
- Cost (Out-of-Pocket): Free
- Long waiting lists, typically around 158 days (over 5 months)
- Additional fees may apply for premium contact lenses
Private Hospital Without Cover
- Cost (Out-of-Pocket): $1,500 – $4,500+ per eye
- Surgery can often be scheduled immediately, depending on surgeon availability
- Additional costs for specialist consultations may apply
Private Hospital With Cover
- Cost (Out-of-Pocket): Approximately $700
- 2-month waiting period to claim, or 12 months for pre-existing conditions
- Out-of-pocket costs can vary based on your health fund and the surgeon you choose
Can You Get Cataract Surgery for Free with Medicare?
If you’re facing cataract surgery, you’re likely wondering how Medicare fits into the equation. Well, here’s some good news: Medicare does cover this surgery, making it free if you’re willing to go through a public hospital.
However, if you want more advanced lenses that aren’t included in Medicare’s package, there will be additional costs to consider.
The biggest issue with having surgery in a public hospital is the waiting times. The average wait for cataract surgery during the 2021-2022 year was around 158 days. In specific regions like NSW and NT, these waits can even extend to 278 and 200 days, respectively. If you’re in a hurry due to deteriorating vision, it might be worth exploring private health insurance options for quicker access to treatment.
Is cataract surgery covered by Australian private health insurance policies?
Absolutely, private health insurance has your back when it comes to cataract surgery. Depending on your policy, you could be looking at out-of-pocket expenses ranging from $0-$700.
What tier of private health insurance covers cataract surgery?
In Australia, cataract surgery generally falls under the gold-tier health cover. Some silver plus policies might offer coverage as well. Be cautious with lower-tier policies; they might only offer restricted cover, leaving you with a higher bill to foot yourself.
What exactly is cataract surgery?
If you’re struggling with cloudy vision, it might be time to consider cataract surgery. This is when the lens of your eye gets a bit foggy. The procedure involves swapping out that cloudy lens with a new artificial lens or intraocular lens. Your ophthalmologist is the one who completes the surgery.
Is cataract surgery a day surgery?
Most times, yes! Cataract surgery is often considered a day surgery, meaning you’re not staying in the hospital overnight. You’ll likely be under sedation during the procedure and can head home once the effects wear off.
What other eye conditions should I be aware of?
Cataracts might be what you’re dealing with now, but it’s good to know about other conditions like astigmatism and glaucoma. Some health insurance providers cover these conditions as well, so keep that in mind when choosing your policy.