Medicare can fully cover appendix surgery as long as you receive treatment in a hospital. If you want to choose your own doctor, hospital and potentially get treated quicker, you might be better with health insurance. Appendix treatment is available with most policies for as little as $72 per month.
Appendicitis surgery cost in Australia
If you're treated as a public patient in a public hospital, appendicitis surgery is generally free in Australia.
However, you'll have some out of pocket expenses if you get treated in a private hospital and don't have health insurance. For example, the fee listed on the Medicare Benefits Schedule for an appendicectomy is $463.50. As Medicare covers 75% or $347.65 of the scheduled fee, you'll need to pay the remaining 25% of the fee yourself — that's $115.85.
It's extremely unlikely to be that cheap though as doctors often charge much more than the MBS fee. You will also need to consider anaesthetist, assistant and diagnostic fees.
Compare health insurance for appendix removal
You'll find health insurance for appendix removal in all bronze level health insurance policies, but a handful of basic policies can cover you as well. We've listed them below alongside costs. Keep in mind that you'll have a 2 month waiting period for new conditions or 12 months for pre-existing ailments. All prices are based on a single individual with less than $93,000 income and living in Sydney.
Finder survey: How many Australians of different ages made a hospital claim for any of these conditions?
Response
75+ yrs
65-74 yrs
55-64 yrs
45-54 yrs
35-44 yrs
25-34 yrs
18-24 yrs
Cataracts
27.27%
8.72%
3.11%
0.59%
0.54%
2.35%
Joint replacements
18.18%
3.49%
1.86%
1.18%
0.54%
1.05%
1.18%
Dental surgery
11.36%
4.07%
4.97%
3.55%
3.78%
3.16%
7.06%
Gastrointestinal endoscopy
11.36%
9.3%
7.45%
2.96%
5.41%
2.63%
Heart and vascular system
11.36%
7.56%
5.59%
0.59%
2.7%
1.05%
Hernia and appendix
11.36%
2.91%
4.35%
2.96%
2.16%
1.58%
Eye surgery (not cataracts)
9.09%
4.65%
2.48%
1.08%
1.58%
3.53%
Pregnancy and birth
9.09%
2.91%
3.73%
6.51%
5.41%
3.68%
Bone joint and muscle
6.82%
5.23%
4.97%
2.37%
2.7%
2.11%
1.18%
Cancer treatment
6.82%
7.56%
1.86%
0.59%
1.62%
1.58%
Gynaecology
6.82%
4.65%
5.59%
7.1%
4.86%
3.16%
I've never made a hospital claim
6.82%
8.14%
14.91%
19.53%
24.32%
28.42%
27.06%
Joint reconstructions
6.82%
2.91%
2.48%
0.54%
1.05%
Rehabilitation
6.82%
1.74%
1.86%
3.78%
3.16%
1.18%
Brain and nervous system
4.55%
0.58%
0.62%
0.59%
1.08%
0.53%
1.18%
Breast surgery
4.55%
1.74%
0.54%
1.58%
Lung and chest
4.55%
0.58%
1.24%
2.37%
0.54%
0.53%
Skin
4.55%
2.33%
1.86%
1.78%
1.62%
2.11%
1.18%
Sleep studies
4.55%
4.65%
1.24%
0.59%
1.08%
Back neck and spine
2.27%
1.74%
3.11%
1.18%
2.16%
Blood
2.27%
1.86%
1.18%
1.08%
1.18%
Ear nose and throat
2.27%
4.65%
6.21%
1.78%
3.78%
3.68%
3.53%
Other
2.27%
2.91%
4.97%
5.92%
5.41%
5.79%
3.53%
Pain management
2.27%
1.16%
2.48%
2.37%
2.7%
1.05%
1.18%
Tonsils, adenoids and grommets
2.27%
1.16%
0.62%
1.18%
3.78%
3.16%
1.18%
Weight loss surgery
2.27%
1.24%
1.78%
1.08%
1.18%
Digestive system
2.91%
3.11%
1.78%
1.08%
2.11%
1.18%
Male reproductive system
2.33%
1.24%
1.18%
0.54%
1.58%
Diabetes management
1.16%
0.54%
0.53%
Kidney and bladder
1.16%
1.24%
1.18%
1.62%
0.53%
Podiatric surgery
1.16%
1.24%
0.59%
0.53%
Plastic or reconstructive surgery
0.58%
1.86%
1.05%
Hospital psychiatric services
1.86%
0.59%
4.32%
0.53%
1.18%
Miscarriage
1.24%
1.78%
1.62%
Dialysis for chronic kidney failure
0.62%
0.53%
Assisted reproductive services
1.78%
1.62%
1.05%
Pain management with device
0.59%
2.16%
1.58%
Palliative care
0.59%
1.62%
1.18%
Source: Finder survey by Pure Profile of 1006 Australians, December 2023
Does Medicare cover appendix surgery?
Yes. If you're treated as a public patient in a public hospital, Medicare can cover 100% of appendix surgery expenses. Remember though, as a public patient, you generally won't be able to choose your own doctor or the day that you're admitted to hospital and receive surgery.
If you receive treatment as a public in a private hospital, the Medicare Benefits Schedule Fee (30720) for an appendicectomy is $463.50, of which Medicare covers 75%. However, doctors aren't obligated to stick to the MBS fee, so you might have to pay considerably more than the 25% if they do charge more.
How does health insurance cover appendix surgery?
You'll find appendix removal covered with all bronze tier health insurance policies under hernia and appendix. With private health insurance, you can choose your own doctor, hospital and in many cases, you'll get treated much quicker. If you already have health insurance, chances are you've already served the waiting period as it's included in most policies.
The majority of insurers cover the cost of surgical and theatre fees, as well as for any medicine you receive whilst in hospital. It will also generally cover the cost of accommodation in a private hospital or bed.
There may be some out of pocket expenses if you don't have some form of gap cover. To have a good indication of any out of pocket expenses, you should find out the price of the following:
Principal surgeon
Anaesthetist
Assistants
Diagnostics for example x-rays, lab tests and medical imaging
AHM hospital cover policies cover the surgical removal of your appendix if you have appendicitis and need hospital treatment except for Starter Basic Hospital cover. This includes all agreed hospital charges in a partner private hospital in a shared or private room. In a public hospital, AHM will cover accommodation charges for a shared room and pay benefits towards the cost of a private room. A 12-month waiting period applies for pre-existing conditions, but this is shortened to two months in all other cases.
If you require appendix removal, hospital cover from Australian Unity covers hospital accommodation costs, theatre fees, in-hospital pharmaceuticals and more . A two-month waiting period applies.
GMHBA Hospital Cover includes cover for theatre fees, doctor's fees and accommodation in a public or private hospital when you need to have your appendix removed except for Basic Plus (Restricted). Pharmaceuticals you receive as an inpatient are also covered. A two-month waiting period applies.
HCF Hospital Cover provides cover for the cost of an appendectomy, including hospital accommodation, theatre fees, surgical fees and pharmaceuticals. Whether or not you receive treatment in a private or public hospital varies depending on the level of cover you select. A two-month waiting period applies.
If you need to have your appendix surgically removed, cover is provided by HIF's suite of health insurance policies. This includes accommodation in a private hospital or as a private patient in a public hospital, plus theatre care, surgical fees and pharmaceuticals you receive in hospital. A two-month waiting period applies.
All of Transport Health's hospital cover policies include cover for appendix removal. This includes hospital accommodation, emergency ambulance transport, theatre fees and pharmaceuticals. A two-month waiting period applies.
What will happen if appendicitis is left untreated?
If left untreated, appendicitis is a potentially life-threatening condition. With this in mind, doctors will always take a cautious approach and operate on a patient, even if a confirmed diagnosis of appendicitis has not been reached.
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Gary Ross Hunter is an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146).
Want to get health cover for grommets? Find out how private health insurance and Medicare costs compare and what you'll be covered for. Choose the option that suits you best.
Find out how private and public hospitals compare in terms of wait times and safety. Can private health insurance get you treatment where public hospitals can't?
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Australian Unity
GMHBA
HCF
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