How does health insurance cover brain surgery?

Brain surgery is covered by all bronze tier health insurance policies — compare 30+ policies from $86 per month.

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The thought of brain surgery can be really stressful and overwhelming. Fortunately, both Medicare and private health insurance can help with brain surgery costs. Australia's public health system can partially cover you and private health insurance can chip in as well. A bronze tier hospital policy costs around $86 a month plus can give you the freedom to choose your own doctor and get your own bed.

Compare health insurance quotes for brain surgery and treatment

Name Product Stroke Brain or spinal cord tumours Head injury Epilepsy Price Per Month Hide CompareBox Apply
ahm starter bronze
$86.10
Medibank Bronze Everyday
$86.25
Qantas Bronze Hospital Plus
$87.45
Frank Private Hospital (Bronze)
$89.60
HBF Gold Hospital
$159.30
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How can I pay for brain surgery?

Both Medicare and private health insurance can contribute towards the cost of brain surgery.

Public system

Medicare

Medicare can cover 100% of many of the MBS fees associated with brain surgery if you are treated as a public patient in a public hospital. Keep in mind though that if any healthcare provider charges more than the MBS fee, as they often do, you'll have to pay for it yourself.

Surgical Extraction

Private health insurance

You can get private health insurance for brain and nervous treatment with all bronze tier hospital policies. This can cover you for care in a private hospital and can include investigation and treatment of the brain, chemotherapy, immunotherapy for cancer and more. Costs generally range from around $85 a month.

How does medicare cover brain surgery and treatment?

Medicare will usually cover the cost of staying and being treated as a public patient in a public hospital. You generally won't be able to choose your own doctor or choose when you want to undergo brain treatment or surgery. This is largely because public waiting times are normally longer as they're busier, so you don't have the same flexibility as you would with private health care.

Medicare will also pay a benefit towards seeing a specialist, such as a neurosurgeon. The neurosurgical consultation structure consists of an initial consultation (Medicare Benefits Schedule no. 6007) and four categories of subsequent consultations. These categories relate to both the length of consultation time and the complexity of what is being discussed. Here's a break down of some of the prices (correct as of 7th September 2021):

  • Level 1. 6009 - Fee: $45.40 Benefit: 75% = $34.05, 85% = $38.60
  • Level 2. 6011 - Fee: $90.35 Benefit: 75% = $67.80, 85% = $76.80
  • Level 3. 6013 - Fee: $125.15 Benefit: 75% = $93.90, 85% = $106.40
  • Level 4. 6015 - Fee: $159.35 Benefit: 75% = $119.55, 85% = $135.45

Medicare also provides cover for deep brain stimulation, which is sometimes required for Parkinson's disease or for treating tremors or dystonia. Because there are so many different types of brain treatment, you should consult your local Medicare office to find out exactly what you're covered for.

How does private health insurance cover treatment?

You can get private health insurance for brain and nervous treatment with all bronze tier hospital policies. Costs generally range from around $85 a month and includes cover for:

  • Investigation and treatment of the brain
  • Brain-related conditions
  • Spinal cord and peripheral nervous system
  • Chemotherapy, radiotherapy and immunotherapy for cancer (these come under a separate service but are also included in all bronze policies)

You will generally have to serve a waiting period of 2 months (12 months for pre-existing conditions) before you can claim though you will get to choose the doctor of your choice and treatment is generally very quick.

Compare health insurance options side-by-side

Ready to compare? Simply pop your details in and hit search policies. To make sure brain treatment is covered, you can select brain and nervous system (and chemotherapy, if you also want that included) from the side bar, which will filter your options.

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