Medically necessary cataract surgery is covered by Medicare, but waiting times typically exceed 150 days.
Private health insurance that covers cataract surgery
Below are some policies from Finder partners that cover cataract surgery.
Cataract surgery is covered under some silver plus and all gold-tier policies. All have a 2-month waiting period before you can claim or 12 months if it is a pre-existing condition.
We update our data regularly, but information can change between updates. Confirm details with the provider you're interested in before making a decision.
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How much is cataract surgery?
The cost of cataract surgery depends on whether you use the public or private system and whether you have private health insurance. The table below contains the key details.
Cover type
Cost (out-of-pocket)
Details
Public hospital under Medicare
Free
Waiting lists for surgery in a public hospital can be long, typically 158 days (5+ months). You may need to pay extra for premium lenses.
Private hospital without cover
$1,700 – $4,000+ per eye
Waiting period for surgery depends on surgeon availability. In many cases, the procedure can be performed immediately. You may also need to pay for specialist consultations.
Private hospital cover
$700
A 2-month waiting period before you can claim or 12 months with a pre-existing condition. The waiting period for surgery depends on surgeon availability. The out-of-pocket costs vary based on your fund and surgeon.
How does Medicare cover cataract surgery?
Cataract surgery is covered by Medicare, which means that public patients will have to pay nothing if they undergo the procedure in a public hospital. You will have to pay for the lenses if you want access to premium lenses not covered by Medicare.
The average waiting time for cataract extraction was 158 days in 2021–2022, according to data from the Australian Institute of Health and Welfare. 10.6% of people waited over a year for surgery. Australians in NSW and NT are likely to wait even longer, with median waits at 278 and 200 days respectively.
If you live in a state with a long waiting period or your vision is seriously affected, you might consider comparing private health insurance for shorter waiting times.
42702
This is the Medical Benefits Schedule (MBS) item number typically used for cataract surgery – to remove the lens from an eye because it is no longer clear. It is replaced by an artificial lens so the person can continue to see.
How does private insurance cover cataract surgery?
You can get private health insurance for cataract surgery with all gold-tier hospital policies and some silver plus policies.
Waiting periods vary depending on the surgeon but generally, it can be performed immediately. Unlike the public system, you will be able to choose your specialist as well as when and where you have the surgery done.
Costs generally range from $35 to $40 per week for gold-tier health insurance. This covers you for all 38 clinical categories.
Gold-tier policies are tailored to people with chronic illnesses and the elderly. They include lots of other services such as joint replacement and insulin pumps. Keep in mind that 12 waiting periods apply for pre-existing conditions.
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Frequently asked questions
Yes, private health insurance can pay for most or sometimes all of the costs of cataract surgery. Out-of-pocket expenses range from $0–$700.
Cataracts surgery is covered in all gold-tier health insurance policies as well as some silver plus policies. There are a few products on the market that offer restricted cover for cataract surgery on lower tiers, but this will not cover the full cost of private treatment and could leave you with significant out-of-pocket costs.
You might have some out-of-pocket expenses for cataract surgery with private healthcare. The MBS codes for cataract surgery are 42701 and 42702 and the MBS fee is $350 and $804 respectively.
You may have out-of-pocket expenses if you are treated in a private hospital or receive any specialist appointments. This is because private doctors are under no obligation to adhere to the MBS fee, so you may have to pay the difference. Make sure you consult your ophthalmologist about charges before surgery.
While you might be able to find the best health insurance policy for some treatments, there is no policy that really stands out for cataracts. Your best bet is to compare health insurance policies that cover cataracts, then simply pick one that suits your budget, from a health fund that you like.
Cataract surgery is necessary to treat cataracts that are significantly affecting a person's eyesight and quality of life. Ordinarily, the lens of your eye is clear but the cataract causes it to become cloudy, which affects your vision. The procedure involves removing the lens of the eye and replacing it with an artificial one. Surgery is performed by an eye doctor (ophthalmologist) and is both common and safe.
Cataract extraction was the most common surgical procedure in 2021–2022 with over 58,186 patients receiving the operation through Medicare. The procedure is either performed on both or 1 eye at a time, giving patients a few weeks for recovery in between procedures.
Older people are more prone to problems with cataracts. Australian citizens are able to get Medicare treatment at any age, but it may be worth considering private health insurance for seniors if you're over 60 and want private treatment. With a gold policy, you'll also be covered for other treatments associated with age, including joint replacement, hip replacement and varicose vein treatment.
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, news.com.au, The Telegraph, Explore Travel and Escape. Gary holds a Kaplan Tier 1 General Insurance (General Advice) certification and a Kaplan Tier 1 Generic Knowledge certification which meets the requirements of ASIC Regulatory Guide 146 (RG146).
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