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Health insurance for cataract surgery

Cataract surgery: Compare costs, waiting times and out-of-pocket expenses

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What you need to know

  • Cataract surgery is covered under Gold-tier health cover, available from $40 per week.
  • Without insurance, private cataract surgery can cost from $1,600 to $3,000+ per eye.
  • Medically necessary cataract surgery is covered by Medicare, but waiting periods can be long.

What is cataract surgery?

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 2017-18 with over 70,000 patients receiving the operation through Medicare. The procedure is either performed on both eyes or one eye at a time, giving patients a few weeks for recovery in between procedures.

Private health insurance that covers cataract surgery

Below are some policies from Finder partners that cover cataract surgery. Cataract surgery is covered under all gold-tier policies and some silver plus-tier policies. All have a 2-month waiting period before you can claim, or 12 months if it is a pre-existing condition.

1 - 10 of 34
Name Product Treatments Price Apply
deluxe silver plus
Silver Plus$750 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$153.20
per month
Medibank Silver Plus Security
Silver Plus$750 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$157.12
per month
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$158.13
per month
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$160.07
per month
deluxe silver plus
Silver Plus$500 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$160.25
per month
Silver Plus Hospital $750/$1500
Silver Plus$750 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +25 other treatments covered
$162.43
per month
Medibank Silver Plus Security
Silver Plus$500 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$164.92
per month
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +26 other treatments covered
$166.28
per month
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$166.37
per month
Silver Plus Hospital $750
Silver Plus$750 excess
  • Lung and chest
  • Back neck and spine
  • Cataracts
  • Joint replacements
  • Blood
  • Dental surgery
  • Palliative care
  • Pregnancy and birth
  • +27 other treatments covered
$167.59
per month
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Compare up to 4 providers

All prices are based on a single individual with less than $90,000 income and living in Sydney.

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 typeCost (out-of-pocket)Details
Public hospital under MedicareFree.Waiting lists for surgery in a public hospital can be long, often 6 to 18 months. You may need to pay extras for premium lenses.
Private hospital without cover$1,600 - $3,000+ per eye.Waiting period for surgery depends on surgeon availability. In many cases, the procedure can be performed immediately.
Private hospital cover$400 - $2,500+, plus your policy excess.2-month waiting period before you can claim, or 12 months with a pre-existing condition. The waiting period for surgery will depend on surgeon availability. Out-of-pocket cost will vary based on your fund, surgeon, and excess.

How does Medicare cover cataract surgery?

Cataract surgery is covered by Medicare, which means that public patients will have to pay little or 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.

According to 2017-18 data by the Australian Institute of Health and Welfare, the average waiting time for cataract extraction was 86 days with a small percentage waiting over a year for surgery. However, those in NSW and Tasmania are likely to wait much longer, with median waits at 223 and 146 days respectively. If both eyes require surgery, there's also generally a gap of up to 3 months between surgery on each eye.

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.

How does private insurance cover cataract surgery?

You can get private health insurance for cataract surgery with all gold tier hospital policies, you can also sometimes find it in silver plus policies. Waiting periods will vary depending on the surgeon but generally, it can be performed immediately. Unlike the public system, you will be able to choose who your specialist is 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 and cover you for all 38 clinical categories for ultimate peace of mind. Gold tier policies are tailored specifically to those with chronic illnesses and the elderly so they include lots of other services like joint replacement and insulin pumps as well. Keep in mind that waiting periods apply, including 12 months for pre-existing conditions.

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