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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.
We update our data regularly, but information can change between updates. Confirm details with the provider you're interested in before making a decision.
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 type
Cost (out-of-pocket)
Details
Public hospital under Medicare
Free.
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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Frequently asked questions
Cataracts surgery is covered in all gold-tier health insurance policies, as well as some silver plus-tier 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 to pay.
You might have some out-of-pocket expenses for cataract surgery with both public and private healthcare. With Medicare, the Medical Benefits Schedule (MBS) codes for cataract surgery are 42701 and 42702 and the MBS fee is $337 and $772.80 respectively. Keep in mind that you will probably have out-of-pocket expenses if you are treated in a private hospital. Your doctor is also under no obligation to adhere to the MBS fee which means you would have to pay the difference. With private health insurance, you may have some out-of-pocket costs depending on your excess, the lenses you choose and surgeon costs. However, most gold tier policies provide comprehensive coverage which should keep costs to a minimum. Either way, make sure you consult your ophthalmologist about any additional charges before surgery.
Cataract surgery is performed by an ophthalmologist. You usually don't need to stay overnight in the hospital after surgery. It's usually done using ultrasound energy or laser-assisted technology to remove the cloudy lens. The eye doctor will give you an artificial lens which becomes a permanent part of your eye; you won't notice it at all after surgery. The lens improves your vision by focusing light on the back of your eye.
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 usually takes between 10 and 30 minutes per eye. You will usually receive local anesthetic so you won't feel anything when the ophthalmologist performs the surgery. Unless factors such as your age or health condition mean that you require extra attention, you should be able to leave the hospital the same day.
Gary Hunter is a writer at Finder, specialising in insurance. He’s been writing about life, health, travel, home and pet insurance for over three years, has pored over hundreds of product disclosure statements and written more than 500 insurance articles. Gary holds a Tier 1 General Insurance (General Advice) certification and is passionate about helping Aussies understand their policies so that they can get better value for their money.
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