Health insurance for cataract surgery

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

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Cataract surgery is extremely common and is covered by Medicare. However, waiting times for surgery tend to be long, sometimes more than a year. Private health insurance can give you access to cataract surgery sooner, with the right coverage.

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 private health insurance policies that cover cataract surgery. The hospital level is Silver, which is Mid-tier hospital coverage that includes at least 26 services. All prices are based on a single living in Sydney, earning less than $90,000 with a $500 hospital excess.

Name Product Cataract Surgery Artificial lens surgery Price Per Month Hide CompareBox Apply
Frank Basic Hospital 500 (Basic+)
ahm deluxe silver plus
Qantas Silver Plus Hospital
HBF Gold Hospital
HCF Hospital Silver Plus

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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 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 level 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.

How do out-of-pocket costs work for cataract surgery?

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.

How is cataract surgery done?

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.

How long does cataract surgery take?

Cataract surgery usually takes between 10 and 30 minutes per eye. You will usually receive local anaesthetic 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.

Cataract surgery recovery and side effects

After surgery, your vision should improve within a few days but it usually takes between four and six weeks for your vision to fully recover. It's normal for your vision to be blurry at first and to feel mild discomfort and itchiness. Avoid rubbing or applying pressure on your eye. Your doctor should also give you eye drops to prevent any infection from occurring.

Cataract surgery is really common so side effects are rare. However, the following complications can occur. If they do, see a doctor immediately.

  • Eye swelling
  • Eye infection
  • Bleeding
  • Feeling of pressure behind or inside your eye
  • Loosening of artificial lens
  • Build-up of fluid in your eye
  • Retinal detachment

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