Health insurance for cosmetic surgery

Cosmetic surgery isn't covered by health insurance, but medically necessary plastic surgery is.

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Medicare and health insurance won't pay for cosmetic surgery because it's not medically necessary — for example, surgery intended to improve a person's aesthetic appearance. However, you can get insured for reconstructive surgery that corrects abnormalities and repairs bodily function. You'll find it included in a bronze-level health insurance policy or above.

Which health funds cover medically necessary plastic surgery?

Here's a sample of policies from Finder partners that include private cover for plastic surgery. All the prices listed are based on a single policy.

ProviderPolicy NameTreatments includedPriceApply
Silver Hospital
  • Burns requiring a graft
  • Cleft palate
  • Club foot
  • Angioma
$118.52Go to Site
Silver Everyday Hospital Plus
  • Burns requiring a graft
  • Cleft palate
  • Club foot
  • Angioma
HCF health insuranceHospital Bronze Plus
  • Burns requiring a graft
  • Cleft palate
  • Club foot
  • Angioma
ahm logoCore Bronze Plus
  • Burns requiring a graft
  • Cleft palate
  • Club foot
  • Angioma
$107.45Go to Site
nib helath insurance logoSilver Hospital
  • Burns requiring a graft
  • Cleft palate
  • Club foot
  • Angioma
$121.49More info

Quotes are based on single person living in Sydney earning less than $90,000 per year. Quotes include a $500 excess.

How does health insurance cover reconstructive and cosmetic surgery?

Plastic surgery can be split into two categories:

Reconstructive surgery is performed to correct abnormalities, whether they're congenital or acquired, and repair damage as a result of trauma.

  • It's covered by Medicare and health insurance because it's considered medically necessary.

Cosmetic surgery is typically carried out to improve appearance rather than health. For example, facelifts, implants, eyelid surgery and liposuction.

  • It's not covered by Medicare or health insurance because it's not considered medically necessary.

What plastic surgery procedures does private health insurance cover?

If you need to undergo reconstructive plastic surgery, you can get cover for the following types of procedures:

  • Surgeries on congenital abnormalities. A condition that exists at or before birth, such as a cleft palate or a nasal deformity that results in breathing difficulties.
  • Surgeries following burns. Skin grafts, reduction of skin tightening and treatment of scarring.
  • Surgeries following traumatic injuries. Facial bone fractures and breaks that need to be repaired or reset.
  • Surgeries following the removal of cancers or tumours. Breast reconstruction following a mastectomy and skin grafts following the removal of a tumour.
  • Surgeries to repair scars. Lacerations or scarring.

Get health insurance for plastic surgery: compare from 30+ policies

Use this free tool to see more options from Australian health funds. On the results screen simply tick 'Refine Search' then head to Hospital Cover and select 'medically necessary plastic surgery' to see a side by side comparison.

Do I need health insurance for plastic surgery?

It's impossible to predict what the future holds and what sort of medical treatment you may require. If reconstructive plastic surgery is excluded from your cover, you could be hit with significant out-of-pocket costs should you ever need treatment.

You can also get health insurance for plastic surgery with some bronze plus policies. These only cost around $95 a month. If you want peace of mind, it may be worth switching to a policy that covers you.

Picture: Shutterstock

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2 Responses

    Default Gravatar
    KarrenMarch 20, 2018

    Query: re:Breast reduction surgery when medically needed for health reasons, how does this work regarding costs? I have HAD hospital cover?

      Avatarfinder Customer Care
      JhezMarch 21, 2018Staff

      Hi Karren,

      Thank you for your comment.

      Generally, health insurance covers surgical and accommodation costs under the hospital cover policy if the breast reduction surgery is medically necessary and not only for cosmetic purposes. You may learn more on how insurance cover breast reduction surgery. To compare the policies, you may fill out the form on the page provided and click the “Search Policies” button. Once done, you’ll see the quotes from different health insurance providers with a list of detailed benefits.

      Please make sure to read the eligibility criteria, features, and details of the policy, as well as the relevant Product Disclosure Statement PDS/T&C’s of the policy before making a decision and consider whether the product is right for you. If necessary, speak to the insurance brand to verify any details.


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