Health insurance for grommets

Medicare and private health insurance can cover you. Here's how.

Female doctor helping male patient

Grommets are most common among children, though adults sometimes need them as well. They're usually necessary if your child gets a lot of ear infections or glue ear.

You can get cover with Medicare and private health insurance, though costs can vary massively. Read on to find out which option suits you best.

When might you need grommets in your ears?

There are a few reasons you might need grommets. These include:

If you have multiple ear infections

Multiple ear infections can often lead to your child's ear looking red and swollen. This is because, as a result of infection, the tube in the ear has difficulty getting air into it, leading to a build-up of fluid.

Ear infections can be really painful no matter what age you are. If they occur frequently, it can have an impact on your child's quality of life. In some cases, it can even lead to hearing loss.

If you have glue ear

Glue ear is a common childhood ailment that's caused when fluids build up in the middle ear. It's usually an effect of multiple ear infections or allergies. It can cause hearing loss and even affect your child's speech development.

Grommet surgery

Surgery for grommets usually takes around 15 minutes but your child will need to be placed under general anaesthetic. An operation is often necessary if your child has had glue ear for 3 months or more. It might also be recommended if a child has more than 3 ear infections in less than 6 to 12 months.

Grommets are tiny tubes which are inserted into your child's eardrum in order to help drain any excess fluid and allow air to enter into the middle ear. When a grommet is inserted, it helps restore normal hearing and relieve any discomfort and pain. Most of the time, grommets will stay in for around 6 to 12 months and usually come out on their own. You will need to get them removed by a doctor if they don't come out naturally.

Grommets in children

Because children are still growing, it means that their eustachian tubes are narrower and more horizontal than an adult's fully developed tubes. As a result, they can block more easily.

Most children have problems with their eustachian tube. The eustachian tube connects the middle ear to the back of the nose and throat. If it gets blocked by mucus or inflammation, then there is less air pressure in the middle ear than in the ear canal. This causes a build up of fluid and usually leads to glue ear.

Grommets in adults

If you still get ear infections into your adulthood, it's possible that you have a more serious issue than if you were a child. You should visit your GP and see whether or not grommets could be a solution for you. Persistent ear infections can in some cases lead to permanent hearing loss.

Be aware that you may not be covered for treatment with Medicare. According to the Medicare Benefits Schedule (MBS) item no. 45659, which involves the correction of a congenital deformity of the ear, you must be less than 18 years of age to qualify for the Medicare benefit. However, you should be covered for a simple grommet procedure in most cases.

How does health insurance cover grommets?

Both private health insurance and Medicare cover grommets but costs can vary a lot. Check out which option is best for you.

You can get cover for grommets with a bronze policy, which usually costs around or just under $20 a week. It should be covered under tonsils, adenoids and grommets and generally comes with a 2-month waiting period. However, if you've been on a family policy that included you as a child, it's likely you've already served the waiting period so you can get seen quickly.

Your health provider should be able to confirm how much they'll cover prior to grommet surgery, so you'll know what the out-of-pocket expenses will be. Depending on your excess, provider and doctor, you could be looking at around $200 to $700 for out-of-pocket expenses.

The MBS fee for grommets is currently at $238.80 per ear though the average cost for the procedure is closer to $2,000. That's because doctors don't need to stick to the MBS fee, and there are also consultation, anaesthetist, nurse and hospital fees to consider as well. It's also likely to be more expensive if your child needs grommets in both ears.

Compare options for private health insurance

Provider Policy name Treatment Excess Cost per month Apply
AHM logo ahm Essential Basic Plus Hospital treatment of the tonsils, adenoids and insertion or removal of grommets. $500.00 $72.15 Go to site
HCF Logo HCF Hospital Bronze Plus Hospital treatment of the tonsils, adenoids and insertion or removal of grommets $500.00 $91.60 Go to site

Prices are based on a single individual living in Sydney with less than 90K income.

How does public and private health care for grommets compare?

When it comes to your child, your primary concern is their health. Here are some factors worth considering when it comes to choosing between public or private health care for grommets.

Waiting times

With Medicare, waiting times for all procedures vary depending on your local public hospital's demand for grommet operations. However, grommets are generally classed as category 3 waiting times, which means it could be up to 12 months before your child is treated.

Alternatively, most private health funds have a 2-month waiting period, which may be shorter if you've already served the waiting period. Even if it costs a little more, private health insurance often gets your child seen to faster.

Out-of-pocket expenses

Because grommet treatment prices can vary massively if you go through Medicare, it's always going to be more of a gamble than with private health care. However, if you're willing to take the risk of large, out-of-pocket expenses as high as $3,000 – as well as potentially longer waiting times – then public care might be suitable for you.

Private health insurance, on the other hand, will still have some out-of-pocket costs, depending on your cover, but is generally more affordable. It also lets you choose someone you know and trust, as well as the hospital your child will be treated in.

Ear grommets side effects

The vast majority of ear grommets have no complications and very few side effects. Nevertheless, you should keep an eye out for the following:

  • Cold air and water may cause a bit of pain and discomfort after the operation.
  • Persistent discharge from the ear which may require antibiotics.
  • Sometimes a hole in the eardrum can remain once grommets have fallen out.
  • In rare cases, the body rejects the grommet and the ear can become inflamed. If this occurs, the grommet will have to be taken out.

Picture: GettyImages

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