Tonsil checkup

Health insurance for tonsil and adenoid removal

Does health insurance cover the cost of the removal of tonsils and adenoids?

The removal of your tonsils and adenoid glands is included in most private health insurers’ basic policies. These procedures are included in basic private health insurance plans and you don’t need to pay for extras to be covered for a tonsillectomy or adenoidectomy.

Compare extras policies that cover tonsil and adenoid removal

Which Australian health insurers cover tonsil and adenoid removal?

Health fundHospital policies that cover tonsils and adenoids Waiting periods
HIF health insurance
    • GoldStar Hospital
    • Gold Hospital
    • GoldSaver Hospital
      • GoldStarter Hospital
      • GoldVital Hospital
  • 2 months
health.com.au health insurance
  • High Hospital
  • HeartCare Hospital
  • Basic Hospital
  • Simple Essentials 60
  • 2 months
teachers health fund
  • Restricted health fund
  • Top Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months
CBHS Health Fund
  • Restricted health fund
  • Comprehensive Hospital
  • Active Hospital
  • Limited Hospital
    • Basic Hospital
  • 2 months
AHM health insurance
  • Top Hospital
  • White Deluxe
  • White Classic
  • White Lite
  • 2 months
Australian Unity
  • Platinum Hospital
  • Gold Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months
GMHBA health fund
  • Gold Hospital
  • Silver Hospital
  • Bronze Hospital
  • 2 months
HCF health insurance
  • Premium Hospital
  • Mid Plus Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months
nib health insurance
  • Top Hospital
  • Advantage Hospital
  • Standard Hospital
  • Basic Hospital
  • 2 months
Transport Health insurance
  • Top Hospital Cover
  • Healthy Choice Hospital Cover
  • Basic Hospital Cover
  • 2 months
Health fundHospital policies that cover tonsils and adenoids Waiting periods
ahm
  • Top Hospital
  • White Deluxe
  • White Classic
  • White Lite
  • 2 months
Australian Unity
  • Platinum Hospital
  • Gold Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months
Budget Direct
  • Top Hospital
  • Mid Hospital
  • Public Hospital
  • 2 months
Bupa
  • Top Hospital
  • Standard Hospital
  • Budget Hospital
  • 2 months
CUA Health
  • Premium Hospital
  • Premium Hospital - Non-obstetrics
  • Standard Hospital
  • Basic Hospital
  • 2 months
Frank Health Insurance
  • Best Hospital
  • Better Hospital
  • Basic Hospital (Some Private)
  • Basic Hospital
  • 2 months
GMF
  • Complete Hospital Cover
  • Mid Hospital Cover
  • Lite Hospital Cover
  • 2 months
GMHBA
  • Gold Hospital
  • Silver Hospital
  • Bronze Hospital
  • 2 months
HBF
  • Top Hospital
  • Mid Family Hospital
  • Saver Hospital
  • 2 months
HCF
  • Premium Hospital
  • Mid Plus Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months
health.com.au
  • High Hospital
  • HeartCare Hospital
  • Basic Hospital
  • Simple Essentials 60
  • 2 months
hif
    • GoldStar Hospital
    • Gold Hospital
    • GoldSaver Hospital
      • GoldStarter Hospital
      • GoldVital Hospital
  • 2 months
Latrobe Health Services
  • Top Hospital
  • 2 months
Medibank
  • Top Hospital
  • Top Hospital Essentials
  • Standard Hospital
  • Basic Hospital
  • Hospital Essentials
  • 2 months
nib
  • Top Hospital
  • Advantage Hospital
  • Standard Hospital
  • Basic Hospital
  • 2 months
Phoenix Health Fund
  • Top Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months
Queensland Country Health Fund
  • Top Hospital
  • Intermediate Hospital
  • 2 months
Transport Health
  • Top Hospital Cover
  • Healthy Choice Hospital Cover
  • Basic Hospital Cover
  • 2 months
CBHS health fund
  • Restricted health fund
  • Comprehensive Hospital
  • Active Hospital
  • Limited Hospital
  • Basic Hospital
  • 2 months
Defence Health
  • Restricted health fund
  • Premier Hospital
  • Value Hospital
  • Essentials Hospital
  • 2 months
Navy Health
  • Restricted health fund
  • Premium Hospital
  • Healthy Hospital
  • Saver Hospital
  • 2 months
Teachers Health Fund
  • Restricted health fund
  • Top Hospital
  • Mid Hospital
  • Basic Hospital
  • 2 months

Does Medicare cover tonsillectomy and adenoidectomy or do you need health insurance?

A tonsillectomy or adenoidectomy can be performed at a public or private hospital. However, the cost, waiting times and extra benefits will differ depending on which system you are treated under.

  • Public health system. While you can elect to have the surgery performed at a public hospital where the procedure will be covered by Medicare, waiting times can be as long as years and many patients don’t have the luxury of time.
  • Private health system. Using the services of a private ear, nose and throat specialist (ENT) is quicker. However, the out of pocket expenses can run into the thousands of dollars if you’re not insured. Private hospital cover gives you the option of choosing the doctor you want as well as having the surgery performed when you want.

Who can benefit from cover for removal of tonsils and adenoids?

The removal of tonsils and adenoids is a common procedure for children to have done, which makes having private health cover important for families. However, it’s not just children who have their tonsils removed, so it’s something to think about even as you get older.

Surgery to remove the tonsils and adenoid glands is covered by Medicare, but waiting lists can make public cover an unattractive option for children. This is one of the reasons why having private health insurance is so important. Not only can private health insurance help you avoid waiting lists, it also provides you with the opportunity to choose your own doctor.

Some tonsil and adenoid treatment statistics you might find interesting

Why do people get their tonsils removed?

Tonsils can get infected, which can lead to a condition called tonsillitis. When this happens to your adenoid glands the condition is called adenoiditis. The two conditions are related and adenoiditis can lead to tonsillitis and vice versa. Recurring infections of the tonsils and adenoids need to be treated by a either a tonsillectomy or adenoidectomy.

The symptoms of tonsillitis and adenoiditis can include:

    • Bad breath
    • Nausea
    • Fever
      • Ear infections
      • Swelling of the tonsils and adenoids
Although the tonsils and the adenoids are one of the first layers of defense against external sources of infection, they’re not the last. Your body can function quite well without your tonsils and adenoids, and removal of the lymphatic tissue is a common enough procedure, especially among young children.

What is an ENT doctor and how do you choose one?

  • An ENT doctor is someone that specialises in ear, nose and throat (ENT). These doctors are also known as Otolaryngologists.
  • Tonsillectomy and adenoidectomy procedures are typically performed by an ENT specialist and take about an hour to complete. Patients are required to stay overnight in hospital.
  • You will need to see a general practitioner (GP) to get a referral to an ENT. Your GP may be able to recommend a preferred or trusted specialist, but you can also choose your own.
  • Your insurer may be able to provide a list of ENT specialists who have a relationship or agreement with your fund. You can also check the registry of the Australasian College of Surgeons to find a doctor in your area.

Questions to ask you ENT specialist and insurer

The following questions will help you find a ENT specialist and prepare for a tonsillectomy or adenoidectomy procedure.

Questions to ask your insurer

Questions to ask your ENT specialist

    • What are the costs for initial consultations, the procedure and follow up consultation(s)? (You will be given a list of the expenses you will incur and you’re required to provide consent to these charges.)
    • What’s the best way to prepare for the procedure?
    • What’s the best way to recover from tonsillectomy or adenoidectomy surgery?

Compare health insurance for tonsil and adenoid removal and request a quote

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