Health insurance for hernia surgery

A hernia can be painful and expensive if left untreated. Luckily, Medicare and private health insurance both cover hernia surgery. Private cover also lets you minimise your waiting time for treatment, reducing the chance of complications.

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How much does hernia surgery cost?

The average cost of hernia surgery ranges from around $2,400 to $10,000. Medicare will cover some of this in a public hospital, while private health insurance can cover the cost of hernia surgery in a private hospital. Private hospital coverage can also get you treated sooner, minimising potential losses from time off work.

There are a number of things you can do to estimate the cost of your own hernia surgery:

  • Find out what your surgeon's costs are.
  • Find out the cost of any post-surgery extras like pain medication.
  • Be aware of hidden out-of-pocket expenses. X-rays and anaesthesia can cost a lot.
  • Ask for the Medicare code.
  • Call your insurer and give it your Medicare details.
  • Find out your doctor's estimated rebate.

Health insurance that covers hernia surgery

Below are some policies from Finder partners that cover hernia surgery. All quotes are based on a single hospital policy in Sydney with a $500 excess. All include a 2 month waiting period for new conditions, and 12 months for pre-existing.

Name Product Hernia Treatment Excess Price Per Month Hide CompareBox Apply
Frank Entry Hospital (Basic+)
HBF Basic Hospital Plus
ahm essentials basic plus
Qantas Basic Hospital
Medibank Basic Plus Healthy Start
Peoplecare Basic Plus Hospital
HCF Hospital Bronze Plus

Compare up to 4 providers

Quotes are based on less than $90,000 income.

What are the symptoms of a hernia?

The symptoms of a hernia can vary depending on the location. However, signs that you may have a hernia include:

  • A visible lump or swollen area
  • A heavy or uncomfortable feeling in your stomach, especially when bending over
  • Pain or aching, particularly if you're lifting or carrying something heavy
  • An unsettled stomach or constipation
  • The lump disappears when you're lying down
  • The lump enlarges when you cough, stand up or strain

When might you need hernia surgery?

Hernias don't go away on their own; they always require surgery. The longer you have a hernia the higher the risk of developing more serious complications. If they're left untreated, you risk needing an emergency surgical procedure.

How does Medicare cover hernia repairs?

If you have access to Medicare, it will cover hernia repairs for a small fee, as long as you use a public hospital. However, the waiting list can be up to twice as long as for private. Because a hernia can rupture if left untreated, it's advisable you get it seen to sooner rather than later. While surgery is probably cheaper with Medicare, the long waiting period puts your health at risk.

You can claim your Medicare rebate using your Medicare online account. The best way to access this is through myGov. Medicare will only cover up to 75% of the cost, so there will still be some out-of-pocket expenses.

Public vs private waiting list for hernia surgery

  • Public: 56 days
  • Private: 25 days

Source: Australian Institute of Health and Welfare (AIHW) Private health insurance use in Australian hospitals 2006–07 to 2016–17

How can health insurance help with hernia surgery?

Hernia surgery is classified by most insurers as general surgery. You can find a policy that will include hernia surgery in a basic- to mid-level hospital cover. If you do decide to go private, you shouldn't expect to be out of pocket more than $700 depending on the procedure.

While it costs a little more, having a health insurance policy means you will have greater control over the situation. For many, having access to your own doctor and hospital allows you to relax, knowing you're in good hands. There's also no lengthy surgery queue if you go private. Not only does this reduce the likelihood of complications developing, but it also lets you get back to work sooner.

If you're new to health insurance you may have a one-off 12-month waiting period.

What does a hernia operation involve?

The most common place for a hernia to develop is the groin. If the lump can be gently pushed back through the abdominal wall, it's known as a reducible hernia. If the lump resists any form of pressure, it's a non-reducible hernia. Both require surgery.

The damaged spot in the muscle wall (where a hernia has come through) is repaired by stitching together the edges of the healthy muscle tissue. However, surgical procedures vary depending on the area of muscle wall in need of repair. For instance, special mesh patches are used to repair larger hernias that need to be reinforced.

How long is the recovery time for a hernia?

Most people who have surgery are able to go home the same day, so you shouldn't have to spend much time in hospital. Recovery time is around three to four weeks.

You can most likely return to light activity after three weeks, though you shouldn't exercise vigorously until around the six-week mark, depending on how you're feeling.

Don't do anything that causes you pain, especially bending over or lifting heavy objects. Remember to rest as much as possible and sit or lie comfortably for the first few weeks.

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