Health insurance for hernia surgery

Hernias are common in Australia. Here are you public and private options.

A hernia is painful and can be very serious if left untreated for too long.

Luckily, waiting time with private health insurance (PHI) is on average just a few weeks. Getting cover for hernia surgery is also surprisingly easy and affordable: if you already have private hospital cover, you may already be covered.

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.

How to claim the Medicare rebate

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 does PHI cover 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, a PHI policy gives you a 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, 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 do different insurers offer for hernia repair surgery?

Below are some examples from Finder 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.

Provider Tier Price per month Apply

starter bronze

Bronze $86.80 Go to site

Hospital Bronze Plus

Bronze $91.60 Go to site

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

What is the cost of hernia surgery?

The average cost of hernia surgery ranges from $2,430 to $9,933. It's vital then that you have some form of cover or risk paying a considerable amount of money, not to mention the potential losses from time off work.

How to work out your own estimate

There are a number of things you can do to work out your estimate:

  • 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.

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.

Compare more options for hospital cover

Looking to do a bit more research? Simply enter your details below to see side-by-side options from more health funds in Australia.

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