Health insurance for hysterectomy surgery
Hysterectomy is covered under Medicare, but private treatment can cost over $12,000 without the right coverage.
Key takeaways
- Medically necessary hysterectomy is covered under Medicare, but waiting periods can stretch into several months.
- The cost of a private hysterectomy without insurance can be over $12,000.
- With private hospital insurance, average out-of-pocket costs for hysterectomy are around $500.
Cost of a hysterectomy in Australia
As a public patient in a public hospital, medically necessary hysterectomies will be fully covered by Medicare in Australia, so a hysterectomy will cost you nothing. However, the waiting period for hysterectomy can be in the months, so you may have to wait in line.
It's a different story in the private system, however. Without private cover, a hysterectomy in a private hospital can set you back over $12,000 in Australia. The cost will vary considerably depending on how complex the surgery is.
If you have private hospital cover you may still be up for a small out-of-pocket fee. According to Medical Costs Finder, the typical out of pocket cost for both vaginal and open abdominal hysterectomy is around $500-$600.
Finder survey: How many Australians have made a hospital claim related to gynaecology?
| Response | Female | Male |
|---|---|---|
| Gynaecology | 7.47% | 1.67% |
Source: Finder survey by Pure Profile of 1006 Australians, December 2023
What is a hysterectomy?
A hysterectomy involves the removal of the womb (uterus), with or without the cervix. The operation can also include the removal of the ovaries and the fallopian tubes. There are several different types of hysterectomy, including laparoscopic, abdominal, partial and total hysterectomy, all of which can vary significantly in price.
If you have a hysterectomy, you will no longer have periods and won't be able to get pregnant.
Is a hysterectomy covered by Medicare?
Hysterectomy is covered under Medicare. With Medicare, there are little to no out of pocket expenses for hysterectomy surgery if you are a registered public patient and have surgery in a public hospital. If you are treated as a private patient, in a public or private hospital, Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee for each item and your health fund pays the remaining 25%. Your surgeon and anaesthetist can charge more than the MBS fee, and that difference is your out of pocket cost.
If you decide to use the public healthcare system, it's worth noting that waiting periods for a hysterectomy can be very long; the average public hospital wait is 54 days. Depending on how quickly you need to have surgery, you may consider going private for speedier treatment.
You are also unable to choose your own doctor or consultation times. If having your own doctor will provide you with greater peace of mind or you have a busy schedule, then treatment as a private patient is probably more suited to you.
How to claim the Medicare rebate
You can claim your Medicare rebate using your Medicare online account. This can be accessed through myGov. Speak to your doctor or call a Medicare consultant if you can't access it online. If you elect to have surgery through Medicare, make sure you get your rebate or you could be looking at paying for the entire surgery. Remember though, Medicare will cover 75% of costs in certain cases so the rebate will still leave you with a bill.
How does private health insurance cover a hysterectomy?
If you decide to go private, a hysterectomy falls under the Gynaecology clinical category, which every Bronze, Silver and Gold hospital policy has to cover. The average waiting time for surgery in a private hospital is 28 days.
Whilst many product disclosure statements (PDS) explicitly state that they cover "hysterectomy surgery", it can sometimes be listed under "gynaecological procedures". If this is the case, you need to make sure that hysterectomy treatment is included in your policy.
You should also make sure your policy covers the specific type of surgery you need as many only include vaginal or abdominal hysterectomies. Make sure you do this well in advance of surgery, or you put yourself at risk of paying for everything.
Unless you have no gap, there will be some out of pocket expenses for a hysterectomy which are likely to be around $500, depending on your cover. Because you have a lot more control with private healthcare, you can really lower costs. The amount really depends on the decisions you make, from your excess to your choice of hospital and doctor. Doing your research beforehand puts you in a much better position to control what you pay.
Below are some examples from Finder partners that cover gynaecological procedures including hysterectomy. All prices are based on a single individual with less than $105,000 income and living in Sydney.
How much will I be out of pocket?
If you have surgery as a private patient, Medicare pays 75% of the MBS fee and your health fund pays the other 25%, but any amount your doctors charge above the MBS fee is yours to pay. This could lead to you paying thousands of dollars. Indeed, gap payments of $2,000 or more are becoming increasingly common, according to the Australian Prudential Regulation Authority (APRA), so be sure to avoid this.
If you opt to go private, you'll likely receive some out of pocket costs depending on the range of services that are covered by your policy, as well as your excess.
Whereas in an emergency you can't control which hospital or surgeon performs your procedure, it's very often that you know well in advance if you need a hysterectomy. That's why it's crucial you do your research beforehand. There are a number of things you can do to work out your estimate:
- Call your surgeon to get a cost estimate.
- Ask if your surgeon is in your private health insurance provider's preferred list to help find the most affordable option.
- Ask for your surgeon's extra costs; things like an anaesthetist can cost a lot.
- Make sure there are no hidden out of pocket expenses like x-rays.
- Ask for your Medicare code.
- Call your private health insurance provider and give them your Medicare code.
- Call the anaesthetist and ask them for a cost estimate.
- Find out your doctor's estimated rebate.
What are the different types of hysterectomy?
If you're considering a hysterectomy, your doctor or gynaecologist has probably explored all other options. As one of the more common types of elective operation performed in Australia, it's crucial you know what your insurer covers and the out of pocket expenses.
Common reasons for a hysterectomy include:
- Fibroids – benign tumours, sometimes also referred to as myomas.
- Cancer of the cervix, uterus, ovaries or fallopian tubes.
- Menstrual problems such as very heavy bleeding or extreme pain.
- Endometriosis – uterine glands that grow in other pelvic tissues.
- Pelvic inflammatory disease.
- Uterine prolapse – when the uterus pushes into the vagina.
Of these, fibroids are the most common reason for a hysterectomy. You will need to stay overnight in hospital and can expect to be there for between 2 and 7 days depending on your circumstances and the type of surgery you have.
This type of hysterectomy involves removing both the uterus and the cervix. The majority of patients undergoing hysterectomies have a total hysterectomy.
In this case, the uterus is removed but the cervix is left in place. A partial hysterectomy can help to reduce sex-related consequences. If the cervix is kept, regular cervical screening is still necessary. The surgery can be performed laparoscopically or abdominally.
This is a minimally invasive procedure using a laparoscope, a small telescope-like instrument with a camera at the end. The surgeon will insert this to see your pelvic organs by making a small incision in your navel. They will then make three or four small incisions through which other instruments are used. The surgeon will remove the uterus in pieces – and may also remove the fallopian tubes and ovaries if necessary – either through the incisions or the vagina.
For an abdominal hysterectomy, the surgeon will usually make a vertical or horizontal incision along your abdomen. For most women, this will leave a small scar.
This is usually performed when there are adhesions or if the uterus is very large. It's also generally recommended when the patient has very large fibroids or cancer. You will probably need a longer stay in the hospital for an abdominal hysterectomy.
A vaginal hysterectomy is performed through an incision at the top of the vagina. It is usually performed when there is a uterine prolapse. It is performed entirely through the vagina, so you won't be left with any scars and should expect a shorter hospital stay.
What are the side effects of a hysterectomy?
Although most patients don't develop side effects after a hysterectomy, they can include:
- Injury to nearby organs.
- Anaesthesia problems, such as breathing or heart problems.
- Blood clots in the legs or lungs.
- Infection and/or heavy bleeding, especially if you are overweight.
- Internal haemorrhage.
- Difficulties with urination.
- Internal scar tissue.
- Early menopause, only if the ovaries are removed.
- Pain during sexual intercourse or decreased sexual desire.
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