Health insurance for gastroscopy

What is a gastroscopy?

A gastroscopy, or upper endoscopy, is a medical procedure where a thin, flexible tube with a camera (an endoscope) is inserted through the mouth and down into the esophagus, stomach and duodenum. This allows doctors to visually examine the lining of these organs to diagnose and sometimes treat conditions like ulcers, inflammation, or tumours and to take tissue samples for biopsies.

Is gastroscopy covered by Medicare?

Necessary gastroscopy will be covered by Medicare in a private hospital. However, depending on your doctor, there may be additional costs. Ask your doctor about costs and check that you're covered by Medicare.

Waiting times for the procedure can vary and can depend on whether you are categorised under category 2 or 3. If it's the latter, you could be waiting up to 12 months for a gastroscopy.

How is gastroscopy covered by private health insurance?

You can get cover for gastroscopy with all bronze tier hospital policies. Bronze tier policies start at around $25 a month, but your final price will vary.

Waiting period for gastroscopy health insurance

Gastrointestinal endoscopy comes with a two-month waiting period, unless you have a pre-existing condition, in which case the waiting period is 12 months. If you're switching health insurance then any previously served waiting periods for your hospital cover will automatically transfer across.

Gastroscopy cost

Without private health insurance, the average cost for a gastroscopy is around $1,350. This doesn't include out-patient costs or out-of-pocket expenses like assistants, anaesthetists, diagnostics or doctors' costs. With this included, costs are more likely to be around $2,000 to $3,000.

In a public hospital, this will all be covered by Medicare.

If you have private health insurance, most of your costs will be covered, but not all. According to Medical Costs Finder, the average out-of-pocket costs for gastroscopy is around $100 to $200. Check with your health fund before the procedure to find out how much they will cover, and try to get it in writing.

Frequently asked questions

• How much does a private gastroscopy cost in Australia?

  Without Medicare or insurance, a gastroscopy will run $2,000 to $3,000 all in. However, the cost of a private gastroscopy in Australia can vary significantly depending on several factors, including the location, the specialist's fees, the hospital or day clinic used and whether biopsies or other procedures are performed during the endoscopy. Expect costs to range from several hundred to several thousand dollars. Obtaining a detailed quote from your specialist and hospital is essential for accurate pricing.

• Will health insurance cover an endoscopy?

  Yes, health insurance can cover gastroscopy in Australia, as long as it is covered in your policy. That typically means you'll need a bronze tier hospital policy.

• Does Medicare cover gastroscopy?

  Medicare does help with the cost of a gastroscopy, yes. How much it covers depends on where you have the procedure. Public hospitals are generally fully covered, but private facilities will usually mean some out-of-pocket expenses.

To make sure you get accurate and helpful information, this guide has been edited by Tim Bennett as part of our fact-checking process.

Written by

Gary Ross Hunter

Journalist

Gary Ross Hunter has over 6 years of expertise writing about insurance, including life, health, home, and car insurance. Having reviewed hundreds of product disclosure statements and published over 800 articles, he loves simplifying complex insurance topics for everyday readers. Gary has contributed to major outlets like Yahoo Finance, The Sydney Morning Herald, and news.com.au, and holds a Bachelor of Arts (Honours) in English Literature from the University of Glasgow, along with a Tier 2 General Advice certification, ensuring his work adheres to ASIC’s RG146 standards. See full bio

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