Health insurance for gastroscopy
Gastroscopy is generally a simple procedure and is covered by Medicare and by private insurance, but the final cost can vary.
Key takeaways
- Gastroscopy is a common procedure to help diagnose and prevent gastrointestinal conditions.
- Medicare covers the procedure in full if you are a public patient in a public hospital; in the private system you will need bronze hospital cover or above.
- It's a quick procedure, so in the private system out of pocket costs are pretty low.
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 oesophagus, 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?
As a public patient in a public hospital, a medically necessary gastroscopy is covered by Medicare in full. If you choose to be treated as a private patient, in either a public or a private hospital, Medicare covers only 75% of the Medicare Benefits Schedule (MBS) fee for your doctor's services. Private patient hospital costs such as theatre fees and accommodation are not covered by Medicare at all, which is what hospital cover is for. Depending on your doctor, there may also be additional out-of-pocket 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 week, 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.
As a public patient 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
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