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Health insurance for appendicitis
Emergency appendix removal is partially covered by Medicare, while some private health insurance policies can cover the rest.
Medicare can fully cover appendix surgery as long as you receive treatment in a hospital. If you want to choose your own doctor, hospital and potentially get treated quicker, you might be better with health insurance. Appendix treatment is available with most policies for as little as $72 per month.
Appendicitis surgery cost in Australia
If you're treated as a public patient in a public hospital, appendicitis surgery is generally free in Australia.
However, you'll have some out of pocket expenses if you get treated in a private hospital and don't have health insurance. For example, the fee listed on the Medicare Benefits Schedule for an appendicectomy is $463.50. As Medicare covers 75% or $347.65 of the scheduled fee, you'll need to pay the remaining 25% of the fee yourself — that's $115.85.
It's extremely unlikely to be that cheap though as doctors often charge much more than the MBS fee. You will also need to consider anaesthetist, assistant and diagnostic fees.
Compare health insurance for appendix removal
You'll find health insurance for appendix removal in all bronze level health insurance policies, but a handful of basic policies can cover you as well. We've listed them below alongside costs. Keep in mind that you'll have a 2 month waiting period for new conditions or 12 months for pre-existing ailments. All prices are based on a single individual with less than $93,000 income and living in Sydney.
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Finder survey: How many Australians of different ages made a hospital claim for any of these conditions?
| Response | 75+ yrs | 65-74 yrs | 55-64 yrs | 45-54 yrs | 35-44 yrs | 25-34 yrs | 18-24 yrs |
|---|---|---|---|---|---|---|---|
| Cataracts | 27.27% | 8.72% | 3.11% | 0.59% | 0.54% | 2.35% | |
| Joint replacements | 18.18% | 3.49% | 1.86% | 1.18% | 0.54% | 1.05% | 1.18% |
| Dental surgery | 11.36% | 4.07% | 4.97% | 3.55% | 3.78% | 3.16% | 7.06% |
| Gastrointestinal endoscopy | 11.36% | 9.3% | 7.45% | 2.96% | 5.41% | 2.63% | |
| Heart and vascular system | 11.36% | 7.56% | 5.59% | 0.59% | 2.7% | 1.05% | |
| Hernia and appendix | 11.36% | 2.91% | 4.35% | 2.96% | 2.16% | 1.58% | |
| Eye surgery (not cataracts) | 9.09% | 4.65% | 2.48% | 1.08% | 1.58% | 3.53% | |
| Pregnancy and birth | 9.09% | 2.91% | 3.73% | 6.51% | 5.41% | 3.68% | |
| Bone joint and muscle | 6.82% | 5.23% | 4.97% | 2.37% | 2.7% | 2.11% | 1.18% |
| Cancer treatment | 6.82% | 7.56% | 1.86% | 0.59% | 1.62% | 1.58% | |
| Gynaecology | 6.82% | 4.65% | 5.59% | 7.1% | 4.86% | 3.16% | |
| I've never made a hospital claim | 6.82% | 8.14% | 14.91% | 19.53% | 24.32% | 28.42% | 27.06% |
| Joint reconstructions | 6.82% | 2.91% | 2.48% | 0.54% | 1.05% | ||
| Rehabilitation | 6.82% | 1.74% | 1.86% | 3.78% | 3.16% | 1.18% | |
| Brain and nervous system | 4.55% | 0.58% | 0.62% | 0.59% | 1.08% | 0.53% | 1.18% |
| Breast surgery | 4.55% | 1.74% | 0.54% | 1.58% | |||
| Lung and chest | 4.55% | 0.58% | 1.24% | 2.37% | 0.54% | 0.53% | |
| Skin | 4.55% | 2.33% | 1.86% | 1.78% | 1.62% | 2.11% | 1.18% |
| Sleep studies | 4.55% | 4.65% | 1.24% | 0.59% | 1.08% | ||
| Back neck and spine | 2.27% | 1.74% | 3.11% | 1.18% | 2.16% | ||
| Blood | 2.27% | 1.86% | 1.18% | 1.08% | 1.18% | ||
| Ear nose and throat | 2.27% | 4.65% | 6.21% | 1.78% | 3.78% | 3.68% | 3.53% |
| Other | 2.27% | 2.91% | 4.97% | 5.92% | 5.41% | 5.79% | 3.53% |
| Pain management | 2.27% | 1.16% | 2.48% | 2.37% | 2.7% | 1.05% | 1.18% |
| Tonsils, adenoids and grommets | 2.27% | 1.16% | 0.62% | 1.18% | 3.78% | 3.16% | 1.18% |
| Weight loss surgery | 2.27% | 1.24% | 1.78% | 1.08% | 1.18% | ||
| Digestive system | 2.91% | 3.11% | 1.78% | 1.08% | 2.11% | 1.18% | |
| Male reproductive system | 2.33% | 1.24% | 1.18% | 0.54% | 1.58% | ||
| Diabetes management | 1.16% | 0.54% | 0.53% | ||||
| Kidney and bladder | 1.16% | 1.24% | 1.18% | 1.62% | 0.53% | ||
| Podiatric surgery | 1.16% | 1.24% | 0.59% | 0.53% | |||
| Plastic or reconstructive surgery | 0.58% | 1.86% | 1.05% | ||||
| Hospital psychiatric services | 1.86% | 0.59% | 4.32% | 0.53% | 1.18% | ||
| Miscarriage | 1.24% | 1.78% | 1.62% | ||||
| Dialysis for chronic kidney failure | 0.62% | 0.53% | |||||
| Assisted reproductive services | 1.78% | 1.62% | 1.05% | ||||
| Pain management with device | 0.59% | 2.16% | 1.58% | ||||
| Palliative care | 0.59% | 1.62% | 1.18% |
Source: Finder survey by Pure Profile of 1006 Australians, December 2023
Does Medicare cover appendix surgery?
Yes. If you're treated as a public patient in a public hospital, Medicare can cover 100% of appendix surgery expenses. Remember though, as a public patient, you generally won't be able to choose your own doctor or the day that you're admitted to hospital and receive surgery.
If you receive treatment as a public in a private hospital, the Medicare Benefits Schedule Fee (30720) for an appendicectomy is $463.50, of which Medicare covers 75%. However, doctors aren't obligated to stick to the MBS fee, so you might have to pay considerably more than the 25% if they do charge more.
How does health insurance cover appendix surgery?
You'll find appendix removal covered with all bronze tier health insurance policies under hernia and appendix. With private health insurance, you can choose your own doctor, hospital and in many cases, you'll get treated much quicker.
If you already have health insurance, chances are you've already served the waiting period as it's included in most policies.
The majority of insurers cover the cost of surgical and theatre fees, as well as for any medicine you receive whilst in hospital. It will also generally cover the cost of accommodation in a private hospital or bed.
There may be some out of pocket expenses if you don't have some form of gap cover. To have a good indication of any out of pocket expenses, you should find out the price of the following:
- Principal surgeon
- Anaesthetist
- Assistants
- Diagnostics for example x-rays, lab tests and medical imaging
How finder partners cover appendix in detail
| Health fund | What services are covered? | Apply |
|---|---|---|
 AHM | AHM hospital cover policies cover the surgical removal of your appendix if you have appendicitis and need hospital treatment except for Starter Basic Hospital cover. This includes all agreed hospital charges in a partner private hospital in a shared or private room. In a public hospital, AHM will cover accommodation charges for a shared room and pay benefits towards the cost of a private room. A 12-month waiting period applies for pre-existing conditions, but this is shortened to two months in all other cases. | More info |
 Australian Unity | If you require appendix removal, hospital cover from Australian Unity covers hospital accommodation costs, theatre fees, in-hospital pharmaceuticals and more . A two-month waiting period applies. | More info |
 GMHBA | GMHBA Hospital Cover includes cover for theatre fees, doctor's fees and accommodation in a public or private hospital when you need to have your appendix removed except for Basic Plus (Restricted). Pharmaceuticals you receive as an inpatient are also covered. A two-month waiting period applies. | More info |
 HCF | HCF Hospital Cover provides cover for the cost of an appendectomy, including hospital accommodation, theatre fees, surgical fees and pharmaceuticals. Whether or not you receive treatment in a private or public hospital varies depending on the level of cover you select. A two-month waiting period applies. | More info |
 HIF | If you need to have your appendix surgically removed, cover is provided by HIF's suite of health insurance policies. This includes accommodation in a private hospital or as a private patient in a public hospital, plus theatre care, surgical fees and pharmaceuticals you receive in hospital. A two-month waiting period applies. | More info |
 Transport Health | All of Transport Health's hospital cover policies include cover for appendix removal. This includes hospital accommodation, emergency ambulance transport, theatre fees and pharmaceuticals. A two-month waiting period applies. | More info |
What will happen if appendicitis is left untreated?
If left untreated, appendicitis is a potentially life-threatening condition. With this in mind, doctors will always take a cautious approach and operate on a patient, even if a confirmed diagnosis of appendicitis has not been reached.
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