Health insurance for cosmetic surgery
Cosmetic surgery isn't covered by health insurance, but medically necessary plastic surgery is.
What different scores mean
9+
Excellent
These products offer a balance between low pricing and more features.
7+
Great
Competitive products within their group.
5+
Standard
Usually these products would either have fewer treatments covered or higher pricing.
0+
Basic
Offering basic cover with limited features or higher pricing.
How does Medicare or health insurance cover cosmetic surgery?
Plastic surgery can be split into two categories - reconstructive and cosmetic surgery. Whether your treatment will be covered by Medicare or private hospital insurance depends on which category it falls into.
Reconstructive surgery
Reconstructive surgery is performed to correct abnormalities. These could be from birth or acquired through life, or be damage as a result of trauma or a bad accident.
Reconstructive surgery is generally considered medically necessary and will be covered by Medicare. Silver and Gold hospital policies must also cover medically necessary plastic and reconstructive surgery, and some Basic and Bronze policies include it too.
Cosmetic surgery
Cosmetic surgery is typically carried out to improve appearance rather than health. For example, facelifts, implants, eyelid surgery and liposuction.
It's not covered by Medicare or health insurance because it's not considered medically necessary.
What counts as medically necessary for plastic surgery?
There are a lot of valid medical reasons for plastic surgery. A few examples include the following:
- Reconstructive facial surgery after a bad car accident
- Surgery to correct your nose if you're unable to breathe properly
- A single breast reduction to even them out after removing a cancerous breast
Finder survey: How many people made a hospital claim for any of these conditions?
| Response | Female | Male |
|---|---|---|
| Plastic or reconstructive surgery | 0.96% | 0.21% |
Source: Finder survey by Pure Profile of 1006 Australians, December 2023
Policies that cover medically necessary plastic surgery
Here's a sample of policies from Finder partners that include private cover for plastic surgery. All prices are based on a single individual with less than $105,000 income and living in Sydney.
Finder Score - Hospital cover health insurance
Each month we analyse our hospital insurance products and rate each one on price and features. What we end up with is a nice round number out of 10 that helps you compare hospital cover a bit faster.
Before we start scoring, we need to make sure we're comparing like-for-like. Just as it doesn't make sense to compare a bicycle with a Ferrari, it doesn't make sense to compare basic hospital policies to top-tier Gold policies. Each policy is given a price score and feature score. These are then combined to determine each policies's Finder Score.
Medicare vs private for medically necessary plastic surgery
There will be some differences to your experience in the public or private system. Assuming your hospital cover is enough to cover the procedure, the big differences will be around surgery wait times and out-of-pocket costs.
Surgery wait times
When you need surgery, you'll be put into a queue of people waiting for a spot with a surgeon. There are wait lists for both the private and public system, but the private lists are generally a lot shorter.
How long are the lists? It depends, unfortunately. Public waiting lists can often be in the months or years. It will also depend on how urgent your condition is. If you need urgent work as the result of trauma, you'll probably get seen very quickly. On the other hand, surgery that's deemed less urgent might see you drop down the list a lot.
Private hospital insurance is generally the most reliable way to get quick treatment.
Out-of-pocket costs (the gap payment)
In the public system, you won't need to pay anything for your surgery, though there may be some incidental costs. This is the benefit of going 100% public. Private treatment, though offering your choice of surgeon and faster treatment, could see you have some out-of-pocket costs.
How much these costs are vary significantly based on the exact surgery you're going in for. Here are a couple of examples from Medical Costs Finder, the government database of typical out-of-pocket costs for private patients:
- Unilateral breast reduction: Typically $1,000, up to $6,500+
- Bilateral breast reduction: Typically $8,400, up to $11,000+
- Droopy eyelid surgery: Typically $650, up to $3,100+
- Septoplasty (nose reconstruction): Typically $680, up to $2,100+
To get an estimate of your out-of-pocket costs, you can check Medical Costs Finder, but you should also call your health fund for a more accurate estimate.
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Query: re:Breast reduction surgery when medically needed for health reasons, how does this work regarding costs? I have HAD hospital cover?
Hi Karren,
Thank you for your comment.
Generally, health insurance covers surgical and accommodation costs under the hospital cover policy if the breast reduction surgery is medically necessary and not only for cosmetic purposes. You may learn more on how insurance cover breast reduction surgery. To compare the policies, you may fill out the form on the page provided and click the “Search Policies” button. Once done, you’ll see the quotes from different health insurance providers with a list of detailed benefits.
Please make sure to read the eligibility criteria, features, and details of the policy, as well as the relevant Product Disclosure Statement PDS/T&C’s of the policy before making a decision and consider whether the product is right for you. If necessary, speak to the insurance brand to verify any details.
Regards,
Jhezelyn