Health insurance for hernia surgery

A hernia can be painful and expensive if left untreated. Luckily, Medicare and private health insurance both cover hernia surgery. Private cover also lets you minimise your waiting time for treatment, reducing the chance of complications.

Who is this cover for?

Key takeaways

  • Hernia repair can be cover for free under Medicare, but with wait lists of up to a few months.
  • Private hospital policies that are at least Bronze tier will cover hernia repair.
  • The cost of private hernia repair without insruance can be over $10,000.

How much does hernia surgery cost?

In the public system, hernia repair is free. However, you'll need to wait for surgery, with waiting lists up to a couple of months long. To avoid that, you'll can use the private system.

If you don't have private health insurance, you could be on the hook for anywhere from $3,000 to over $10,000 for hernia repair, depending on how complex the surgery is, and how long you need to stay in hospital.

If you have a bronze or higher tier hospital policy and have served your waiting periods for hernia repair, most of that will be covered. According to Medical Costs Finder, the average out-of-pocket cost for hernia repair patients with insurance is between $400 and $500. That said, if you need surgery you're best bet is to call your insurer first, to figure out how to minimise the out of pocket costs.

Health insurance that covers hernia surgery

Below are some policies from Finder partners that cover hernia surgery. All quotes are based on a single hospital policy in Sydney with a $500 excess. All include a 2 month waiting period for new conditions, and 12 months for pre-existing. All prices are based on a single individual with less than $97,000 income and living in Sydney.

1 - 10 of 59
Name Product AUFHI-NEW Treatments Price Apply
Frank Entry Hospital (Basic+)
Basic Plus$750 excess
Frank Health Insurance logo
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
  • +5 other treatments covered
$82.48
per month
Go to Site
All treatments
Bupa HI Pty Ltd logo
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
  • +8 other treatments covered
$84.51
per month
Go to Site
All treatments
GMHBA Limited logo
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
  • +5 other treatments covered
$85.23
per month
Go to Site
All treatments
essentials basic plus
Basic Plus$750 excess
ahm health insurance logo
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
  • +5 other treatments covered
$87.04
per month
Go to Site
All treatments
starter bronze
Bronze$750 excess
ahm health insurance logo
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +14 other treatments covered
$88.70
per month
Go to Site
All treatments
Qantas Insurance logo
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
  • +7 other treatments covered
$89.42
per month
All treatments
Bupa HI Pty Ltd logo
  • Rehabilitation
  • Joint reconstructions
  • Dental surgery
  • Hernia and appendix
  • Eye excluding cataracts
  • Pain management
  • Gynaecology
  • Lung and chest
  • +8 other treatments covered
$89.53
per month
Go to Site
All treatments
simple bronze plus
Bronze Plus$750 excess
ahm health insurance logo
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +16 other treatments covered
$90.24
per month
Go to Site
All treatments
Bupa HI Pty Ltd logo
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +16 other treatments covered
$91.83
per month
Go to Site
All treatments
GMHBA Limited logo
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +14 other treatments covered
$93.64
per month
Go to Site
All treatments
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When might you need hernia surgery?

Hernias don't go away on their own; they always require surgery. The longer you have a hernia the higher the risk of developing more serious complications. If they're left untreated, you risk needing an emergency surgical procedure.

Does Medicare cover hernia repairs?

Medicare will cover the cost of hernia repair in a private hospital, so you won't have any out of pocket costs. There is a downside though - the waiting periods for hernia repair in the public system can be a couple of months. In the private system, you'll typically only have to wait a matter of weeks for treatment. In the case of a bad hernia, the faster you can have it treated, the better.

Public vs private waiting list for hernia surgery

Public hospital waiting times are not always short. Some surgery waiting lists are a few months long. If you have private hospital cover, you'll generally be able to access shorter waiting periods. Here are the surgery waiting times for hernia surgery from 2015-2016:

  • Public: 56 days
  • Private: 25 days

Finder survey: How many Australians have made a hospital claim related to hernia or appendix condition?

ResponseMaleFemale
Hernia and appendix3.54%2.3%
Source: Finder survey by Pure Profile of 1006 Australians, December 2023

How can health insurance help with hernia surgery?

Hernia surgery is classified by most insurers as general surgery. You can find a policy that will include hernia surgery in a basic- to mid-level hospital cover. If you do decide to go private, you shouldn't expect to be out of pocket more than $700 depending on the procedure.

While it costs a little more, having a health insurance policy means you will have greater control over the situation. For many, having access to your own doctor and hospital allows you to relax, knowing you're in good hands. There's also no lengthy surgery queue if you go private. Not only does this reduce the likelihood of complications developing, but it also lets you get back to work sooner.

If you're new to health insurance you may have a one-off 12-month waiting period.

What does a hernia operation involve?

The most common place for a hernia to develop is the groin. If the lump can be gently pushed back through the abdominal wall, it's known as a reducible hernia. If the lump resists any form of pressure, it's a non-reducible hernia. Both require surgery.

The damaged spot in the muscle wall (where a hernia has come through) is repaired by stitching together the edges of the healthy muscle tissue. However, surgical procedures vary depending on the area of muscle wall in need of repair. For instance, special mesh patches are used to repair larger hernias that need to be reinforced.

How long is the recovery time for a hernia?

Hernia surgery is typically a day surgery. A recent report found 80% of hernia patients go home the same day, so you shouldn't have to spend much time in hospital. Recovery time is around three to four weeks.

You can most likely return to light activity after three weeks, though you shouldn't exercise vigorously until around the six-week mark, depending on how you're feeling.

Don't do anything that causes you pain, especially bending over or lifting heavy objects. Remember to rest as much as possible and sit or lie comfortably for the first few weeks.

Finder: What Is Medicare?, https://www.finder.com.au/health-insurance/what-is-medicare
Finder: What does Medicare cover?, https://www.finder.com.au/health-insurance/what-is-medicare/what-does-medicare-cover
AIHW: Private health insurance use in Australian hospitals 2006–07 to 2015–16, https://www.aihw.gov.au/reports/hospitals/private-health-insurance-use-hospitals/contents/table-of-contents
Services Australia: What's covered by Medicare?, https://www.servicesaustralia.gov.au/whats-covered-medicare[/article_source]

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

Gary Ross Hunter was an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146). See full bio

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Gary Ross has written 647 Finder guides across topics including:
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