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Compare health insurance for cosmetic surgery
Compare health insurance for cosmetic surgery
Written by
Madeline Pettet
Edited by
Laura Crowden
Reviewed by
Andres GutierrezCheck out our range of private health funds
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What’s the difference between cosmetic and plastic surgery?
Cosmetic surgery is plastic surgery for aesthetic purposes, like changing your appearance, whereas reconstructive plastic surgery is a medically necessary procedure aimed at restoring function and correcting congenital defects, developmental abnormalities or damage resulting from trauma, infection, tumours or disease.
For instance, body contouring is usually a form of cosmetic surgery for aesthetic reasons, while weight loss surgery can be a medically necessary procedure to improve a person’s quality of life. Similarly, while popular culture might claim surgical changes to breasts are almost always cosmetic, breast reconstruction or breast reduction surgery after cancer is typically treated as reconstructive plastic surgery. Plastic surgery definitely can change the look of a part of your body, but it’s primarily for treating an underlying condition or issue rather than for cosmetic reasons.
Does health insurance cover cosmetic surgery?
Health insurance doesn’t cover cosmetic surgery but it covers medically necessary plastic and reconstructive surgery. This means that health insurers won’t pay benefits for purely cosmetic procedures or the hospital costs associated with them. However, if the surgery is deemed medically necessary, then the treatment could be covered by your policy – so long as your policy covers plastic and reconstructive surgery.
For instance, even if a treatment alters your appearance, it might be covered by your policy if there’s a medically necessary reason to have it performed (such as breast reconstruction or breast augmentation surgery following breast cancer). Weight loss surgery that is deemed medically necessary could also be covered by your private health fund.
Is cosmetic surgery covered by Medicare?
No. Because cosmetic surgery treatments aren’t medically necessary, like face lifts, there are no Medicare item numbers or benefits available for them. However, medically necessary plastic surgeries may be covered by Medicare rebates, even if they also have some cosmetic benefits.
While using Medicare and the public health system for medically necessary plastic surgery can mean avoiding out-of-pocket costs, there are downsides too. For instance, you won’t be able to choose your doctor or hospital. You may also have a longer wait.
What types of plastic surgery might be covered by my health insurance policy?
Health insurance with cover for medically necessary plastic and reconstructive surgery can help pay for surgeries like skin grafts, breast reconstructions and cleft palate corrections. This kind of cover is for restoring function and correcting appearance after traumatic injuries, illnesses, other surgeries and more.
There are many plastic surgeries that can be medically necessary and therefore covered by health insurance, including:
- surgery to repair traumatic injuries or treat burns, like skin grafts
- surgery after removing cancers or tumours, such as a breast reconstruction after a mastectomy
- surgery for congenital abnormalities, like club feet, cleft palates or nasal deformities
- surgery for lacerations and to repair scars.
Helpful tip:
If your doctor recommends plastic surgery to address a specific health issue, your insurance provider may cover the procedure. In addition, certain medical conditions may be covered by Medicare and/or your health insurance, however others will not.
Providing documentation of your medical history and relevant consultations can be helpful when discussing coverage options with your health insurer. Clearly demonstrating the medical necessity of the procedure increases your chances of receiving coverage.
Dr. Jill Gamberg
GP, Coach and Lifestyle Medicine Physician
How do I compare health insurance for plastic and reconstructive surgery?
Policy type
Silver and gold hospital product tiers have to include benefits for medically necessary plastic and reconstructive surgery, while only gold tier policies must cover medically necessary weight loss surgery. This means that depending on your level of cover, your health fund will pay for some or all of the costs of surgeries that fall under these clinical categories, including hospital fees. How much they will pay will depend on your fund’s agreement or partnership with your specialist and hospital.
Lower tiers of hospital cover, like basic and bronze policies, aren’t required to cover these kinds of surgeries, however cover could be available on basic plus and bronze plus policies.
Excess
Your excess is a set amount you pay towards your hospital treatment. This helps reduce some of the cost for your insurer. You pay it when you’re getting admitted to hospital.
A higher excess usually means that you’ll pay lower premiums. Some health insurance policies may feature a no-excess option, although you’re more likely to find policies that offer excess exemptions, like not needing to pay an excess if you’re only having day surgery. Most policies require an excess payment, up to a maximum of $750 for singles policies and $1,500 for couples and family policies.
Waiting period
You’ll need to hold your policy for a set amount of time before you can make a claim for certain treatments. The waiting period for plastic and reconstructive surgery or weight loss surgery is 2 months – unless it relates to a pre-existing condition, then it has a 12-month waiting period. Unfortunately, most reasons for Weight Loss Surgery are treated as pre-existing.
Keep in mind that if you upgrade your health insurance, like moving to a higher tier of hospital cover, you’ll need to serve any relevant waiting periods before you can claim on your new cover. This applies even if you stay with the same health fund.
Restrictions
Some policies come with certain restrictions that change when and how you can claim plastic and reconstructive surgery. For instance, a policy might cover some of the costs for plastic and reconstructive surgery, but only if you’re admitted as a private patient in a public hospital.
Restrictions can limit the benefits you get from having private health insurance, like reducing how much your fund covers for eligible surgery. This can mean you have high out-of-pocket expenses as a patient in a private hospital. So, you might prefer to skip over a policy packed with restrictions – even if the price is a bargain – for something that gives you a little more choice.
What out-of-pocket costs could I typically need to pay for medically necessary plastic and reconstructive surgery?
Average out-of-pocket costs for a sample of private medically necessary plastic and reconstructive surgeries ranged from $500 to $6,900 in 2023–24 financial year, according to Medical Costs Finder.
Although your health insurance and Medicare can help take care of some of your medically necessary plastic and reconstructive surgery hospital bill as a private patient, it’s possible you might still have out-of-pocket costs due to a range of factors, like:
- your surgery, including the complexity
- your policy, including what’s covered, how much the benefits are, and if you have any excesses or co-payments
- your doctor’s fees, including if they agree to participate in your insurer’s gap cover scheme
- your hospital stay, including how long you stay and if the hospital has an agreement with your insurer.
| Surgery | Typical specialists’ fees | Average out-of-pocket cost |
|---|---|---|
| Droopy eyelid surgery (blepharoplasty) | $2,900 | $750 bilateral otoplasty |
| Gastric band | $4,000 | $500 |
| Rhinoplasty | $6,700 | $4,400 |
| Pin ear back (for someone under 18 years of age; ) | $5,400 | $3,900 |
| Tummy tuck (abdominal lipectomy) | $9,000 | $6,900 |
Note: These figures reflect indicative surgery fees and out-of-pocket costs for a sample of medically necessary plastic and reconstructive and weight loss surgeries in private settings across Australia in 2023–24 financial year, based on Medical Costs Finder and rounded where appropriate. Actual costs may vary depending on your unique circumstances. Data retrieved July 2026.
Frequently asked questions
Do I need plastic and reconstructive surgery as part of my health insurance policy?
You need plastic and reconstructive surgery as part of your health insurance to cover the over 1,600 surgical procedures listed under the plastic and reconstructive surgery category in the Medicare Benefits Schedule. If your policy doesn’t cover you for these treatments – or if there are exclusions or restrictions – it could pose a problem if plastic surgery becomes medically necessary for you. However, it’s up to you to decide if plastic surgery is something you’re likely to need in the future and/or if having cover for it would give you peace of mind.
Keep in mind that some medically necessary plastic surgery procedures might sneak into other categories, like plastic surgery for skin-related conditions (e.g. skin cancer) can fall under the skin clinical category of your hospital cover. Complicated stuff!
Can I change my health insurance cover to include plastic and reconstructive surgery?
Yes, you can either upgrade your private health insurance policy with your existing provider to cover the services you need or switch to a different provider and take out a policy that covers plastic and reconstructive surgery procedures. However, it’s important to be aware that a 12-month waiting period still applies if the treatment is for a pre-existing condition.
Can I get a tummy tuck covered by health insurance?
Private health insurance covers medically necessary tummy tucks (also called abdominoplasties). You’ll need to check if your health insurance includes cover for weight loss surgery, and that a tummy tuck is medically necessary for you.
Remember, it’s about more than feeling good in your swimmers. A medically necessary tummy tuck corrects structural defects and helps to improve your abdominal functionality. For instance, a tummy tuck may be necessary to repair abdominal wall abnormalities caused by pregnancy, significant weight loss, removal of a tumour or other conditions.
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