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Compare Health Insurance for Cosmetic Surgery
Compare Health Insurance for Cosmetic Surgery
Written by
Francis Taylor
Edited by
Laura Crowden
Reviewed by
Dr Jill GambergCheck out our range of private health funds
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Health insurance for cosmetic surgery
When it comes to your health insurance, remember that cosmetic surgery won’t be covered. However, medically necessary plastic or reconstructive surgeries may be.
What’s the difference between cosmetic and plastic surgery?
Cosmetic surgery is plastic surgery for aesthetic purposes, like changing your appearance. You might also put weight loss surgery in this basket. Reconstructive plastic surgery, on the other hand, are medically necessary procedures aimed at restoring function and correcting congenital defects, developmental abnormalities, or damage resulting from trauma, infection, tumours, or disease.
Does health insurance cover cosmetic surgery?
Generally speaking no, if it is for purely cosmetic surgery.
Health funds aren’t required to cover treatments for which Medicare doesn’t pay a benefit. 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 surgery following breast cancer). Weight loss surgery that is deemed medically necessary could also be covered by your private health insurance.
However, when it comes to plastic surgery that isn’t medically necessary, you’ll have to foot the bill yourself.
Keep in mind that some surgical procedures might include Medical Benefit Schedule (MBS) item numbers from both the medically necessary plastic and reconstructive surgery category, and the category the body part comes under (such as podiatric surgery). Complicated stuff!
Is cosmetic surgery covered by Medicare?
As cosmetic surgery treatments aren’t medically necessary, there are no Medicare benefits available for them. However, medically necessary surgeries may come with some cosmetic benefits, along with being covered by Medicare.
In fact, Medicare may have covered some or all of the costs for the almost 300,000 plastic or weight loss surgeries in Australian public and private hospitals in 2022–23. This included skin grafts, scar revisions, and liposuction.1Figure refers to instances of any of the listed MBS codes in PrivateHealth.gov.au’s clinical categories for plastic and reconstructive surgery, and weight loss surgery. Australian Institute of Health and Welfare – Procedures and healthcare interventions (ACHI 12th edition), Australia, 2022-23
While using Medicare and the public health system 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?
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 surgeries. Lower levels of hospital cover, like basic and bronze policies, aren’t required to cover these kinds of surgeries, but insurers may choose to include them.
Excess
This is a set amount you pay towards your hospital treatment. This helps reduce some of the risk for your insurer. As such, a higher excess usually means that you’ll pay lower premiums.
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 two 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.
Restrictions
Some policies come with certain restrictions. 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.
What out-of-pocket costs could I typically need to pay for medically necessary plastic surgery?
With appropriate cover, your health insurance and Medicare can help take care of some of your plastic surgery hospital bill as a private patient. However, it’s possible you might still have out-of-pocket costs.
What you end up needing to pay can depend on:
- 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 your insurer has an agreement with them
- your hospital stay, including how long you stay and if the hospital has an agreement with your insurer.
The type of surgery, too, can play a role. The following graph shows how much the typical out-of-pocket costs were for some common plastic surgeries and weight loss surgeries in private settings in 2022–23.
Of course, if you’re after a more accurate estimate for your circumstances, you could speak with your doctor.
Frequently Asked Questions
Do I need plastic and reconstructive surgery as part of my health insurance policy?
We can never tell what might happen to us in the future and if you find yourself in a situation where you need plastic surgery, such as after an accident, knowing it’s covered by your health insurance can give you much-needed peace of mind.
Over 1,600 surgical procedures are listed under the plastic and reconstructive surgery category in the Medicare Benefits Schedule, so 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.
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 who 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?
If your tummy tuck – otherwise known as an abdominoplasty – is medically necessary, your health insurance may cover it, depending on your policy.
Remember, it’s about more than looking 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, obesity, significant weight loss, trauma, or other conditions.
How can I find a health insurance policy that covers plastic surgery?
We’ll help you compare a range of health insurance policies from different providers.
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