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Health Insurance for Heart and Vascular Systems
Health Insurance for Heart and Vascular Systems
Written by
Tina Sendin
Edited by
Andrew Kemp
Reviewed by
Andres GutierrezCompare Health Insurance Policies
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What are heart and vascular conditions?
Long story short
Most Aussies have at least one risk factor for heart disease
Nine out of 10 of us have one risk factor, and over two-thirds have three or more.
Silver and gold hospital policies generally cover heart conditions
Basic and bronze policies don’t have to, but ‘plus’ policies might. It’s always best to check with the insurer.
A pre-existing condition means a 12-month waiting period
If you have signs or symptoms of a heart problem before taking out a policy, you’ll need to wait a year to claim.
Out-of-pocket costs for private surgery can be significant
For example, the typical out-of-pocket cost for coronary bypass surgery is around $7,400 without private health insurance – and that’s just for specialist fees alone.
What are heart and vascular conditions?
Heart and vascular conditions refer to diseases and conditions that affect the heart and blood vessels. You might also hear them referred to collectively as cardiovascular disease (CVD).
Some of the most common forms of CVD include coronary artery disease (which causes heart attacks), strokes and heart failure. While many people tend to refer to these conditions as simply heart or cardiac disease, private health insurance policies typically call them by their clinical category – ‘heart and vascular system.’
As much as we’d like to keep things light, the statistics about heart and vascular disease in Australia are pretty sobering. It’s estimated that more than a million Australians are living with heart disease, stroke or vascular conditions.1Australian Institute of Health and Welfare – Heart, stroke and vascular disease: Australian facts
While the prevalence of heart and vascular disease is serious, you can be proactive by taking care of your general health and wellbeing – this includes eating healthy, performing regular physical activity, and having regular doctor check-ups.
What are the risk factors for heart disease?
Nine out of 10 Aussies have at least one risk factor for heart and vascular disease.2Heart Research Australia – Risk factors And more than two-thirds of us have three or more risk factors.3Heart Foundation – Are you at risk of heart disease?
There isn’t one single thing that causes heart and vascular disease. Instead, many different risk factors can contribute to it, including:
- high blood pressure
- high cholesterol
- being obese or overweight
- physical inactivity
- low fruit and vegetable intake
- regular drinking
- regular smoking
- a family history of heart-related issues.
When reviewing your health insurance, it’s always a good idea to assess your risk factors and take them into consideration when choosing your health cover. If you have any of the above risk factors, and getting treated in a private hospital is important to you, then you might want to look at health insurance that includes heart and vascular cover.
Can health insurance cover heart conditions?
It sure can! But it depends on the kind of policy you get and the kind of treatment you need. Some types of hospital cover include inpatient hospital treatment for heart and vascular conditions, but not outpatient or specialist treatments.
Hospital cover falls into four tiers: basic, bronze, silver and gold. Each tier must cover particular categories of health treatment, which are determined by the Federal Government. So, which of these tiers include heart and vascular conditions?
Silver and gold always cover heart and vascular conditions
It’s mandatory for any hospital cover that falls into a silver or gold product tier to cover heart and vascular conditions. If you’ve had signs or symptoms of heart or vascular conditions, there’s a waiting period – usually 12 months for pre-existing conditions and two months if you develop a new condition. But once that period ends, you’ll be covered for hospital benefits related to your heart and vascular system.
Basic plus and bronze plus might cover heart and vascular conditions
Hospital cover that falls under the basic or bronze tiers don’t have to cover heart or vascular-related conditions. But insurers have the option to include non-mandatory treatments in a policy and add ‘plus’ to the title – called a ‘plus policy.’ That means basic plus and bronze plus policies could potentially offer cover for heart or vascular conditions.
Just be aware that restrictions could apply in these cases. For instance, under a basic plus policy, if you have restricted cover for heart and vascular and you’re admitted as a private patient in a public hospital, you might only be covered for some of the costs.
To be safe, it’s always a good bet to check out the specifics of any policy you’re considering. This is usually easy enough, though! Just hop on the insurer’s website, check out the information document for their policy, and you’ll see what kind of conditions are covered, and whether any restrictions or exclusions apply.
Does my private health insurance cover heart and vascular disease?
| Cover Type | Heart and vascular disease coverage |
| Basic | No |
| Basic Plus | Maybe |
| Bronze | No |
| Bronze Plus | Maybe |
| Silver | Yes |
| Silver Plus | Yes |
| Gold | Yes |
Which heart conditions can health insurance cover?
As long as you have a hospital policy that covers the heart and vascular system, you’ll be covered for a wide range of inpatient hospital investigations and treatments for heart and vascular conditions. This includes, but is not limited to, treatments for:
- varicose veins
- heart attacks and heart failure
- removal of plaque from arterial walls
- occlusive disease
- aortic aneurysms.
Medical techniques and treatments like angioscopy, angioplasty, coronary bypass surgery, valve repair, stents and electrophysiology studies are also included under hospital cover. However, you’ll probably still want to check with your insurer exactly which medical treatments and techniques are covered, as well as what out-of-pocket costs you might encounter.
Helpful tip
Waiting until you need treatment for heart or vascular conditions may be too little too late when it comes to health insurance. If you have a pre-existing heart or vascular condition, you’ll likely have to wait 12 months before you can make any related claims. It’s helpful to think about the stage of life you’re at, your health condition and your family history as it may be worth adding cover for your heart and vascular sooner rather than later.
Dr. Jill Gamberg
GP, Coach, and Lifestyle Medicine Physician
How much do heart and vascular treatments cost?
The cost of heart surgery in Australia depends on whether you’re going public or private. It’s free for Medicare cardholders, but it could set you back thousands of dollars as a private patient. For instance, a coronary bypass surgery could cost $7,410 and aortic valve replacement $7,000 – both without private health insurance. With it? You could still have an out-of-pocket cost of around $500. But let’s dive into the figures more.
Does Medicare cover heart surgery?
If you’re a public patient planning to have heart and vascular treatments – say a heart bypass or an open heart surgery, you won’t have to worry about the entire cost as Medicare will cover it. You won’t pay for the surgery, public hospital stay, or cardiologist fees.
But there’s a catch: You don’t get to choose your doctor, and you’ll be placed on a public waiting list.
Does private health insurance cover heart surgery?
As a private patient, the total costs can be significant. But this is where private health insurance could help, with hospital cover possibly lightening the financial load. Going in as an insured private patient also comes with perks like shorter wait times, choosing your own doctor, and even staying in a private room.
Let’s look at how much private patients paid in out-of-pocket costs for a variety of heart and vascular treatments, based on 2023–24 data from the Australian Government’s Medical Costs Finder.
Cost of various heart and vascular treatments in Australia
| Heart angiogram with or without heart catheterisation | Aortic valve replacement | Coronary bypass surgery | |
| Medicare Benefits Schedule or MBS item number | 38252 | 38484 | 38502 |
| Typical specialist fee | $1,900 | $15,000 | $16,000 |
| Medicare paid | $930 | $7,500 | $7,900 |
| Insurer typically paid | $720 | $6,500 | $6,900 |
| Typical out-of-pocket cost | $90 | $500 | $510 |
| Percentage of patients with an out-of-pocket cost | 15% | 76% | 75% |
Source: Medical Costs Finder – Heart angiogram with or without heart catheterisation; Heart valve replacement (not TAVI); Coronary artery bypass graft (CABG)
Note: These are the amounts patients typically paid for these services, rounded to the nearest dollar. They do not include hospital payments such as excesses, co-payments, or other payments. These fees may vary depending on your situation. Not all patients had out-of-pocket costs; those who didn’t aren’t included in these figures. Data retrieved February 2026.
It’s worth bearing in mind that this table shows the fees paid to medical practitioners involved in the treatment – like surgeon, assistant surgeon, and anaesthetist. This doesn’t include other out-of-pocket expenses like hospital costs for your treatment and stay – which could set you back thousands of dollars.
You’ll also need to consider other costs like the excess you need to pay your health fund if you need to go to the hospital for treatment, co-payment fees that correspond to each day you spend in the hospital, and other things after your treatment – like pain management.
What should I look at when comparing policies?
Besides the obvious factors – the cost of your premiums and your level of cover – there are a few specifics you might want to look at to make sure you’re getting a suitable policy. These include:
Waiting periods
This is the length of time you’ll have to hold the policy before you can make a claim for specific treatments in hospital. If you have a pre-existing condition – such as a heart problem you had before you took out the policy – the maximum waiting period insurers can apply is 12 months. If you don’t have a pre-existing condition, the maximum waiting period is two months.
Excess
An excess is an amount that you agree to pay towards a treatment before your health insurance kicks in. When you choose a policy, you can sometimes choose your excess amount. Choosing a higher excess usually means paying lower premiums.
Hospital network
Different insurers have specific arrangements with different hospitals. Insurers might provide a different rebate depending on which hospital you use. Also, specific hospitals might be ‘no gap providers,’ meaning they won’t charge any extra fees beyond what your insurer covers. If you have a specific hospital in mind for treatments, it’s usually worth checking what kind of arrangement they have with your insurer.
Where can I find and compare health insurance?
If you’re looking for health insurance policies that cover heart and vascular conditions, then iSelect can help you out. You can use our comparison tool to compare hospital (and even extras cover) online then weigh up which one best suits your budget and heart health needs. Or if you’d prefer, you can give our friendly team a call on 1800 784 772.
It’s quick, easy to use, and – best of all – it’s free! The policy you find might just make your heart skip a beat (in a good way).
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