Health insurance for cosmetic surgery
Expert tips for choosing health insurance
Our health insurance expert, Steven Spicer, has some helpful tips for comparing health insurance.
Steven Spicer
Executive General Manager – Health, Life & Energy
Find the right level of cover
Finding the right level of cover for your needs is a vital part of choosing your next policy. Before comparing policies, consider your health needs, family history, and what inclusions you’re likely to use. These considerations can help you avoid paying for cover you won’t use while still getting the cover you need.
Check your inclusions
Knowing what exactly your policy includes and what it doesn’t is important for any health insurance policy. Different private health funds and policies may vary in their inclusions and exclusions. If you’re not sure what your health fund includes on your policy, read your policy documents or chat with one of our health insurance experts.
Look for value for money
While having the lowest premiums possible might seem like your best option at first, you don’t want this to come at the cost of inclusions that you need. You may want to consider increasing your excess to lower your overall costs rather than giving up the cover you might need. However, you may need to think about if you can afford higher excess when it comes time to claim.
What is cosmetic surgery?
Cosmetic surgery is any medical procedure that reshapes an otherwise healthy part of the body to improve its appearance.1 This covers a wide range of procedures performed all over the body. Some straightforward cosmetic surgeries can be performed by doctors who are trained to carry out limited cosmetic procedures. More complicated surgeries need to be performed by a specialist plastic surgeon.
Cosmetic surgery examples
Cosmetic surgery is a term that can apply to many different procedures. Here are some of the most common cosmetic surgery procedures: 1,2
- Breast augmentation surgery (breast implants, breast lift)
- Eyelid surgery (blepharoplasty)
- Liposuction
- Tummy tuck (abdominoplasty)
- Nose surgery (rhinoplasty)
- Changing the shape of your ears (pinnaplasty)
- Surgical face lifts.
There are procedures also regarded as cosmetic surgeries that are not listed above. Many surgeries above can be medically necessary for some patients and may therefore be treated as reconstructive surgery in those cases. You should speak to your doctor about whether a procedure you are considering is medically or clinically necessary in your case.
Reconstructive surgery
Reconstructive surgery differs from cosmetic surgery because its purpose is to restore the appearance and function of a body part that has been damaged or needs medical attention.1 Some reasons for reconstructive surgery include: 1,3
- Recovery from an accident
- Treatments for scarring or burns
- Injuries caused by trauma to the body
- Recovery from the removal of skin cancer or tumours
- Congenital abnormality (cleft palate, club foot, ear deformity, etc)
- Breast reconstruction (after a mastectomy).
While reconstructive surgery may use similar techniques to cosmetic surgery, it’s considered medically necessary and is, therefore, more likely to be covered by health insurance providers and Medicare.
What affects the cost of cosmetic surgery in Australia?
Several factors can influence the cost of cosmetic surgery, including:
- The type of surgical procedure
- The extent of the surgery (how much work you’re getting done)
- Your choice of cosmetic/specialist plastic surgeon
- Complexity of the procedure
- Length of hospital stay
- Whether your procedure is deemed medically necessary.
Does private health insurance cover cosmetic surgery?
Cosmetic surgery that is not medically necessary isn’t covered by most private health insurance policies. If you’re having a procedure purely for cosmetic reasons, you’ll have to pay all expenses yourself.
However, if your procedure is deemed medically necessary you may be able to claim a benefit from your health fund. For example, breast surgery and plastic and reconstructive surgery are both clinical categories that can be included on hospital cover. Depending on your circumstances, medically necessary breast reconstructive surgeries may be claimable under these clinical categories. Breast surgery (medically necessary) is a minimum requirement for Bronze tier cover, while plastic and reconstructive surgery (medically necessary) is a minimum for Silver tier and above.
If your medical procedure is medically necessary and has a Medicare Benefits Schedule Item Number, your health fund may help cover some of your costs and minimise out-of-pocket expenses when you are admitted to hospital as an inpatient. This will depend on your level of cover, and the specific details of your policy.
If your health fund covers your procedure, there are a range of benefits. Private health insurance allows you to be treated in a private hospital or healthcare facility which means you can:
- Avoid lengthy public hospital waiting lists
- Choose your specialist/clinic
- Get a private hospital room (subject to availability).
Is cosmetic surgery covered by Medicare?
If your surgery is for aesthetic reasons and involves otherwise healthy body parts, Medicare won’t cover it. Plastic surgery procedures may be covered if they’re considered a medical necessity (for example, reconstructive surgery after an accident). Medicare will cover some costs if your procedure has an MBS item number.
While Medicare provides an invaluable service, there are some downsides to using the public system. One of the biggest disadvantages is that public hospitals usually have long waiting times for elective surgeries, meaning it could take months before you can undergo medically necessary reconstructive cosmetic surgery.
Meet our health insurance expert, Steven Spicer
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.
Want to learn more about health insurance?
1 Health Direct – Guide to cosmetic surgery. Accessed November 2024.
2 Australian Government: Department of Health and Aged Care – Cosmetic surgery. Accessed November 2024
3 Australian Society of Plastic Surgeons – Reconstructive. Accessed November 2024.