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Health Insurance For Cosmetic Surgery

Megan Fraser Fact Checked Updated: 03 October 2023
Types of Health Insurance

There’s a big distinction between cosmetic surgery and reconstructive surgery, and it’s an ongoing question of whether or not your procedure is medically necessary. Medicare and health insurance companies will only pay for reconstructive surgery because it’s considered essential for correcting bodily abnormalities or improving function. On the other hand, plastic surgery is purely elective and isn’t covered by most insurance plans.

Of course, that doesn’t mean you can’t get a private health  insurance policy for cosmetic surgery at all. Some speciality insurers offer coverage for procedures like liposuction or breast augmentation. However, these policies are expensive and may not be worth the cost unless you get a particularly extensive procedure. Learn more about the difference between plastic and reconstructive surgery and if your health insurance plan covers cosmetic surgery. 

Key facts

  • Generally, health insurance policies do not cover plastic surgery.
  • Medicare does cover all or some of the costs of reconstructive surgery.
  • Surgeries such as skin grafts and breast implants needed after cancer are covered by medical aid.
  • You can purchase a Gold tiered policy to cover your cosmetic surgery procedure.

What’s the difference between cosmetic and reconstructive surgery?

Cosmetic surgery primarily refers to elective surgeries done to improve one’s appearance. Most of these elective procedures are chosen by patients who want to change their appearance for aesthetic reasons.

Plastic surgery is a medical field that includes both cosmetic and reconstructive procedures. Cosmetic surgery is performed to alter the appearance of patients, while reconstructive surgery is performed to correct defects or deformities. 

Plastic surgery

Cosmetic surgery aims to improve appearance. It involves procedures that range from relatively simple, such as laser hair removal, to more complex surgeries, such as breast augmentation or facelift. In general, plastic surgery is performed by surgeons who have completed specialised training in this area. 

Reconstructive surgery

Reconstructive surgery is a type of plastic surgery that is performed to correct physical defects or abnormalities. This can include congenital disabilities, burns, scars, and any other type of damage that affects the normal appearance or function of the body. 

How much does plastic surgery cost

The cost of cosmetic surgery can vary widely depending on the doctor you use, the procedure you opt for, and if you have private health insurance. Generally speaking, though, the cost of plastic surgery is significantly higher than that of more traditional forms of surgery. 

  • Breast Augmentation: $7,000 to $15,000
  • Tummy Tuck: $9,000 to $18,000
  • Rhinoplasty: $8000 to $20,000
  • Facelift: $6,500 to $30,000
  • Breast Reduction Surgery: $9,000
  • Breast Lift: $6,000 to $8,000
Health Insurance For Cosmetic Surgery

Does health insurance cover cosmetic surgery in Australia?

Plastic surgery and non-surgical cosmetic procedures are not recognised by Medicare, meaning that patients have to pay for these treatments out of their pockets. There are many reasons Medicare doesn’t cover these treatments. One is that they are considered elective, which means they’re not medically necessary. Another reason is that there’s no evidence that these treatments improve health outcomes. 

However, certain private health insurance policies cover plastic surgery procedures. These tend to be higher-level policies and require a 12-month waiting period before the patient can claim. 

What type of plastic surgery might be covered by my health insurance policy?

Certain bronze policies may cover medically necessary breast reduction, correction of tuberous breast deformity, male gynaecomastia, and breast reconstruction after a mastectomy. Silver coverage may offer benefits for procedures mentioned in the bronze level, with the addition of medically necessary upper eyelid reduction or blepharoplasty, otoplasty for prominent ears, and scar revision procedures. Finally, gold level policies include all that is mentioned, plus abdominoplasty, arm lift or brachioplasty and thigh lift, gastric banding, gastric bypass, and sleeve gastrectomy. 

Is cosmetic surgery covered by Medicare?

There are several different types of plastic surgery procedures that people can elect to have, from breast augmentation and tummy tucks to facelifts and nose jobs. While cosmetic surgery can greatly improve a person’s appearance, it is important to remember that these procedures are not medically necessary. As a result, Medicare does not provide any benefits for cosmetic surgery. However, some private health insurance plans may offer partial coverage for cosmetic surgery, so it is always worth checking with your insurer to see if you have any benefits available.

How can I find a health insurance policy that covers plastic surgery?

The best and most effective way to find a private health insurance policy that covers plastic and cosmetic surgery is to review and compare numerous health insurance companies and their various policies. You can use the Comparing Experts comparison tool to help make your search faster. 

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Switching insurers for cosmetic surgery

There’s no one-fits-all solution, and that’s when it’s important to upgrade your policy. You may find that your needs change over time, and you can upgrade your policy to cover those services. If you want to switch insurance companies and polcies to cover plastic and reconstructive surgery, you can do so easily. However, it’s important to be aware of the 12-month waiting period. 

Frequently asked questions and answers

  • Does private health insurance cover breast implants?

    Generally speaking, private health insurance policies do not cover breast implants unless they are considered medically necessary. For example, if you had a mastectomy due to breast cancer, you could be covered for breast implants. However, some gold-tiered policies cover cosmetic procedures such as breast implants. Be sure to review your level of coverage and see if your health insurance provider will allow you to claim back for the costs.
  • Can insurance cover cosmetics?

    In Australia, there are two main types of health insurance: private and Medicare. Medicare is a government-run health insurance program that covers most medical procedures. Private companies provide private health insurance and generally cover procedures that Medicare doesn’t, such as dental and optical care. However, private health insurance companies are not required to pay benefits for purely cosmetic procedures. This means that if you have private health insurance and want a cosmetic procedure, you will likely have to pay for the entire cost yourself. The same is true for the hospital costs associated with cosmetic procedures. So, if you’re considering a cosmetic procedure, it’s important to factor in the possibility that you may have to pay for the entire cost yourself.
  • Why are cosmetic surgeries not covered by insurance?

    Medicare is a government-funded health insurance scheme that provides cover for Australian residents. It covers a range of medically necessary services, including hospital treatments, GP visits, and some allied health services. However, it does not cover cosmetic surgery. This is because cosmetic surgery is not considered to be medically necessary. While it can sometimes be used to treat medical conditions, such as skin cancer or burns, the majority of cosmetic surgery is elective, meaning that it is chosen for aesthetic rather than health reasons. As a result, Medicare benefits are not available for cosmetic surgery procedures.
  • Can a tummy tuck be medically necessary?

    No, generally speaking, a tummy tuck cannot be medically necessary. A tummy tuck is a plastic surgery procedure that is considered medically unnecessary, and will therefore usually not be covered by a health fund.
  • Does insurance cover teeth shaving?

    If you receive teeth shaving due to a medically necessary reason, your health fund may provide coverage for it. However, if its an elective cosmetic surgery, your health insurance policy may not provide coverage. Be sure to check with private health funds and purchase a polciy that does provide benefits that meet your needs and lifestyle.

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