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Health Insurance For Cosmetic Surgery

You might require plastic surgery, either due to medical or personal reasons. If you’re looking for cosmetic surgery financing opportunities, you might be considering Medicare and/or Private Health Insurance. Use the guide below to discover whether health insurance and Medicare can help you cover the costs.
Fact Checked

Updated: 24 May 2024

Private health insurance for medically necessary plastic surgery is generally available from select health funds. However, your choice of Hospital policy and level of coverage will usually determine if you’ll receive a benefit and how much you can expect.

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Does private health cover plastic surgery?

Health insurance will generally pay a benefit for plastic surgery as part of your Hospital plan if the operation is deemed medically necessary. Australian private health funds aren’t required to pay for treatments that Medicare doesn’t pay a benefit for, including cosmetic procedures and the hospital cost they incur. Cosmetic procedures are usually not covered by Medicare or private health funds.

Is cosmetic surgery covered by Medicare?

No, cosmetic surgery is generally not covered by Medicare when it is not deemed medically necessary.

What does plastic surgery for medical reasons mean?

Plastic surgery for medical reasons can be defined as procedures necessary to assist the patient to overcome a medical condition that is detrimental to their health — for example, breast surgery to remove lesions or tumours.

However, Insurers have different views regarding what constitutes reconstructive surgery and what’s defined as cosmetic surgery. You might want to check with your health insurance provider to see what their terms and conditions are, as well as their exclusions and restrictions.

Examples of plastic surgery generally covered by Hospital insurance and Medicare

The following are examples of item numbers on the Medicare Benefits Schedule (MBS) that relate to medically necessary plastic and reconstructive surgery:

What’s the difference between cosmetic and reconstructive surgery?

Reconstructive surgery is generally described as plastic surgery that is medically necessary to improve a patient’s health, for example, due to disease, trauma, or congenital and developmental defects. Cosmetic surgery in Australia is typically used to enhance a person’s physical appearance and not to improve their health.

Examples of reconstructive surgery
Examples of cosmetic surgery
Facial reconstruction to correct defects or improve breathing
A face-lift, cheek or chin enhancement
Breast reconstruction after breast cancer treatments, such as a mastectomy
Breast augmentation or breast lift
Repair of a cleft lip and palate
Eyelid Surgery to correct droopy eyelids and wrinkles
Skin grafting after severe burns
Rhinoplasty to change the appearance of your nose
Foot or hand reconstruction, such as surgery for webbed toes
Tummy tuck or liposuction

Health funds that cover cosmetic surgery (medically necessary)

Most Hospital policies cover plastic surgery and reconstructive surgery provided it is listed in your benefits and deemed medically necessary. Also, the procedure typically has to be on the Medicare Benefits Schedule. The below hospital policies offer coverage for reconstructive surgery:

Source: privatehealth.gov.au

The above information is based on the monthly premium for a single adult living in NSW purchasing a standalone Hospital policy with a $750 Excess. (18 February 2020)

Take note: The waiting period for plastic surgery is generally 2 months. However, 12 months for pre-existing conditions.

Questions to ask your health fund before scheduling reconstructive surgery

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Frequently Asked Questions and Answers

Yes, you can generally upgrade your health insurance plan to include coverage for medically necessary plastic surgery if it’s available from your health fund. However, you’ll usually have to serve the waiting period if this benefit was not previously covered.

The costs for breast reduction surgery in Australia, generally depend on several factors, including the state you live in, the hospital, and your surgeon and anaesthetist fees. As of February 2020, the typical costs for the complete procedure ranges between $8,000 to $14,500.

The cost for breast reduction surgery when you have private health insurance can vary depending on your choice of hospital and surgeon, as well as the policy you have. As of May 2019, the total cost is between $4,000 to $10,000 depending on your Hospital policy, and whether the procedure is deemed medically necessary.

Provided the procedure is medically necessary, Medicare will generally pay a maximum of $675.35 per breast as of February 2020. However, Medicare does not cover breast implants.