Private health insurance for ear grommets

In this guide we’ll answer the questions you might have about kids’ grommets and private health cover, like how much they cost and whether or not they’re covered by insurance.

What are grommets?

Ear grommets, also known as tympanostomy tubes, are a common solution for children experiencing recurrent ear infections or fluid accumulation in the middle ear. Ear grommets are small ventilation tubes, typically less than half a millimetre long, surgically inserted into the eardrum to facilitate fluid drainage and airflow to the middle ear. This intervention is performed during a minor procedure called myringotomy, which usually lasts about 10 to 15 minutes under general anaesthesia. Grommets typically remain in place for six to twelve months, although some may last up to 18 months. In cases where they do not extrude naturally, a minor removal procedure may be necessary.

What does a grommet do?

Grommets are primarily recommended for children with persistent ear infections or conditions like glue ear, where mucus builds up in the middle ear and hampers hearing. Ear infections can arise from respiratory illnesses, leading to blockage of the eustachian tube and fluid accumulation. The insertion of grommets helps equalise pressure in the ear, facilitating proper drainage and improving your child’s hearing.

Source: ENT Clinic Sydney

How much does a grommet operation cost?

Grommet surgery cost in Australia can vary anywhere from $800 to $3,000, depending on various factors such as whether one or both ears require treatment. An average cost tends to come in at around $2,500. This price includes: 

• consultation fees

• anaesthetist fees

• hospital charges. 

It’s advisable to request a detailed quote from your child’s surgeon, which can be presented to your health fund for coverage clarification.

Note: Treatment through the public health system is usually free (covered by Medicare), but you might face a wait, depending on demand at your local hospital. Grommet surgery is often considered a 'Category 3' elective procedure, with waiting times of up to 12 months. After your hospital stay, there could be extra costs for medication or allied health services.

Does private health insurance cover grommet surgery?

Yes. As grommet insertion is an elective procedure, the degree of cover can vary significantly based on your hospital insurance policy, and your health insurer. Generally, more comprehensive health plans are likely to include this type of procedure, but reviewing your specific cover details with an expert is a good idea before any major procedure.

Key factors influencing coverage: 

• Your policy type: More extensive health (hospital) insurance plans typically offer broader cover for elective surgeries like grommet insertion.

• Surgeon fees: Surgeons can set their own rates, which may lead to out-of-pocket expenses known as "the gap." Health funds usually contribute a set amount toward these fees, and any remaining balance must be covered out of your pocket; 81% of patients had out of pocket costs for grommet surgery in 2023, ranging from under $200 to over $900. (Correct as per Department of Health and Aged Care’s statistics for 2022-23)

Can you avoid paying any out-of-pocket costs?

If your health fund provides a gap cover scheme and your surgeon participates in it, this can significantly reduce your or eliminate your out-of-pocket ‘gap’ expenses. Additionally, an excess fee might be applicable, which is a predetermined amount you agree to pay before your insurance contributes toward hospitalisation costs. Some hospital policies waive the excess for children.

A health insurance broker can help you work out which insurers offer no-gap or gap-cover policies as well as an excess waiver for kids. Given the potential costs associated with this procedure, understanding your health insurance policy is important for parents. With a proactive approach, you can make informed decisions that best support your children's health and wellbeing.

Sources

Health Direct: Grommets

Raising children: Middle ear infection

Medibank: insertion of grommets

Medical Costs Finder

ENT Clinic Sydney

Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

• 1

  Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.

• 2

  An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.

• 3

  Family health cover means your children are covered under the same policy as you.

• 4

  Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).