Private health insurance for cataracts surgery

A condition that affects your eyesight is worrying at any age. While cataracts are fairly common, the cost of having them treated remains fairly high and it can be challenging to understand exactly what the surgery involves and what type of private health insurance you need to cover it.

To make life simpler, we’ve put together the following guide outlining what you need to know about getting your cataract surgery covered by a private health insurer.

What is cataract surgery?

Cataracts affect the lenses of your eyes, making them cloudy and causing blurred, fuzzy eyesight. If left untreated, they can lead to blindness*.

A cataract procedure removes the cataracts from your eye by removing the eye lens altogether and swapping it for an artificial one.

What is medically necessary for cataract surgery?

Your eye doctor (known as an ophthalmologist) may decide that cataract surgery is medically necessary if your cataracts severely affect your vision, and non-surgical treatments would be ineffective`.

How much does cataract surgery cost?

Depending on where you have the work done, the average cost of cataract surgery in Australia ranges from between $2000-$3500 per eye** without the right private health cover in place.

Keep in mind that, since cataracts typically affect both eyes, you'll usually pay for surgery on both at the same time. Fortunately there are ways to significantly reduce your out-of-pocket costs, or avoid them entirely.

By taking out appropriate private health cover, you’ll typically pay no more than a few hundred dollars^, or even none. In 2021, less than 50% of private patients paid out of pocket for cataract surgery^. If you're older, you may be entitled to the Commonwealth Seniors Card, which can help with day surgery. Find out more about health cover for seniors here.

How is cataract surgery done?

Cataract surgery is usually an outpatient day surgery, which means you won't need to stay in hospital overnight. When you go in for the surgery, your cataract surgeon (ophthalmologist) will use either laser-assisted technology or ultra-sound energy to take out the cloudy lens that has been affecting your vision.

They'll then replace this with an artificial lens^^.

Afterwards, the lens will be a permanent part of your eye, but you won't feel it or even notice that it’s there.

How long does cataract surgery take?

Cataract surgery is a straightforward procedure that usually takes around 10 minutes per eye.

Once the surgery is done, you may be asked to wait in a recovery room for up to an hour until the sedation or local anaesthesia wears off.

A follow-up appointment will usually take place the following day to ensure there are no complications.

Any side effects of the surgery, such as redness or soreness, should be gone within a few days, and you'll be able to see the full benefits of your new surgery within a week^^.

How long are the waiting periods in the public system for cataract surgery?

If you use Medicare to cover your cataract surgery costs, you’ll be able to get the procedure done in a public hospital, though you may still have some out-of-pocket expenses. The downside to this is that public hospital waiting times can be quite long compared to those in a private hospital. Find out more about waiting times here.

According to the latest available data from the Australian Institute of Health and Welfare, the average waiting time for cataract surgery in Australia is around 86 days.

Obviously, if your cataracts are causing major issues, this may be too long. If you have the right private health insurance in place, you should be able to have the surgery done much sooner - often within days.

How does health insurance cover private cataract surgery?

Health insurance providers generally cover the cost of cataract surgery under Gold tier hospital cover plans, though some health insurance plans for seniors may also cover it on a Silver or Silver Plus tier.

If your current policy doesn't cover cataracts or you need to find a more suitable plan, you can use our free insurance comparison tool to compare health insurance policies and find the right coverage for you, or speak to one of our experts today.

How long do you have to wait to use your cover for cataracts?

If your cataracts are a pre-existing condition, you may have a 12-month waiting period before you can claim for surgery. If they’re a new condition that develops after you take out your policy, the waiting period is likely to be two months.

However, if you switch your cover to an equivalent or lower tier, you’re not required to re-serve any waiting periods and you can claim right away.

What is hospital cover?

Hospital cover is health insurance that covers some or all of the costs of hospital services that are on the Medicare Benefits Schedule (MBS).

For example, if your cataract surgery costs $2,000, Medicare may cover up to 70% of that and your private insurer may pay the remaining 30%.

If your eye doctor charges more than the MBS fee, you might have to cover the rest as a gap fee^.

How much will cataracts cost with private health insurance?

Providing you have the right hospital cover plan in place, your private health insurance will either pay all of the costs of your surgery not covered by Medicare, or the majority of them.

With the right private health cover, a surgery which costs thousands of dollars will likely cost you, at the very most, a few hundred dollars^.

It’s worthwhile taking the time to find a suitable plan which covers as many of your costs as possible. Speak with a Compare Club health cover expert today.

*Cataracts **www.kindsight.com.au ^Medical Costs Finder `Cataract Surgery ^^All About Vision