Private health insurance for cataracts surgery

Cataracts are a common eye condition that can cause blurry vision, sensitivity to light, and difficulty with daily activities. Surgery is the only effective way to treat cataracts, but without insurance, the procedure can be subject to lengthy public hospital wait times and can be expensive in the private sector. For Australians facing cataract surgery, understanding how private health insurance can help cover the cost and reduce wait times is essential.

This guide explains how private health insurance relates to cataract surgery, what’s covered, and how to choose the right policy for your needs.

What Are Cataracts?

Cataracts occur when the eye’s natural lens becomes cloudy, reducing vision. This condition often develops with age but can occur earlier due to injury, medical conditions like diabetes, or prolonged exposure to UV rays.

What is Cataract Surgery?

Cataract surgery is a highly effective procedure that replaces the cloudy lens with an artificial intraocular lens (IOL), restoring clear vision. The surgery is typically performed as a day procedure, meaning no overnight hospital stay is required for most patients.

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 Does Medicare Cover Cataract Surgery?

Medicare covers part of the cost of cataract surgery performed in a public hospital. This includes:

• Surgery performed by a public specialist.

• The use of general or local anaesthesia.

• A public hospital day stay or overnight stay if required.

The Catch: Waiting Times

While Medicare covers cataract surgery in public hospitals, wait times in the public system can be long, often exceeding 6-12 months.

If you require surgery urgently or prefer to choose your own surgeon, private health insurance is a good option.

What is Covered by Private Health Insurance for Cataract Surgery?

Hospital Fees: Accommodation, theatre fees, and nursing care in a private hospital.

Surgeon and Anaesthetist Fees: Medicare and your private insurance policy will provide partial or full cover for specialists, depending on your insurer’s agreements.

Day Surgery Costs: Coverage for cataract procedures that don’t require overnight admission.

Intraocular Lens Replacement: Insurance may cover standard artificial lenses, although premium lenses designed to correct astigmatism or multifocal vision may incur out-of-pocket costs.

Key Considerations When Choosing a Policy:

Hospital Cover: Ensure cataract surgery is listed as a covered category under "Eye Surgery" or "Cataracts."

Gap Cover Options: Some insurers have agreements with eye surgeons, which can significantly reduce or eliminate out-of-pocket costs.

Waiting Periods: Cataract surgery is generally subject to a 12-month waiting period for pre-existing conditions on most health insurance policies.

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.

What If You Need Extras Cover?

While cataract surgery itself is covered under hospital policies, extras policies can complement your treatment by covering related expenses, such as:

Pre-Surgery Optical Needs: Prescription lenses, or specialist consultations otherwise not covered by Medicare.

Post-Surgery Expenses: New prescription glasses or contact lenses following cataract surgery.

Choosing a combined hospital and extras policy may provide broader coverage and greater peace of mind.

Why Compare Private Health Insurance Policies for Cataract Surgery?

Not all health insurance policies provide the same level of cover for cataract surgery, so ensuring you have the right policy is critical. Comparing insurers can help you:

Minimise Out-of-Pocket Costs: Some funds have agreements with certain hospitals and surgeons to reduce or eliminate gap fees.

Access to Surgeons: Choose a policy that allows you access to a wider network of experienced eye specialists, ensuring high-quality care.

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.

Take the Next Step

Cataracts can severely impact your quality of life, but with the right private health insurance policy, you can access timely and high-quality eye care without financial stress. Whether you’re concerned about out-of-pocket costs, long wait times, or getting the best possible surgeon, private health cover is an investment in your vision and well-being.

At Compare Club, our specialists can help you find a policy that meets all your cataract surgery needs. Let us help you compare options#, avoid unnecessary costs, and take the next step toward better vision.

Contact us today to find the perfect health insurance policy for cataract surgery.

Frequently Asked Questions

Do I Need Private Hospital Cover for Cataract Surgery?

While you can access cataract surgery through the public system, private hospital cover can offer faster treatment, your choice of surgeon, and access to private facilities. If avoiding a long waitlist is important to you, hospital cover is highly recommended.

Are Premium Lenses Covered by Insurance?

Private health insurance can cover standard intraocular lenses used in cataract surgery. However, premium lenses designed to correct astigmatism or provide multifocal correction may require additional payments. It’s best to confirm this with both your specialist and insurer.

How Much Will I Pay Out of Pocket with Health Insurance?

The amount depends on your policy, insurer, and doctor. Some insurers cover all costs if the surgeon is part of their no-gap or known-gap scheme. Others may require you to pay a portion, especially for premium lenses or non-standard services. Always check for gap arrangements with your insurer and service provider.

Is Cataract Surgery Covered Under Basic Insurance Policies?

No, cataract surgery is typically only covered under some Silver Plus or Gold-tier policies. If you hold a lower-level policy (e.g., Bronze or Basic), you may need to upgrade your cover and serve waiting periods before you can make a claim.

Are There Waiting Periods for Cataract Surgery?

Yes, most private health insurance providers impose a 12-month waiting period for pre-existing eye conditions, including cataracts.

What is a Pre-Existing Condition?

A pre-existing condition is any ailment, illness, or condition where signs or symptoms were present during the 6 months before you joined your policy. If you’re planning on needing cataract surgery, it’s a good idea to take out private health insurance early.

Sources:

• Medicare Australia, Private Health Insurance Ombudsman

• Royal Australian and New Zealand College of Ophthalmologists

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

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).