Health insurance for heart conditions

Chris Stanley

Chris Stanley

Updated 11/01/2023
Fact Checked

While health insurance does cover certain heart and vascular procedures, it’s important to know whether your particular condition is covered by your current health policy - and what to do if it isn’t.

Health insurance for heart conditions

More than 4 million Australians live with cardio-vascular disease. This represents 16.6% of the total Australian population.

A Guide To Private Health Insurance For Heart Conditions

Each year, around 1.2 million Australians are diagnosed with heart or vascular conditions^. If you’re one of them, living with your condition can be worrying enough without the added burden of figuring out how you’ll pay for life-changing treatment.

That’s why we put together this complete guide to insurance for heart patients, answering all your questions so you can make an informed decision about your next steps.

Key Points

  • Heart and vascular cover can help reduce - or even eliminate - out-of-pocket expenses for heart surgeries and other treatments.

  • Most health funds place this cover in the Gold and Silver tier options, and some Bronze Plus plans.

  • Individual circumstances can make a difference to the level of cover that suits you best. Taking time to compare a range of policies can help you find the most cost-effective cover for you.


What’s covered by heart and vascular health insurance?

Depending on the health cover tier you choose, heart and vascular insurance typically covers most of the costs involved in heart-related private hospital admissions. This includes:

  • Hospital admission costs (whether to a private hospital or a public hospital as a private patient).

  • Theatre fees.

  • Specialist surgery and consultatnt fees.

  • Scans and tests.

  • Medicinal and other treatments.

How much does heart surgery cost?

The average cost of heart surgery in Australia is around $21,400`. With the right cover in place, your out of pocket expenses may only be around $50.

How much does open heart surgery cost with Medicare?

Open-Heart surgery can be used to carry out various procedures such as Coronary Artery Bypass Grafts (CABG), heart valve replacements and heart transplants.

Depending on the type of surgery you need and your health cover, total costs can range from $32,000 - $39,000, with out-of-pocket expenses averaging around $400.^^

Medicare then only covers 85% of the costs of seeing a specialist. Since most cardiac care is expensive and the costs can add up very quickly, it is wise to look at private cover to pay for the difference. If you have to stay in the hospital, take heart medication, or have other expensive treatments, you may find private health cover useful.

Furthermore, Medicare doesn't allow you to choose your doctor. So while you will get the emergency care you need, for ongoing care, you may decide to look into private health insurance to ensure that you can have the specialist you want looking after your heart.

The good thing is that no matter what, you are protected at a basic level for emergency care. You can get tests done, can get your basic hospital stay (if needed) covered, and more.

The bad news is that paying for ongoing care to see a specialist may be left to you. As such, either make sure that you are able to afford the out of pocket expenses, or consider private health cover to help you pay.

Which health insurance is good for heart patients?

Heart and vascular care sits in the Silver tier of hospital cover and is the primary insurance for heart health. It covers the costs of public and private hospital admissions, as well as any surgery you may need for heart disease or heart attacks.

Opting for Extras Cover also gives you access to services for improving your overall heart health.

Extras Cover can include programs for increasing your fitness and losing weight, or accessing a number of medicines not included in the Pharmaceutical Benefits Scheme (PBS)**.

Does health insurance cover heart surgery?

Providing the required waiting period has passed, Silver-tier hospital cover and above will cover your heart surgery.

If you currently only have Bronze or Basic cover, you can use our free online comparison tool to find a suitable option for upgrading your cover#. If you’re likely to need surgery, it’s best to do this as soon as possible due to the waiting periods.


Does my health insurance cover heart disease?

The treatment for conditions resulting from heart disease (heart attack/bypass surgery, etc.) are generally covered by Silver, Silver Plus and Gold tier hospital covers.

What are the best private health cover tiers for heart conditions? Silver hospital cover is the lowest tier that covers heart and vascular surgery.

That said, there is variation between funds. Some Silver Plus plans may also cover non-heart and vascular items that you need, such as joint replacements or cataracts.

Our complete guide to hospital surgery cover breaks down the differences between each tier of cover.

How do I find the appropriate health insurance for my heart condition?

The most effective way to find the ideal health insurance policy for your heart condition is to consider your own unique circumstances, and all of your heart health needs.

Take the time to explore the details of multiple policies to find one that covers everything you need without any hidden costs or out-of-pocket expenses. This way, you can be sure that you're getting the most cost-effective plan for your individual circumstances.

Over the past five years, Compare Club has helped Australians save an average of $300 on their annual health insurance when they compared policies from our panel of insurers and switched to better value cover*.

What to look out for when comparing health cover

If you have an existing heart condition, or if you have a family history of heart disease, it may be wise for you to compare private health insurance before making a choice.

This way you can choose potential policies based on what cover you'll get and what premium you'll pay for your heart care. Look out for information about:

  • Cardiac surgeries

  • Cardiac treatments

  • Cardiologist consultations

  • Heart related medications

  • Any other specific health care you might require

The heart is the most hard-working part of our body.

We should take care of it as best as we can, not just through health insurance but also through lifestyle changes such as healthy eating habits, regular exercise, and avoiding unhealthy environments.

This way, we can help our hearts and hope to live longer as well as saving money on health care costs/


^ ** ^^How-much-do-common-surgeries-cost *Average savings based on 136,746 customers between 1 Jan 2018 - 23 December 2022. `Surgery-cost-calculator #Compare Club compares selected products from a panel of trusted insurers. We do not compare all products in the market.

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.

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Chris Stanley

Sales & Operations Manager for Health Insurance