Private health insurance for hernia surgery

Hernias can be incredibly painful and seriously affect your quality of life. Still, with the cost of surgery running into the thousands, it’s little wonder so many Australians are reluctant to get their hernia surgically repaired.

Here, we look at exactly how much surgery might cost and answer your questions about how private health insurance and Medicare can help you cover your expenses.

How much does it cost to have hernia surgery?

For private patients, the average cost of hernia surgery in Australia ranges between $5,000+ and $6,000. 

Does Medicare pay for hernia surgery?

If you're being treated in a public hospital as a Medicare patient, then Medicare will usually cover hernia repairs. 

While that sounds like good news, the waiting lists for hernia surgery in public hospitals can be significant and, since untreated hernias can rupture, going private may be the best move for the sake of your health.

If you take this route, Medicare will cover part of your surgery costs (around 20% - 25% of the Medicare Benefit Schedule (MBS) fee) leaving you to make up the rest. 

Is hernia surgery medically necessary?

Given the costs involved, you may well be tempted to try and avoid hernia surgery altogether.

In some cases, this might be okay. If you have a small hernia without any symptoms and it isn't causing you too much trouble, your doctor may recommend that you keep an eye on things and get the surgery only once symptoms (hiatal hernia) occur. This may even be the case following tests to diagnose hiatal hernia.

That said, a hernia will unlikely ever disappear on its own and will  likely get worse over time. Symptoms you might have (e.g. chest pain, difficulty swallowing, sliding hiatal hernia, abdominal cavity, acid reflux) could even lead to serious problems such as strangulation. 

As such, surgery is often recommended as it's the only way for complete open hernia repair. Different kinds of hernia such as hiatal hernia may also warrant surgery more than others.

Does private health insurance cover hernia surgery?

Most private health insurance providers offer plans which cover the majority of hernia treatment costs, often reducing your out-of-pocket spending from several thousand dollars to -at most- a few hundred. From laparoscopic hernia surgery to hiatal hernia repair surgery to hiatus hernia repair, there are many types of treatments that are covered by health insurance.

Our helpful health insurance comparison tool can help you find cover to help you keep your hernia surgery costs to a minimum.

Are there any gap fees for getting hernia surgery?

Depending on the type of private health insurance coverage you get, your gap fees are likely to range from $250 to $400, though the Department of Health's medical cost finder notes that 40% of hernia patients with private health insurance paid nothing for their treatment. What are the standard waiting times for elective surgery for hernias?

According to the latest available data from the Australian Institute of Health and Welfare, 50% of hernia patients were admitted for surgery in a public hospital within 56 days of being placed on the waiting list, while 90% were admitted within 259 days.

In a private hospital, waiting lists are dramatically reduced, with a patients necessitating surgery typically waiting no more than 25 days and often much less depending on the availability of your surgeon.

What are the waiting periods for claiming on health insurance for hernia surgery?

As with many medical procedures, there is a waiting period for claiming on your health insurance for hernia surgery. 

This is the standard 12 months if you take out your policy while your hernia is a pre-existing condition, or two months if it’s a new condition that develops after you first take out your policy. 

How do you find the best health insurance for hernia operations?

The most effective way to find the right health insurance for your hernia operation is to take the time to really look into the details of each policy and ensure that it covers everything you need so that you're left with very little -if any- out-of-pocket expenses. 

This means finding health insurance that can cover the specific operations that you may need such as laparoscopic surgery and hernia repair surgery as well as ensuring that your surgeon has an agreement with your insurer regarding costs

Over the last 5 years Compare Club has helped Australians save an average of $300* when they compared policies from our panel of insurers to find a better value option^  for them. 

We can help you do the same when you call to speak to our team today. Alternatively, use our free online comparison tool^ today to find the coverage you need at a price you can afford.

References

Department of Health and Aged Care, Medical Costs Finder, accessed 19th August 2022.

Australian Institute of Health and Welfare, Elective Surgery, accessed 19th August 2022. 

*Based on 136,746 customers between 1 Jan 2018 - 23 December 2022.

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).