Find The Best Health Insurance For Weight Loss Surgery

Considering weight loss surgery isn’t a decision that’s made lightly. If you feel like you’ve exhausted all of your options, it’s important to know the costs and risks associated with this type of surgery.

Weight loss surgery isn’t always covered by Medicare, so this guide takes you through the ins and outs of health insurance for weight loss surgery.

Is weight loss surgery covered by my health insurance?

Many private health funds cover weight loss surgery. However, it’s usually part of their top tier gold policies, so keep in mind that premiums will probably be on the higher side. There is also the potential for gap fees, depending on your surgeon and the type of after-care that’s offered. 

Is weight-loss surgery covered by Medicare?

Medicare will only cover weight-loss surgery under certain circumstances, such as a patient being diagnosed with clinically severe obesity. 

To even get a diagnosis, you have to meet certain criteria, which includes a solid track record of trying (and failing) to lose weight naturally. 

You also need a body mass index (BMI) over 40, or above 35 when you have a medical condition like heart disease. 

Do all private insurers cover weight loss surgery?

Most private health insurers in Australia do have a policy that covers weight loss surgery, but it comes at a premium.

This is because the surgery is offered on gold cover plans and can come with a range of extra services you might not need.

Speaking to a Compare Club specialist can help you find the best type of cover at a decent price.

What are the common types of weight loss surgery?

The three most common types of bariatric or weight loss surgery are lap band surgery, a gastric bypass and a gastric sleeve surgery.

Lap band surgery 

This surgery is also called gastric banding and involves an adjustable ring fitted around the top part of the stomach that effectively creates a very small pouch.

This causes food to stay in the upper stomach for longer, creating the sensation of being full.

This surgery has an average hospital stay of one day.

Gastric sleeve 

Here, 80% of the stomach is removed, allowing the patient to only consume small amounts of food for a prolonged period of time. This surgery has an average hospital stay of two to four days.

Gastric bypass 

During gastric bypass surgery, the stomach is stapled to form a little pouch and some of the intestine is removed.

The stomach is then joined directly to the small intestine. As a result, food bypasses most of the stomach and fewer calories are absorbed.

This surgery has an average hospital stay of two to three days with regular appointments afterwards every one to two months.

What types of weight loss surgeries are covered by health insurance?

The type of surgery and the costs covered can vary from policy to policy. That’s why it’s important to compare what’s covered in different policies before you commit. 

How much does weight loss surgery cost in Australia?

The average cost, without health insurance or Medicare, depends on the state you live in and the type of surgery you’re having. 

Having private health insurance will dramatically reduce the amount of money you pay for weight-loss surgery, but the price also depends on the surgeon you see and the type of care you receive post-surgery. See the below table for more info.

You’ll also need to check if your insurer has a no-gap or known-gap scheme so you’re not surprised by any additional out-of-pocket costs.

These can cost you anywhere between $2,800 to $7,000, depending on your surgery type, surgeon fees, your private health insurance excess fee, the amount of time you’ve spent in hospital and where in Australia you live.

What type of health cover do you need for weight-loss surgery?

Some surgeons recommend that you need a Gold Hospital plan (the top-tier cover) to be covered for weight-loss surgery. There may be a 12-month waiting period as obesity is usually considered a pre-existing condition.

Many private health funds offer weight loss classes and additional support as part of their top level extras packages.

If you’re interested in covering some of the costs associated with losing and maintaining weight, Compare Club can help you find coverage that meets your needs.

How can I find an appropriate health insurance policy for weight loss surgery?

To find a suitable private health insurance for weight loss surgery, it pays to compare. Not all policies are the same, so it can be a good idea to look at your individual needs, budget and lifestyle to help you find “the one.”

Our experts can walk you through your options and handle all the paperwork for you once you’ve made your choice.

This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.

Bariatric Surgery Source, Weight Loss Surgery Australia, 2021, https://www.bariatric-surgery-source.com/weight-loss-surgery-australia.html#