Cosmetic surgery isn't covered by health insurance, but medically necessary plastic surgery is.
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*Prices updated December 2024, in line with Finder's database of health insurance policies. Prices reflect the cheapest available for a single individual with less than $97,000 income and living in Sydney with a $750 excess.
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These products offer a balance between low pricing and more features.
7+
Great
Competitive products within their group.
5+
Standard
Usually these products would either have fewer treatments covered or higher pricing.
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Basic
Offering basic cover with limited features or higher pricing.
Key takeaways
Medicare or insurance will not pay for cosmetic surgery that is not medically neccessary.
However you can get cover for reconstructive surgery with a valid medical reason.
This is covered by the bronze tier of private hospital insurance.
How does Medicare or health insurance cover cosmetic surgery?
Plastic surgery can be split into two categories - reconstructuve and cosmetic surgery. Whether your treatment will be covered by Medicare or private hospital insurance depends on which category it falls into.
Reconstructive surgery
Reconstructive surgery is performed to correct abnormalities. These could be from birth or acquired through life, or be damage as a result of trauma or a bad accident.
Reconstructive surgery is generally considered medically neccessary and will covered by both Medicare and your private hospital insurance.
Cosmetic surgery
Cosmetic surgery is typically carried out to improve appearance rather than health. For example, facelifts, implants, eyelid surgery and liposuction.
It's not covered by Medicare or health insurance because it's not considered medically necessary.
Finder survey: How many people made a hospital claim for any of these conditions?
Response
Female
Male
Plastic or reconstructive surgery
0.96%
0.21%
Source: Finder survey by Pure Profile of 1006 Australians, December 2023
What counts as medically neccessary for plastic surgery?
There are a lot of valid medical reasons for plastic surgery. A few examples include the following:
Reconstructive facial surgery after a bad car accident
Surgey to correct your nose if you're unable to breathe properly
A single breast reduction to even them out after removing a cancerous breast
Policies that cover medically neccessary plastic surgery
Here's a sample of policies from Finder partners that include private cover for plastic surgery. All prices are based on a single individual with less than $97,000 income and living in Sydney.
Finder Score - Hospital cover health insurance
Each month we analyse over 10,000 hospital insurance products and rate each one on price and features. What we end up with is a nice round number out of 10 that helps you compare hospital cover a bit faster.
Before we start scoring, we need to make sure we're comparing like-for-like. Just as it doesn't make sense to compare a bicycle with a Ferrari, it doesn't make sense to compare basic hospital policies to top-tier Gold policies. Each policy is given a price score and feature score. These are then combined to determine each policies's Finder Score.
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*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
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Comparing quotes from 40+ funds...
Medicare vs private for medically neccessary plastic surgery
There will be some differences to your experience in the public or private system. Assuming your hospital cover is enough to cover the procedure, the big differences will be around surgery wait times and out-of-pocket costs.
Surgery wait times
When you need surgery, you'll be put into a queue of people waiting for a spot with a surgeon. There are wait lists for both the private and public system, but the private lists are generally a lot shorter.
How long are the lists? It depends, unfortunately. Public waiting lists can often be in the months or years. It will also depend on how urgernt your condition is. If you need urgent work as the result of trauma, you'll probably get seen very quickly. On the other hand, surgery that's deemed less urgent might see you drop down the list a lot.
Private hospital insurance is generally the most reliable way to get quick treatment.
Out-of-pocket costs (the gap payment)
In the public system, you won't need to pay anything for your surgery, though there may be some incidental costs. This is the benefit of going 100% public. Private treatment, though offering your choice of surgeon and faster treatment, could see you have some out-of-pocket csots.
How much these costs are vary significantly based on the exact surgery you're going in for. Here are a couple of examples from Medical Costs Finder, the government database of typical out-of-pocket costs for private patients:
Unilateral breast reduction: Typcially $1,000, up to $6,500+
Bilateral breast rexuction: Typcially $8,400, up to $11,000+
Droopy eyelid surgery: Typcially $650, up to $3,100+
Septoplasty (nose reconstruction): Typcially $680, up to $2,100+
To get an estimate of your out-of-pocket costs, you can check Medical Costs Finder, but you should also call your health fund for a more accurate estimate.
Tim Bennett is a Finder insurance & utilities expert. For over 10 years he's reported on news, politics, finance and other topics as a journalist and radio presenter. Tim's roles have included radio news reader and breakfast at the ABC, news producer for SBS and producer for Fairfax Media. Tim regularly appears as a health insurance expert on programs like Sunrise and SBS news, as well as in the Australian, The Daily Telegraph, The Courier Mail and more. See full bio
Tim's expertise
Tim has written 122 Finder guides across topics including:
Gary Ross Hunter was an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146). See full bio
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Accessing treatment from one of your health fund’s preferred providers can help you save money but can also limit your health care choices. Find out more here.
Health insurance for weight loss surgery starts at around $62 a week with gold-tier hospital policies. It comes with a 12-month waiting period, so it's worth getting sooner rather than later.
Query: re:Breast reduction surgery when medically needed for health reasons, how does this work regarding costs? I have HAD hospital cover?
Finder
JhezelynMarch 21, 2018Finder
Hi Karren,
Thank you for your comment.
Generally, health insurance covers surgical and accommodation costs under the hospital cover policy if the breast reduction surgery is medically necessary and not only for cosmetic purposes. You may learn more on how insurance cover breast reduction surgery. To compare the policies, you may fill out the form on the page provided and click the “Search Policies” button. Once done, you’ll see the quotes from different health insurance providers with a list of detailed benefits.
Please make sure to read the eligibility criteria, features, and details of the policy, as well as the relevant Product Disclosure Statement PDS/T&C’s of the policy before making a decision and consider whether the product is right for you. If necessary, speak to the insurance brand to verify any details.
Regards,
Jhezelyn
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Depending on your age, you may be eligible for an
aged-based discount. This is used to estimate your
rebate.
Under 65
65 - 69
70 or older
What's your household's taxable income?
This is the combined income you and your spouse earn before tax. It's needed to calculate the correct Australian government rebate.
$93,000 and under
$93,001 to $108,000
$108,001 to $144,000
$144,001 and over
What kind of health insurance do you need?
Combined (Extras + Hospitals)
Extras
Hospital
What level of hospital coverage would you like?
You can change this at any time later.
Legend
Covered
Restricted cover, You may be partially covered for
this category.
Not covered. Optional for insurer to include.
*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
What extras cover do you need? (Optional)
Select as many as you want or move to the next step
Preventative & general dental
Major dental & implants
Optical
Physiotherapy
Podiatry
Non-PBS pharmaceuticals
Chiropractic
Emergency ambulance
Remedial massage
Email me my results (optional)
To get a copy of your results for later, add your email below
Query: re:Breast reduction surgery when medically needed for health reasons, how does this work regarding costs? I have HAD hospital cover?
Hi Karren,
Thank you for your comment.
Generally, health insurance covers surgical and accommodation costs under the hospital cover policy if the breast reduction surgery is medically necessary and not only for cosmetic purposes. You may learn more on how insurance cover breast reduction surgery. To compare the policies, you may fill out the form on the page provided and click the “Search Policies” button. Once done, you’ll see the quotes from different health insurance providers with a list of detailed benefits.
Please make sure to read the eligibility criteria, features, and details of the policy, as well as the relevant Product Disclosure Statement PDS/T&C’s of the policy before making a decision and consider whether the product is right for you. If necessary, speak to the insurance brand to verify any details.
Regards,
Jhezelyn