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Health insurance for gastroscopy
Gastroscopy is generally a simple procedure and is covered by Medicare and by private insurance, but the final cost can vary.
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Key takeaways
Gastroscopy is a common procedure for older adults, and can help diagnose and prevent more serious conditions from developing.
The procedure is covered by Medicare in a public hospital, and under bronze policies in the private system.
If you have private health insurance your out of pocket costs are likely to be less than $200 or so.
Is gastroscopy covered by Medicare?
Necessary gastroscopy will be covered by Medicare in a private hospital. The Medical Benefits Schedule (MBS) code for gastroscopy is 30473 and 30478 and the MBS fee is currently at $249.50. However, depending on your doctor, there may be additional costs. In some cases, Medicare will cover most of the costs and you will have very little out-of-pocket expenses, so make sure you do your research beforehand. Ask your doctor about costs and check that you're covered by Medicare.
Waiting times for the procedure can vary and can depend on whether you are categorised under category two or three. If it's the latter, you could be waiting up to 12 months for a gastroscopy.
How is gastroscopy covered by private health insurance?
You can get cover for gastroscopy with all bronze tier hospital policies. Bronze cover usually costs around $22 a week and should cover gastrointestinal endoscopy. Most policies come with a two-month waiting period if you don't already have similar cover, so you'll get to see a doctor quickly. If you have a pre-existing condition, the waiting period is 12 months.
Check with your health provider before the procedure to find out how much they will cover. Ask them about potential out-of-pocket expenses, such as consultation fees, doctor fees and nursing fees, as well as any anaesthesia fees in relation to the procedure. That way, you'll be able to work out whether you will have any out-of-pocket expenses and how much they will be. Depending on factors like your excess, insurance provider, doctor and hospital fees, you could be looking at around $40 to $150 for out-of-pocket expenses.
Gastroscopy cost
Without private health insurance, the average cost for a gastroscopy is around $1,350. This doesn't include out-patient costs or out-of-pocket expenses like assistants, anaesthetists, diagnostics or doctors' costs. With this included, costs are more likely to be around $2,000 to $3,000.
In a public hospital, most of this should be covered by Medicare. If you have private health insurance, most of your costs should be covered. According to Medical Costs Finder, the average out-of-pocket costs for gastroscopy is around $100 to $200.
Compare Finder Partners private health Insurance that covers gastroscopy
All prices are based on a single individual with less than $97,000 income and living in Sydney.
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.
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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
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Comparing quotes from 40+ funds...
What is a gastroscopy?
A gastroscopy is a procedure used to examine your oesophagus, stomach and the first part of your small intestine, also known as the duodenum. For the procedure, you would probably need to take a sedative. Your doctor would then put a thin tube with a camera, called a gastroscope, into your stomach through your mouth. The doctor would gently feed the tube down your oesophagus to your stomach and duodenum.
Your doctor often uses small biopsy forceps that can pass through the gastroscope to take tissue samples for diagnosis.
Finder survey: How many Australians have made a hospital claim related to a gastrointestinal endoscopy?
Response
Female
Male
Gastrointestinal endoscopy
5.56%
5%
Source: Finder survey by Pure Profile of 1006 Australians, December 2023
What is a gastroscopy looking for?
A gastroscopy is used to look for abnormalities in your oesophagus, stomach and duodenum. Common reasons for a gastroscopy include symptoms and issues like indigestion, nausea or difficulty swallowing. The following are some other reasons your doctor might prescribe the procedure:
Abdominal or chest pain
Reflux
Nausea and vomiting
Abdominal bloating
Stomach ulcers
If your doctor recommends you get a gastroscopy, it's often because they are looking for the following:
The narrowing of the oesophagus, known as oesophageal stricture
Stomach polyps
Hiatal hernia
Coeliac disease
Bleeding in your stomach
Lactose intolerance
Inflammation of the stomach (gastritis)
Stomach cancer or oesophagus cancer
How long does a gastroscopy take?
The procedure takes around 15 minutes and is considered very safe. Preparation takes a little longer as your stomach needs to be empty. You'll usually need to fast for at least five hours before the procedure, depending on the time of day you get it done.
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To make sure you get accurate and helpful information, this guide has been edited by Tim Bennett as part of our fact-checking process.
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
Gary Ross's expertise
Gary Ross has written 659 Finder guides across topics including:
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