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Private Health Insurance For Breast Reduction

Name: Private Health Insurance For Breast Reduction
Creator: Savvy
Published: 2023-04-03T10:04:24+09:30

Compare quotes for private health insurance that covers medically-necessary breast surgery through Savvy.

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Written by , updated on July 6th, 2023

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Are you considering the possibility of surgery for breast reduction or augmentation and wondering if private health insurance will help cover the cost? Medicare won’t cover these procedures unless there is a medical reason for needing them.

You can find out what the Medicare rules are regarding medically-necessary breast surgery here with Savvy and compare policies for private health insurance which may be able to assist with the cost. Get free online quotes from a panel of some of Australia’s leading health insurers through us today.

What type of health insurance covers medically-necessary breast reduction surgery?

If you qualify for medically-necessary breast reduction surgery, a private health insurance hospital cover policy can assist with the cost of the surgery. Coverage for this type of surgery is usually only available with silver or gold hospital cover policies. However, it’s important to check the exact details of the plan you're considering, as some health insurance policies don’t cover this type of surgery at all.

Breast reduction surgery won’t be covered by Australia’s Medicare system if it’s undertaken purely for cosmetic reasons. However, there are many circumstances where breast reduction and augmentation surgery are considered medically necessary, most often following surgery for breast cancer or developmental abnormality. Other reasons may include:

Back pain
Neck and shoulder discomfort
Headaches (particularly migraines)
Breast hypertrophy (increase in density and weight of the breasts)
Shortness of breath
Numbness in the arms and fingers
Re-occurrent skin infections and irritations
Inability to participate in exercise or sporting activities
Self-esteem and mental health issues caused by breast size

Your doctor will need to provide documentation to your health fund to certify that your breast reduction is considered medically necessary. If the diagnosis is accepted, Medicare will pay a benefit amount towards the cost. Private health insurance can assist with additional costs which may not be covered by Medicare, such as gap fees charged by your surgeon or anaesthetist or day theatre fees if you have the procedure performed in a private hospital. Usually, breast reduction only requires a short stay in hospital, possibly one to two nights.

Savvy can help you compare health insurance policies which may include cover for mammoplasty. All you need to do is fill in an online form and you can have a range of health insurance quotes to compare from our panel of insurers, including some of Australia’s top health funds.

How much does medically-necessary breast reduction surgery cost in Australia?

Breast reduction surgery, or reduction mammoplasty, can cost anywhere between $7,000 and $20,000* in Australia, depending on whether surgery is necessary on one or both breasts. If surgery has been performed to remove a tumour in one breast, reduction surgery (or augmentation on the side which has been operated on) is often only required on one side to even up the dimensions of both breasts. The complexity of the procedure may also impact the cost of your surgery.

An example of the costs charged for a bilateral breast reduction (both breasts), taken from a leading breast clinic in Victoria, are:*

Item	Full cost	Estimated out-of-pocket cost
Initial consultation	$250	$180
Surgeon's fees	$12,000	$8,650
Anaesthetist's fees	$2,250	$1,950
Hospital excess	$0 - $750	$0 - $750

*All figures and quotes are correct as of April 2023.

Types of health insurance

Hospital cover

This can help you pay for medical treatment if you need to be admitted to hospital. It can help cover the cost of your admission or accommodation and the fees charged by doctors, surgeons and anaesthetists. It can also cover other costs associated with a stay in a private hospital.

Extras cover

This helps cover the costs of health care treatments outside a hospital setting which aren’t covered by Medicare. This can include major and minor dental treatment, orthodontics, hearing aids, physiotherapy, glasses, contact lenses and podiatry (in most cases with annual limits).

Cover for singles

This is a standard health insurance policy designed for a single person, rather than being tailored to cater to the needs of a couple or family. It may include hospital cover plus extras, or either of these types of insurance on their own, depending on what you're after for your health cover.

Cover for families

A family health insurance policy is designed for a family unit including dependent children who may reach up to 31 years of age with some insurers. It offers private health insurance suitable for the whole family and may include shared limits for all members included in your policy.

Cover for seniors

A health insurance policy aimed at seniors is designed to appeal to people who are in the second half of their life. These are often specific Silver Plus policies that offer the same cover as other health insurance policies, with the exception that pregnancy and childbirth cover may not be included.

OVHC

Visitors who are in Australia on a temporary basis for travel, work or study may be able to take out Overseas Visitors Health Cover (OVHC). Many visas issued in Australia come with a requirement to take out this type of insurance, which covers visitors who may not be covered by Medicare.

Ambulance cover

Ambulance cover is generally available either packaged into your private health insurance or on its own as a separate policy or subscription. By having this protection, you could be covered for all eligible ambulance travel in Australia (subject to your insurer's terms and conditions).

Basic hospital cover

The cheapest and most barebones form of private hospital insurance, this can include cover for rehab, in-hospital psychiatric services and palliative care. Having this policy will enable you to avoid paying the Medicare Levy Surcharge (MLS) and Lifetime Health Cover (LHC) loading.

Bronze hospital cover

Bronze hospital cover is a step up from basic insurance, including 18 further clinical categories such as ear, nose and throat, bone, joint and muscle, digestive system, joint reconstructions, gynaecology and chemotherapy, radiotherapy and immunotherapy for cancer.

Silver hospital cover

Silver hospital cover is the second-most expensive type of policy and offers the second-most clinical categories. On top of what's offered by basic and bronze cover, it also includes heart and vascular system, lung and chest, blood, hearing device implantation and dental surgery.

Gold hospital cover

The highest level of private hospital insurance available in Australia, gold policies can offer cover for pregnancy and birth, weight loss surgery, assisted reproductive services and insulin pumps on top of all the categories provided by silver, bronze and basic hospital insurance.

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Frequently asked questions about private health insurance for breast reduction

What criteria are applied by Medicare for determining if breast reduction is medically necessary?

If your doctor certifies that your breast reduction is medically necessary, you will also have to fulfil the following criteria in order to get a Medicare rebate:

The surgery is considered necessary to treat pain
Non-surgical procedures have been tried but haven’t worked
Symptoms have lasted at least six months

If I get health insurance for my breast reduction, will there be any waiting periods?

Yes – there may well be waiting periods that apply before you can make a claim on your health insurance hospital policy. The length of time that you may have to wait will depend on the level of private health cover that you’ve previously had and the tier of cover you may move up to. However, as a pre-existing condition on its own, breast reduction can come with a waiting period of 12 months.

How do I compare health insurance policies that will cover some of the cost of breast reduction surgery?

Some aspects of private hospital cover to compare when looking at policies side-by-side include:

Cost of the policy – how much you’ll pay in premiums each month
Coverage – exactly what the policy covers, and any exclusions there may be
Excess – make sure you're comparing health cover at the same level and with a similar excess, such as a silver policy with a $250 excess with another silver policy with a $250 excess. This will ensure you are comparing policies that offer a very similar level of coverage
Co-payments – check if any co-payments are required for hospital admission. These co-payments can be up to $100 a night.

What expenses can an extras policy cover after I have breast reduction surgery?

If you also have extras cover, some of the costs of receiving outpatient treatment may be covered by your extras policy. These could include:

physiotherapy to aid with scar healing
nutritional advice to help keep your weight down
visits to a chiropractor to assist with musculoskeletal positioning as your body adapts to less weight on your chest

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Helpful health insurance guides

Looking for health insurance to cover your condition or treatment?

Read one of our helpful guides on a range of different ailments and potential hospital or extras treatments to help you find out if they're covered.

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