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Is Plastic Surgery Covered By My Private Health Insurance?

Is Plastic Surgery Covered By My Private Health Insurance?

Is Plastic Surgery Covered By My Private Health Insurance?

If you’re unhappy about the shape or size of your nose, ears, breasts or any other part of your body, you might consider plastic or cosmetic surgery. It’s common now for people to alter their looks via hair transplants, dental work, liposuction cosmetic or plastic surgery and other treatments.

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And let’s face it; we’d all like to look like movie stars or beautiful celebrities and to stay looking young. Also, the societal pressure to repair and reshape our bodies is strong, but is the work covered by private health insurance?

The quick answer is, maybe, maybe not. It depends on what cover you’ve opted for in your health insurance policy and whether you want the surgery for cosmetic reasons or need it for reconstruction. If a procedure is medically essential, you are more likely to be covered by your health fund or even Medicare. However, always check your health insurance policy because not all funds cover all types of plastic surgery or other procedures. And also if your fund advertises that ‘reconstructive surgery’ is included, always check it.

Cosmetic surgery is popular, but it can be costly, so it’s definitely worth asking your fund if you’re covered. It’s worth noting that plastic or cosmetic surgical procedures NOT on the Government’s Medicare Benefits Schedule (MBS) list are unlikely to be covered by private health insurance. Also, Medicare doesn’t usually cover patients’ cosmetic surgery unless it’s necessary due to an injury, to improve function or a breast prosthesis or reconstruction after breast cancer surgery(1).

Plastic Surgeons vs Cosmetic Surgeons

Cosmetic vs Plastic Surgeon


Plastic surgeons and cosmetic surgeons are a totally different species. Any medically-trained and registered doctor can call themselves a cosmetic surgeon, and they can legally carry out specific cosmetic surgery procedures. However, to be a qualified plastic surgeon, a medically trained doctor has to complete another five years of study and training through the RACS

(the Royal Australian College of Surgeons)

Medically Necessary vs Cosmetic Surgical Procedures

The training allows the surgeon to be recognised as a specialist with qualifications recognised by the Australian Government.

Anyone can have plastic surgery to alter a physical feature if they’re not happy about the way they look. This is known as ‘elective surgery’, and it aims to improve a person’s self-esteem and self-image by reshaping, enhancing, or defining a part of the body. On the other hand, plastic surgery might be necessary to improve someone’s health or to help them to function normally. As mentioned above, this is called ‘medically necessary’, and it aims to fix an abnormal or damaged function, which may be caused by:

  • Abnormal development
  • Infections
  • Disease or trauma

Is Your Surgery Medically Necessary?

Who determines whether your plastic surgery is medically necessary or for purely cosmetic reasons? Your surgeon. That’s why it’s best to check with your private health fund and your surgeon to make sure your policy will cover what you want or what needs to be done. If you’re looking for a policy because you want cosmetic surgery, find a fund that will have the right inclusions.

It’s worth reiterating the fact that some medical conditions or treatment services may be partially covered by your health fund, which means there will be a gap payment which has to come out of your own pocket, so you need to know how much that will be before you commit. Also, your health fund might cover only certain aspects of your cosmetic surgery. For example, the surgeon’s fees might be covered but not the theatre fees.

Surgeries Possibly Covered by Medicare

Medicare covers some types of plastic surgery if it is necessary for medical or health reasons.

Post-breast cancer surgery implants, liposuction for someone who is morbidly obese, and skin grafts may be covered, as well as the following:

  • Cleft palate
  • Facial bone structure repair
  • Skin grafts
  • Breast reconstruction
  • Breast reduction

Cosmetic Surgeries Not Covered by Medicare

(These may not be covered by your private health fund or may only be partially covered):

  • Facelifts
  • Eyelid lifting
  • Botox or fillers
  • Breast implants or augmentation
  • Liposuction
  • Tummy tuck (abdominoplasty)
  • Nose job (rhinoplasty)

There are some exceptions, for instance, if someone needs a nose job to help them breathe better and sleep properly, then their health fund is more likely to cover the cost partially, and Medicare could cover all of it. But only if it can be proven to be medically necessary. The patient’s nose shape might change for the better into the bargain, but the main aim of the surgery is medical.

Don’t assume your surgery will be covered; always check with your doctor or health fund before you decide to go ahead with it. Another consideration is the possibility that you will have to wait months for your surgery, so always check.

At Trusted Surgeons, we firmly believe that elective procedures and cosmetic surgery should enhance a patient’s quality of life. However, this is not always the case in a profit-driven industry such as plastic and cosmetic surgery. Here, we strive to promote safer and more informed patient decisions. Trusted Surgeons is the leading educational platform for patients.

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References:

  1. https://www.medicare.gov/coverage/cosmetic-surgery

Kym Wallis

Author’s Bio

Kym Wallis, the founding director of Higher Ranking has over 15 years of advertising sales, digital strategy, and business development experience. He is currently working as Digital Adviser for Bioscor AU.