Coronary Bypass Surgery Cost
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Expert tips for choosing health insurance
Our health insurance expert, Steven Spicer, has some helpful tips for choosing the right health insurance for you.
Steven Spicer
Executive General Manager – Health, Life & Energy
Choose the right level of cover
One of the key decisions to make when comparing policies is which level of cover is right for you. Ideally, your policy will cover all your health needs without paying for inclusions you’ll never use. The best place to start is to consider your health needs, family history and lifestyle to help get an idea of what you require from health insurance.
Understand your inclusions
You don’t want to find out you’re not covered when you really need it, especially when it’s an expensive procedure like a coronary bypass. When choosing a policy, it’s essential you understand exactly what each clinical category covers so you can have peace of mind.
Regularly check and adapt your policy
As we age, our health needs will change. The risk of many conditions, including heart disease, increases as we get older, so you’ll want to adapt your policy to meet your changing health needs. If it’s been a while since you looked over your policy, it’s worth checking if there are any changes you need to make. You can upgrade your policy at any time, simply serve the relevant waiting periods before claiming on any new or increased services.
What is coronary artery bypass surgery?
A coronary artery bypass graft (sometimes called heart bypass surgery or coronary revascularisation) is an open cardiac surgery that can help treat and relieve the adverse effects of coronary artery disease.1,2 The surgery involves taking a vein from your leg, chest wall or wrist and grafting it onto the affected heart artery to create a bypass to improve blood flow. Usually, two to four coronary arteries will need to be grafted, depending on the severity and location of the blockages.
The operation is performed under general anaesthetic and takes around 3 hours.1 You’ll likely stay in hospital for 3-5 days before you can go home.
What is coronary artery disease?
Coronary heart disease (or artery disease) occurs when the arteries in your heart become blocked or narrowed.3 This usually occurs due to a build-up of plaque and scar tissue inside the arteries. Narrow or blocked arteries lead to reduced blood flow, which can lead to issues such as blood clots and heart failure. Heart attacks and angina (chest pain or discomfort) can also result from blocked or narrowed arteries.
Are there alternatives to coronary bypass surgery?
Depending on the specifics of your condition, you may be able to have a percutaneous coronary intervention (PCI) or balloon angioplasty.1,2 This involves using a small inflatable balloon to hold the artery open. A stent or a mesh tube may be inserted to keep the artery open. Medication can also relieve symptoms, improve blood flow and help prevent heart disease from worsening. An exercise and diet program may also be suggested, particularly if you’re overweight. These changes are also recommended to those who undergo bypass surgery.
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Cost of bypass surgery in a private setting in Australia
According to the Australian Government’s Medical Cost Finder page, the typical specialist fee for coronary artery bypass graft (CABG) for the procedure in a private hospital is $15,000.4 While this is pricey, the good news is that, in a private setting and for patients with private the relevant private health insurance, Medicare typically covers $7,600 and your insurer will typically cover $6,600. Patients are usually left with around $500 in out-of-pocket costs. The Medicare Benefits Schedule Item Numbers for a coronary artery bypass are 38500 and 38502.
Hospital fees typically cost around $33,000, and this will cover your hospital stay. Depending on your policy, your health fund generally covers some or all of these costs. Depending on your policy and procedure, you may be required to pay an excess or co-payment. You may also have some out of pocket expenses.
Costs can be affected by several factors, including the severity of your condition and complications in surgery, so the above prices should be considered a general guide.
Does private health insurance cover heart bypass surgery?
Private hospital insurance can contribute towards the cost of coronary bypass surgery, provided you have the right level of cover and have served any relevant waiting periods. Your policy must include the clinical category ‘Heart and Vascular system’, which is a minimum requirement in Silver and Gold policies. However, this category may be included in a lower level of hospital cover, depending on the health fund.
Some of the key benefits of being treated as a private patient can include:
- Your choice of specialist and healthcare clinic
- Avoiding public hospital waiting times
- A private hospital room (subject to availability).
Remember, there may be a ‘gap’ between the Medicare Benefits Schedule (MBS) fee and what your specialist charges. Depending on your policy, your fund may not cover this gap payment. Check your product disclosure statement (PDS) or policy documentation for further details. It’s also a good idea to contact your health fund prior to a procedure.
Does Medicare cover the cost of bypass surgery?
Medicare can cover the total cost of bypass surgery if you are treated as a public patient through the public system. There may be some downsides to being treated in a public hospital over a private hospital. Depending on where you live and the demand for public services, there can be long waiting times for treatment in a public hospital. The average waiting time for a coronary artery bypass grafting is anywhere between 19-105 days, depending on which state you’re in.5
Are there waiting periods for coronary bypass surgery?
Whenever you take out a new policy or upgrade your current policy, you will likely have to serve a waiting period before you can make any claims on your policy. The standard waiting period for most new conditions is 2 months, whereas for pre-existing conditions, the waiting period will typically be 12 months. If you’re changing providers and have already served a waiting period for an inclusion, you won’t need to serve it again provided you give your new health fund your previous fund details or provide them with your transfer certificate.
Meet our health insurance expert, Steven Spicer
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.
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1 Health Direct – Coronary artery bypass graft. Accessed January 2025.
2 Health Direct – Coronary heart disease. Accessed January 2025.
3 Victoria State Government: Better Health Channel – Heart bypass surgery. Accessed January 2025.
4 Medical Costs Finder- Coronary artery bypass graft (CABG). Accessed January 2025.
5 Australian Institute of Health and Welfare – Elective Surgery Times 2023-2024. Accessed January 2025.