Cataracts surgery cost

A cataract won’t improve on its own.¹ While glasses (or contact lenses) and better lighting can help during the early stages of cataracts, your doctor or specialist may recommend surgery if the condition impedes your everyday life.

Cataract surgery involves making a small incision in the eye and removing and replacing the clouded natural lens with an artificial lens (also called an intraocular lens or IOL). The surgery takes about half an hour and is carried out by an ophthalmologist.¹ As it is a day surgery, you should be able to go home the same day. The procedure is very common among older Australians.¹ It’s considered safe, painless and is usually successful in restoring sight. If you require cataract surgery on both eyes, each eye will be done on a different day. The gap between surgeries allows the first eye time to recover.

Although surgery is an option, not all cataracts need to be removed and replaced with a lens implant. Once you’ve been diagnosed with cataracts, your ophthalmologist (or eye surgeon) will discuss the suitability of surgery.

Below are some median prices to give you an idea of the average cost of cataract surgery. Many things can influence how much your cataract surgery will cost, so these figures should only be used as a guide.

For cataract surgery in a private hospital, typical specialist fees are around $2,000. Of this amount, Medicare paid $780, while the insurer will typically pay $830. The out-of-pocket costs for patients are $450 on average.³

You’ll also have hospital fees which include accommodation and theatre expenses and any medical devices. Hospital fees for cataract surgery typically cost around $2,400. Your health fund may cover most of this cost, although it’s likely you’ll need to pay an excess.³

Medicare will cover all your costs if you go through the public hospital system. The downside to this approach is the public waiting list is very long. You could be on this list for anywhere between a few months to over a year, depending on where you live and how many other patients are on the list.⁴ Whether it’s worth waiting depends on how much your cataracts impact your life.

When you’re a public patient, you’ll be assigned a surgeon to carry out your procedure. Not all cataract surgeons bulk bill, so if you have a preferred healthcare provider who looks after your eyes, you may be unable to access their services through the public system.

If you choose to go through a private hospital, Medicare won’t cover all the costs. However, there is a Medicare rebate for eligible patients that covers some surgical procedure costs.

Cataract surgery is an in-hospital procedure so private hospital cover can pay a benefit towards the cost of cataract surgery. Cataract surgery is a mandatory inclusion in Gold tier hospital cover. However, depending on your health fund, you may have access to cataract surgery as part of a Plus policy. Remember, cataract surgery doesn’t fall under the same category as optical on an extras policy or eye (not cataracts) on a hospital policy, so it’s important to check what eye care your policy covers.

Private insurance that includes hospital cover can help you to avoid the public hospital waiting list and give you the option to choose your available healthcare specialist. This can greatly reduce your wait time.

There may be waiting periods when taking out a new policy or adjusting existing health insurance. Usually, waiting periods will be two months for new conditions and twelve months for pregnancy and birth related services as well as pre-existing conditions (excluding rehabilitation, hospital psychiatric services and palliative care). A pre-existing condition is an ailment, illness or condition that you showed signs or symptoms of six months before taking out your cover.

Whether you need health insurance to cover cataract surgery depends on your lifestyle and personal preference. Statistically, you’re much more likely to develop cataracts later in life, so if you’re in your twenties, being uninsured for cataract surgery may not be a top concern. However, if you are in or approaching an age group that is more susceptible to cataracts, it may be worth investigating a health insurance policy that includes cataract treatment. Remember, there is a 12 month waiting period if your cataracts are deemed pre-existing, so it is a good idea to take out cover before you need it.

Although age is the most common reason for cataracts, other factors can lead to cataracts earlier in life. Consider your own needs, eye health history and lifestyle whenever adapting your level of cover. Cover for cataract surgery can provide peace of mind.

You can adapt your health insurance throughout your life, adjusting your cover to suit your needs. Just keep in mind that you will likely need to serve a waiting period before claiming on any upgrades. Talking to an expert can help you determine the best insurance policy for you and your loved ones.