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Need a spinal disc replacement? You no longer need Gold-tier cover.

4 min read
20 Aug 2019

Back pain can be excruciating – especially if it’s the result of a slipped or herniated disc. But it can also mean you may need spinal surgery to fix it, which doesn’t come cheap.

Previously, if you required a spinal disc replacement operation, your options were:

  1. potentially wait to be treated in the public system; or
  2. purchase health insurance and have it done privately.

The good news is: if you are looking to do this surgery through the private system, you’ll no longer need Gold-tier health insurance. This is because spinal disc replacement is now included as standard cover in Silver-tier policies.

What’s changed?

When the private health insurance government reforms were first put in place on 1 April 2019, hospital treatments were listed under a range of clinical categories, which were then categorised under different tiers: Gold, Silver, Bronze and Basic.

Spinal disc replacement was listed under the clinical category for joint replacements, along with other surgeries like hip and knee replacements. This category was only a standard feature of Gold-tier policies – the highest level available. Although, it could have also been included in Standard, Bronze or Silver plus policies if the health fund chose to do so.

However, from 1 July 2019, spinal disc replacement surgery was moved and listed under the back, neck and spine clinical category, which means it’s now included as standard cover for all Silver-tier policies.

Compare the Market’s General Manager of Health Insurance, Anthony Fleming, believes these are really positive changes for those suffering from back pain.

‘By moving this feature from the Gold to Silver tier, spinal disc replacement has become more accessible and affordable for those who want it covered through private health insurance,’ Fleming said.

‘This means you no longer need to get a top-of-the-line health insurance policy to be covered for this type of treatment.’

How much cheaper is Silver than Gold?

Previously, Gold policies were the only tier that included cover for spinal disc replacement as a standard. However, spinal disc replacements are now covered under Silver-tier policies, which could cost much less in annual premiums.

Monthly premium range (before rebate)1Median monthly premium (before rebate)Annual premium range (before rebate)2Median annual premium (before rebate)
Gold policy$157 – $283.28$220.14$1,884 – $3,399.36$2,641.68
Silver policy (not including silver plus)$123.45 – $200.75$162.10$1,481.40 – $2,409$1,945.20
1 Figures based on 41 Gold policies offered by 27 different health funds, for one adult that has full or interim Medicare, no current insurance, no dependants, is living in NSW and is looking for hospital cover for most services, analysed on on 2 August 2019.

2 Figures based on 29 Silver policies (not silver plus/advanced) offered by 11 different health funds, for one adult that has full or interim Medicare, no current insurance, one adult, no dependants, is living in NSW and is looking for hospital cover only for most services, analysed on on 2 August 2019.

Based on the policies analysed above for a single adult in NSW and before any rebate is applied, the median premium of a Silver-tier policy would cost almost $60 less a month than a Gold tier policy. This works out to around $700 less a year, which is quite a substantial difference.
Older woman with hands on her lower back in pain

How many Australians need spinal disc replacement?

Back pain is quite prevalent among Aussies.

Four million people in Australia (16.4% of the population) experienced back problems in 2017-18, according to the Australian Bureau of Statistics1. Also, according to the Australian Institute of Health and Welfare (AIHW), there were 91,000 hospitalisations in Australia for neck/back pain in 2016-17, with 45% of these involving surgery2.

However, while spinal disc replacement is typically only a last resort for those whose discs degenerate or whose back pain does not improve with continuous treatment over a period of time, this still affects a fair few Aussies.

Figures from the AIHW from 2017-18 show that fractures of the lumbar (lower) spine and pelvis were among the 20 most common principal diagnoses in 3-character groupings for rehabilitation care3.

In 2017-18, there were 2,415 rehabilitation care separations for lumbar spine and pelvis fractures in public hospitals, while there were 6,530 through private hospitals.

This means that more Australians opted to get private treatment for lumbar spine and pelvis fractures. So, for those people that do choose to get private treatment for a spinal disc replacement, health insurance for this treatment is now slightly more affordable under a lower-tier policy.

If you’re in the market for a health insurance policy that covers your back, neck and spine – or spinal disc replacement in particular – you can compare health insurance policies in minutes through our free comparison service.


[1]  Australian Bureau of Statistics, 4364.0.55.001 – National Health Survey: First Results, 2017-18.
[2] Australian Institute of Health and Welfare – Australia’s hospitals 2016-17 at a glance.
[3] Australian Institute of Health and Welfare – Admitted patient care 2017-18: Australian hospital statistics, Table 5.24.
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avatar of author: Michael Tabet

Written by Michael Tabet

Michael’s all about creativity and thinking outside the box (what box?). He uses his Communications degree to best share his ideas, stories and witty anecdotes. He is Compare the Market's resident TV buff and Harry Potter obsessive (great for trivia); ready to take on the world one word - and coffee - at a time!

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