Does health insurance cover cataract surgery? 

It’s the most common elective procedure performed in Australia, but cataract surgery has a long waiting list in public hospitals. According to Australian Institute of Health and Welfare data, more than 90% of people who had their cataracts done in 2022-23 had to wait more than a year. If you have Private Health Insurance, you can have your cataracts done in a private hospital relatively quickly, by the doctor of your choice, and you might get your own room (if the hospital can accommodate this). But how do you know if your health insurance covers cataracts? 

What are cataracts? 

Cataracts are when the lens of your eye becomes cloudy, usually caused by ageing and exposure to UV light. The most effective treatment for cataracts is surgery to remove the affected lens(es) and replace them with an artificial clear lens, a procedure that takes around half an hour.  

Half of Australians over the age of 50 will experience cataracts, and almost everyone will be affected by the age of 80. 

Is cataract surgery covered by health insurance? 

Yes, cataract surgery is covered by Private Health Insurance, depending on your level of cover.  

Full cover for cataract surgery is included in Gold tier Hospital Cover. Insurers may choose to offer it on Silver policies, although our research found almost all the policies that covered cataract surgery were ‘Silver Plus’. Restricted benefits for cataracts are offered on some Basic Hospital Cover policies, but you may face significant out-of-pocket costs. 

What are the tiers of Hospital Cover and what treatments do they include?

Don’t forget, there may be a waiting period for cataract surgery on health insurance. Usually, this will be 2 months if you have recently started your policy or have upgraded from a lower tier of policy where cataracts were not included. And if your cataracts are considered a pre-existing condition, you may have to serve a 12-month waiting period. Talk to your insurer to find out what waiting periods apply. 

How much does cataract surgery cost? 

If you have cataract surgery in a public hospital, the costs will mostly be covered by Medicare. In a private hospital, cataract surgery is estimated to cost around $4,400, including specialist and hospital fees. If you have Private Health Insurance, the typical out-of-pocket cost for specialist fees is $450, but there may be additional out-of-pocket costs for hospital fees. 

If you want cataract surgery in a private hospital, talk to your insurer to find out whether you’re covered, and ask about the excess, out-of-pocket fees, waiting periods and conditions that may apply. 

What’s the best health insurance policy for cataracts? 

There’s a wide range of health insurance policies available that will cover you for cataracts – and a wide range of prices, too. We found the cheapest Gold policy for one adult in Victoria with a $750 excess was $225.45 per month, and the most expensive was $437.50 per month.  

To find the best health insurance policy for cataracts, use the healthslips.com.au Calculator to search every policy on the market. We don’t sell insurance so the results we give you are unbiased, and you won’t have to enter any contact details.  

Look for a new policy, or compare your existing policy to other policies. 

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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