Cataracts

What is covered under Cataracts?

Hospital Cover for Cataracts includes hospital treatment for a specific eye problem known as a cataract. 

This condition causes clouding of the lens that makes it difficult for people to read, drive at night or see true colours.

This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS). 

Examples include:

• Lens extraction
• Lens removal or repositioning
• Lens removal and replacement with a different lens. 

Some treatments you might expect to be in the Cataracts clinical category are under Eye (not cataracts). For example:

• detached retina
• eye infections
• medically managed trauma to the eye.

Which Hospital Cover tiers include Cataracts?

What does it mean if cover is ‘optional’?

‘Optional’ means that the Australian Government allows insurers to choose whether or not to cover the clinical category under that Hospital Cover tier.

What does ‘restricted cover’ mean? 

Restricted cover means the insurer pays only limited benefits. 

If insurers offer cover for Cataracts under Basic Cover, they can do so on a ‘restricted’ basis. If you are admitted as a private patient in a private hospital for treatments under this clinical category, you will face considerable out-of-pocket costs.

You should check with your insurer before agreeing to be treated as a private patient in a private hospital if you have restricted cover for Cataracts. 

Does Medicare cover Cataracts?

Yes. Medicare includes all treatments under the Cataracts clinical category.

If there is an MBS item number for the treatment, Medicare covers it. 

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