Last Updated on 7 August 2020

Is Laser Eye Surgery covered by Private Health Insurance?


Health insurance for laser eye surgery
Key Points
  • Some health funds provide partial or total coverage for laser eye surgery with their comprehensive policies
  • There are waiting periods to receive surgery
  • Most health funds don’t cover the whole cost of the procedure, leaving you with the remainder of the bill.

 

Laser eye surgery can drastically improve vision and relieve the day-to-day hassle of wearing glasses or contact lenses.

This convenience comes at a cost, and it’s not something everyone can afford with some people getting personal loans to pay for the cost. It can range from thousands of dollars per eye—we’ll go into more detail on cost in this guide.

Private health insurance can help with some or all of the costs, though. Ahead, we’ll explain the coverage options you have when shopping for surgery options.

Is Laser Eye Surgery Covered?

The first question you’re probably asking is, “Does health insurance cover laser eye surgery?” The answer is both yes and no.

Medicare considers it to be elective, and won’t cover any benefits. That means those without private health insurance will have to pay out of their own pocket. The exception to this rule is when the surgery relates to correcting an eye disease.

The bulk of health fund policies don’t cover it either, but there are a few that do. Many of these policies provide rebates like LASIK as an incentive of sorts; providing a reason why you should choose them over the competition.

How Much is Covered?

The amount of surgery covered by your health fund depends on your policy. Only a select few funds cover the full cost, and this is dependent on the charge by the doctor not exceeding the limit.

All policies have a limit of some sort. A few health funds have a lifetime limit, while others have per-person and annual limits. Chances are, only a portion of your surgery is going to be covered by your health fund.

Which Health Funds Cover Laser Eye Surgery?

There are only a handful of private health insurance cover options available in Australia, and these are usually the top level of combined cover.

As we’ve stated, the health funds that offer coverage for these procedures usually do so as an incentive for you to pick their top plans.

Those that do offer coverage may only cover specific types of laser eye surgery. If they cover LASIK and you need SMILE, you’ll want to pick a different fund.

All funds that cover such procedures have waiting periods as well. These are at least one year and can be as long as three years.

Here’s a breakdown of some health funds that provide a benefit at the time of writing.

Health funds that cover laser eye surgery

As you can see, the choices are relatively limited. Health funds are adding and removing items from their coverage all the time, though, so it’s worth checking with your health fund to see what they offer.

HBF, for instance, recently removed the Ultimate Cover option from their portfolio. This was the only coverage type that included laser eye benefits.

What do I look for in a policy?

There aren’t an unlimited number of coverage options available to those interested in laser eye surgery. You probably won’t be able to be too picky here, but there are a few things you can look for to pick the right one.

Other Coverage Options

The first thing to look for in a policy is what other benefits are offered. Pick the policy that is most useful to you and your family.

Since all health funds that cover eye surgery only provide it with their comprehensive policy, get the most out of your dollar by looking for one that offers benefits you will use.

Amount Covered

If eye surgery is your primary concern, you probably want a health fund that covers all or most of the procedure. We’ll get into the pricing below, so you can better compare the general price vs. how much your health fund will cover.

As we’ve said, most health insurance policies don’t cover the entirety of the procedure. You’ll need to work within this budget to get the best value out of your health benefits.

Regardless of the benefits provided, you’re going to have to wait at least a year before you can make a claim. This means you’ll either have to plan well in advance, or consider paying for the surgery entirely out of pocket.

How Much Will Surgery Cost?

Depending on where you receive your surgery, the cost generally costs between $1,500 and $4,000 per eye, though it can cost more or less depending on your surgeon and situation.

Having surgery on both eyes? You’ll be looking at $3,000 to $8,000 or higher. Most outlets charge per eye, and some health funds pay benefits on this basis as well.

The cost isn’t relegated to the surgery alone, though. There may be consultation fees before you’re able to receive the surgery, although this is sometimes included in the total cost.

As you can see, health funds that offer $1,000 to $3,000 for a lifetime limit won’t cover the full cost of surgery. However, many clinics will give payment option plans if the initial cost is too high.

You might be able to find someone who will give you a better rate, but this isn’t an area where you want to cut costs. Do your research on the surgeon, clinic, and type of surgery before you commit.

What are the different kinds of laser eye surgery?

There are a few different kinds of laser eye surgery, and each is better for different eye problems. Here’s a brief overview.

  • LASIK: One of the most common forms of laser eye surgery. This procedure reshapes the corneal tissue under the outer layer.
  • PRK: Corrects nearsightedness (refractive errors). Only reshapes the surface of the cornea.
  • RLE or PRLEX: Similar to cataract surgery. Surgeon replaces the natural lens with an implant. Used in extreme cases.
  • Intacs: Treats nearsightedness. Surgeon places two plastic rings on the outer edge of your cornea to flatten it out.
  • Phakic Intraocular Lens Implants: Treats more extreme nearsightedness than LASIK or PRK. Surgeon places an implant lens behind your pupil or attaches it to your iris.

Should you get surgery?

The decision of whether or not to get laser eye surgery is up to you. Very few health funds provide full benefits for the procedure’s upfront costs. Most people are looking at a health fund that will only pay a small percentage of the total cost.

There are costs associated with having glasses and contact lenses as well, so you might be able to offset the cost by thinking about it as a replacement.

The treatment can make life easier in the long term for those who need it. It can be an expensive procedure, and requires careful consideration.


icon_message_double

Still have questions? Let's talk!

Confused? Not sure if this applies to your situation? Phone us on 1300 163 402 for some free, no obligation advice.

icon_message_double

Or want to compare policies now?