How do I use telehealth extras benefits?
Learn about claiming telehealth benefits on your extras cover. We’re here to help with this short explainer.
2021 Update: How much do common surgeries cost?
We’ve updated our list of 30 hospital surgeries using the latest government data to give you an accurate snapshot of how much health funds and members typically pay for hospital.
The figures are for private hospitals using the government’s Medical Cost Finder tool to show you the median cost (the middle) that health funds covered in the year to 1 July 2020. After all, a lot of the value you get is what folks like us pay when you need to use your cover.
How to read this table
The first column row is key. It shows the percentage of health fund members who paid no out-of-pocket costs for their hospital treatment. For instance, 53% of health fund patients paid nothing for cataract surgery. In the second row, of the remaining 47% of members who had an out-of-pocket cost for cataract surgery, the median cost was $400.
The figures in the third last and second last columns show how much health funds paid on average for surgeries and the final column totals the health fund benefit average per surgery.
Note. The final column shows what you’d pay if you didn’t have hospital cover and you wanted to enter private hospital as a self-funded patient (spoiler: not fun for your pocket!).
Remember that half the surgeries cost more than the figures quoted. Hospital doesn’t come cheaply!
| Surgery type | Health fund | ||||||
|---|---|---|---|---|---|---|---|
| No gap % | Patient out-of-pocket costs | Specialist fees | Medicare specialist benefit | Specialist benefit | Accommodation, theatre and device benefit | Total health fund payment | |
| Cataract | 53 | $400 | $2,000 | $750 | $780 | $2,300 | $3,080 |
| Colonoscopy | 81 | $170 | $1,300 | $590 | $480 | $690 | $1,170 |
| Gall bladder | 30 | $350 | $2,700 | $1,200 | $1,100 | $4,600 | $5,700 |
| Heart surgery (Coronary artery bypass graft) | 23 | $390 | $15,000 | $7,400 | $6,800 | $32,000 | $38,800 |
| Heart surgery (Stenting blocked heart surgery) | 33 | $10 | $3,100 | $1,600 | $1,400 | $16,000 | $17,400 |
| Heart valve replacement | 22 | $410 | $14,000 | $7,000 | $6,300 | $39,000 | $45,300 |
| Pacemaker procedure | 45 | $50 | $2,600 | $1,300 | $1,100 | $18,000 | $19,100 |
| Varicose veins | 36 | $300 | $1,900 | $730 | $700 | $3,000 | $3,700 |
| Hernia (inguinal or femoral) | 40 | $370 | $1,900 | $680 | $660 | $3,600 | $4,260 |
| Thyroid tumour removal | 28 | $560 | $3,700 | $1,500 | $1,200 | $5,000 | $6,200 |
| ACL repair | 20 | $600 | $3,900 | $1,400 | $1,500 | $5,000 | $6,500 |
| Single hip replacement | 19 | $560 | $5,000 | $1,900 | $1,9000 | $21,000 | $22,900 |
| Double hip replacement | 9 | $3,800 | $8,900 | $3,100 | $2,200 | $33,000 | $35,200 |
| Knee replacement | 22 | $560 | $4,700 | $1,800 | $1,800 | $19,000 | $20,800 |
| Shoulder replacement | 23 | $590 | $5,600 | $2,100 | $2,200 | $19,000 | $21,200 |
| Bladder tumour removal | 49 | $280 | $1,700 | $680 | $590 | $1,500 | $2,090 |
| Kidney stone removal | 33 | $310 | $3,100 | $1,300 | $1,300 | $2,300 | $3,600 |
| Prostate removal (endoscopic) | 36 | $460 | $3,000 | $1,200 | $1,200 | $4,600 | $5,800 |
| Radical prostate removal | 9 | $4,400 | $8,600 | $2,600 | $1,600 | $11,000 | $12,600 |
| Caesarean: major complexity | 40 | $400 | $4,400 | $2,000 | $1,900 | $8,600 | $10,500 |
| Caesarean: minor/intermediate complexity | 43 | $410 | $3,800 | $1,700 | $1,900 | $8,000 | $9,900 |
| Vaginal delivery major complexity | 58 | $300 | $3,100 | $880 | $1,700 | $6,000 | $7,700 |
| Vaginal delivery minor/intermediate complexity | 69 | $350 | $2,900 | $810 | $1,700 | $5,800 | $7,500 |
| Adenoids | 22 | $400 | $1,200 | $370 | $420 | $1,200 | $1,620 |
| Grommets | 26 | $400 | $1,300 | $430 | $500 | $1,100 | $1,600 |
| Tonsil removal | 18 | $500 | $1,500 | $420 | $490 | $2,100 | $2,590 |
| Apronectomy (removal of excess abdominal skin and fat) | 9 | $4,600 | $6,700 | $1,300 | $730 | $7,500 | $8,230 |
| Gastric band | 37 | $590 | $3,500 | $1,200 | $1,100 | $8,900 | $10,000 |
| Gastric bypass | 23 | $620 | $4,400 | $1,600 | $1,300 | $9,900 | $11,200 |
| Sleeve gastrectomy (partial stomach removal) | 26 | $850 | $3,400 | $1,300 | $1,000 | $9,700 | $10,700 |
*All Australia, median data 2020 FY
These figures come directly from the Australian Government Department of Health and reflect health funds overall, not just Peoplecare.
Want more help with your planned surgery?
You can get a much more accurate estimate of planned surgery costs (if any) by asking your specialist for an itemised quote called Informed Financial Consent.
After more info? Check out our Going to Hospital Guide.
