Will Medicare Cover

My Gastric Sleeve?

Weight loss surgery can be an effective treatment for those people who are struggling to lose weight through non-surgical methods, like dieting and exercise. If you or a loved one is eligible for Medicare and may be considering weight loss surgery to overcome obesity, there are several factors to consider.

How Does Medicare Regard Weight Loss Surgery?

Unlike cosmetic surgery, Medicare considers weight loss surgery as a genuine health intervention.

Every surgical procedure that is supported by Medicare is listed in a large directory called the ‘MBS’ and each has its own unique Item Number. medicare

Weight Loss Surgery is no different, the Item Numbers for are Gastric Bypass and Mini Gastric bypass is 31572 and for  Sleeve Gastrectomy it is 31575. This means that Medicare will partially cover the costs involved in your surgery.

Private Health Coverage for Weight Loss Surgery

Furthermore, Private Health Funds will cover the hospital fees associated with any procedure that has an Item Number, including weight loss surgery.

Private Health Funds usually offer different levels of cover depending on your monthly premium or plan.

As is common with most procedures, there is usually an out-of-pocket ‘gap’ that the patient must pay as the rebates from Medicare and Private Health Funds are not sufficient to cover all the associated costs with our complete 

Why is there a Gap payment for  weight loss surgery

You may be wondering why is there an out of pocket or “Gap” cost for weight loss surgery, even though you may be having top hospital cover. The costs associated with weight loss surgery are not just due to surgeon, anaesthetist and assistant fees. Rather a large component of this is geared towards our exhaustive After Surgery Support program. Our After Surgery Support program has an outstanding reputation and this is reflected in our testimonial’s.

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Our out of pocket costs for a fully insured person is in the vicinity of $5000-$6000, however this is the total cost which covers everything including anaesthetists fees, assistance fees and all resources included in our after surgery support program. This is what gives you peace of mind and Financial predictability.
 
This demonstrates the real and valuable contribution that Medicare and the Private Health Funds make toward the cost of weight loss surgery.

How much does Medicare actually pay for gastric sleeve?

If we took the example of a gastric sleeve, what Medicare pays is a considerably small proportion of the entire cost associated with not just the surgery but all the after surgery support. As you will Very well appreciate, success following weight loss surgery is not Just about surgery, it is also about the after surgery support. Some would argue that after surgery support is the most crucial component in determining long term success after surgery.

Based on the latest data from Medicare website, Medicare only pays $863.15 for a gastric sleeve.
http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&qt=ItemID&q=31575
By contrast, cosmetic procedures do not have an Item Number and do not attract any support from Private Health Funds or Medicare.

Does Medicare cover nonsurgical weight loss programs?

No, at this stage Medicare does not cover nonsurgical weight loss programs. However, based on your individual situation your GP, may be able to make a chronic diseases management plan which allows you up to 10 visits per calender year to dieticians, psychologists, physiotherapists and other allied health professionals, at significantly discounted rates.

Chronic medical conditions are those that have been, or are likely to be, present for at least 6 months. Examples include:

  • Asthma
  • Cancer
  • Cardiovascular disease
  • Diabetes and obesity
  • Kidney disease
  • Musculoskeletal conditions
  • Stroke.

How much would private health insurance policy cost?

Weight loss surgery can cost anywhere from $15,000 to $25,000 if you don’t have insurance. With private health cover, you can often cut this down by about two-thirds, as your insurance will pay for your accommodation, theatre fees, anesthesia and some doctor’s fees. Below are some Health Providers offering weight loss surgery options.
Source: Finder Partners

Hospital Gold
  • Gastric sleeve
  • Gastric bypass
  • Lap band

$500 Excess

$164.05/ mth

Top Hospital Gold

  • Gastric banding
  • Gastric bypass
  • Sleeve gastrectomy

$750 Excess

$168.90/ mth

Premium Hospital (Gold)
  • Gastric banding
  • Gastric bypass
  • Sleeve gastrectomy

$500 Excess

$176.73/ mth

Quotes are based on a single individual with less than $90,000 income and living in Sydney.

Can I use my Super to pay for Gastric Sleeve Surgery?

You may be able to access your funds to pay for your gastric sleeve surgery. You can apply to access your super to pay for surgery for yourself, your partner or your children. You may choose to apply for funding to cover the entire cost of the procedure or part of the cost.

The Australian Government allows early access to your or another family member’s superannuation to cover the costs involved in bariatric surgery.

The application for early super release is processed by the ATO. You will need to fill out an application form and obtain a written letter of support from both your GP and Specialist (Dr Arun Dhir will provide his letter of support to you upon request after your initial consultation). The processing time by the ATO generally takes around 2-4 weeks and allow a further 4-6 weeks for your superannuation fund to release the funds to your personal bank account.

SuperCare offer an easier solution for patients whereby they process the application with the ATO on your behalf. This service is generally quicker, however a processing fee is applicable.
You might also be able to use Super to cover the costs of travel expenses and accommodation if you live outside of Melbourne as well. Its easier than you think!

online appointment

Do reach out to us via our contact page or arrange a free 15 minutes online appointment with our patient advisor who would be able to provide you with answers to your questions about  weight loss surgery.

Also do not forget to download my free 10 Point Checklist on things you need to do before deciding about weight loss surgery.