Medicare and health funds
Whether Medicare or your private health fund contributes to the cost of your surgery depends on whether the procedure is classified as cosmetic or reconstructive. This page explains how each may apply, and what is worth checking before your consultation.
For a full breakdown of the individual fees involved in surgery, see our Surgery Costs page.
How Medicare works
Medicare provides a rebate for surgery only where a Medicare Benefits Schedule (MBS) item number applies. This is generally the case for reconstructive procedures — surgery to correct a functional problem, congenital condition, or the effects of injury, illness, or previous surgery.
To claim a Medicare rebate, you will generally need:
- A referral from your GP or another specialist, obtained before your consultation
- Assessment by Dr. Anavekar confirming your presentation meets the relevant MBS item requirements
- Any supporting documentation, such as imaging, specialist reports, or evidence of prior conservative treatment
Medicare rebates only cover part of the total cost, and a meaningful out-of-pocket gap should generally be expected even where a rebate applies.
Cosmetic surgery is not covered by Medicare. Where the primary goal of a procedure is to change appearance rather than address a functional or medical issue, no MBS item number applies, regardless of referral.
Private health funds
If your procedure qualifies for a Medicare rebate and you hold private hospital cover, your health fund may also contribute towards hospital and theatre costs. Coverage varies significantly between funds and policies, so it is important to check your own product disclosure statement or contact your fund directly.
Things worth confirming with your health fund before proceeding:
- Whether your level of hospital cover includes the relevant MBS item number
- Any waiting periods that may apply, particularly if you have recently taken out or upgraded your policy
- Your excess or co-payment, and how this affects your final out-of-pocket cost
- Whether the hospital or facility used is recognised by your fund
Health funds do not cover cosmetic procedures, consistent with Medicare.
Known Gap Scheme. Dr. Anavekar generally participates in the Known Gap Scheme (also called Access Gap Cover) offered by major private health funds. Where this applies, your out-of-pocket cost for the surgeon's fee may be capped at approximately $500.
This only applies to simpler cases and shorter operations. The Known Gap Scheme does not apply to longer or more complex procedures, including eyelid surgery, abdominoplasty, breast surgery, and body contouring surgery. Whether the Known Gap Scheme applies to your procedure will be confirmed during your consultation.
What to check before your consultation
Bringing the following to your first consultation helps Dr. Anavekar and our team give you the clearest possible picture of your likely costs:
- Your GP or specialist referral
- Details of your private health insurance, including your policy level and fund
- Any relevant imaging, reports, or documentation of prior treatment
Our team can help clarify what is and is not likely to be covered, but confirmation of your specific eligibility to benefits should always come from your health fund based on your policy and health fund rules.
Questions about cost or cover?
Our team can help you understand what to expect before your consultation.