If you were to pay for a colonoscopy without any help from Medicare or private health insurance, it would likely cost you over $1,000. Thankfully, both can reduce or even completely eliminate that cost.
Quotes are based from less than $90,000 income.
If you’re entitled to Medicare, a colonoscopy should be free as long as you’re treated in a public hospital. However, it’s likely you’ll face a long waiting list. Think months, rather than weeks.
Thankfully, if you have private health insurance at bronze level or above, it’s likely you won’t pay anything. In fact, according to the Department of Health, 80% of private patients with health insurance paid nothing for a colonoscopy. For the remaining 20%, the typical cost was $150.
Yes, Medicare covers the cost of colonoscopies. If you get treatment in a public hospital, you should be covered for 100% of the colonoscopy costs.
However, public hospitals have long waiting lists. Your appointment will likely be made months in advance and you won’t have any say on the time, date or location.
In 2019, Bowel Cancer Australia surveyed 1,500 Australians following their colonoscopy. One-third said they waited more than 2 months for treatment while 7% waited 6 months or more.
Yes. All hospital policies at bronze level or above cover medically necessary colonoscopies. You’ll find it included under gastrointestinal endoscopy.
Remember though, private health insurance only covers 25% of the MBS fee while Medicare covers the other 75%. If your healthcare provider charges more than the recommended fee, you will have to pay the rest. This is called the gap.
According to the Department of Health, only 20% of private patients with private health insurance had to pay a gap fee for their colonoscopy. The typical cost was $150.
Bronze level hospital policies start at around $80 a month and provide cover for 21 clinical categories, including cancer treatment, joint replacement and diabetes management.
The government sets a price for hospital treatments, which it believes is fair. It’s designed as a guide for healthcare professionals and is called the Medicare Benefits Schedule (MBS) fee.
However, healthcare providers don’t have to stick to this price. For example, a certain procedure could have an MBS fee of $100 but a private doctor could easily charge $200.
If you go private, Medicare will only pay 75% of the MBS fee while health insurance pays the other 25%. If your doctor chooses to charge more than the MBS fee, you will have to pay that amount. This is referred to as the gap.
You can ask your doctor and private health insurer about these costs beforehand. If you want to avoid these costs, look for an insurer that provides gap cover as part of your policy.
This can help pay the difference between what your doctor charges and Medicare and private health insurance cover. If you can use a doctor who participates in your insurer’s gap cover, you may be able to avoid paying any out of pocket expenses.
Yes. You usually have to serve a waiting period of 2 months before the insurer will cover you. If you have a pre-existing condition that requires a colonoscopy, then you’ll have to wait 12 months.
However, it’s sometimes possible to find a way around the two-month waiting period. Sometimes insurers will waive certain waiting lists if you buy a combined hospital and extras policy, so it’s worth looking into.
It’s possible to get a colonoscopy for free, if you plan ahead. According to the Department of Health, 80% of patients paid nothing for a colonoscopy in a private hospital with private health insurance. Here’s a simple breakdown of how it’s possible:
- Medicare. Medicare can pay for a chunk of the costs, for example, 75% of the MBS fee if you go private and 100% if you go public. Make sure you get the MBS item number from your doctor and give it to your private health insurer.
- Private health insurance. A policy can pay for treatment in a private hospital (you also usually get to choose your own doctor) which can pay for doctors’ fees, accommodation and theatre fees. It can pay at least 25% of the costs that Medicare won’t cover.
- Out of pocket expenses. If there are still some fees (for instance, if your doctor charges more than the recommended MBS fee or you also have an assistant or anaesthetist fee) you may still have some things you need to pay for yourself. Ask your doctor about them before the procedure and see if you can reduce or eliminate them by getting a health insurance policy and doctor that provides and participates in gap cover.
- Excess. When you submit a claim to your insurer, you’ll usually have to pay a small contribution towards the treatment. The amount you’ll pay depends on the excess you choose or are offered when you buy a policy. To give you an idea, you can usually choose between $0 and $750.