What Is the Difference: Cosmetic vs. Reconstructive Surgery
Before anything else, it’s important to understand the distinction between cosmetic and reconstructive plastic surgery, as this can significantly impact your funding alternatives:
Reconstructive Surgery
Reconstructive plastic surgery is performed to restore function and normal appearance to a part of the body that has been affected by congenital defects, developmental abnormalities, trauma, infection, tumours, or disease. Examples include:
- Breast reconstruction after mastectomy
- Cleft lip and palate repair
- Burn reconstruction
- Hand surgery for injuries or congenital conditions
Reconstructive procedures are generally considered medically necessary and are more likely to be covered by Medicare or private health insurance.
Cosmetic Surgery
Cosmetic plastic surgery is performed to reshape normal structures of the body to change appearance. These procedures are typically elective and include:
- Breast augmentation or reduction for aesthetic reasons
- Rhinoplasty (nose reshaping)
- Facelift
- Liposuction
As cosmetic procedures are considered elective, they are generally not covered by Medicare or private health insurance unless there’s a demonstrable medical need.
Funding Options for Plastic Surgery
Here are the funding options available for plastic surgery in Australia:
1. Private Health Insurance
Private health insurance can be an option for funding certain plastic surgery procedures, particularly those deemed medically necessary. Here’s what you need to know:
- Coverage Varies: The extent of coverage for plastic surgery procedures varies significantly between insurers and specific policies. Some policies may cover a wide range of procedures, while others might have more limited coverage.
- Waiting Periods: Most private health insurance policies have waiting periods before you can claim benefits for plastic surgery. These waiting periods can range from a few months to a year or more, depending on the procedure and your level of cover.
- Pre-existing Conditions: If your need for plastic surgery arises from a pre-existing condition, you may need to serve a longer waiting period (typically 12 months) before you can claim benefits.
- Out-of-pocket Expenses: Even with private health insurance, you may still have out-of-pocket expenses. These can include excesses, co-payments, and any gap between what your doctor charges and what your insurance covers.
Tips before Using Private Health Insurance for Plastic Surgery
- Check your policy details carefully to understand what procedures are covered.
- Contact your insurer directly to confirm coverage for your specific procedure.
- Ask about any waiting periods or restrictions that may apply.
- Discuss with your plastic surgeon any potential out-of-pocket costs.
Remember, while private health insurance can be beneficial for reconstructive procedures, most cosmetic surgeries are not covered unless there’s a clear medical need.
2. Medicare
Medicare, Australia’s public healthcare system, does provide coverage for some plastic surgery procedures. However, this is generally limited to procedures that are deemed medically necessary.
Medicare typically covers:
- Reconstructive surgeries following accidents, injuries, or illnesses
- Procedures to correct functional impairments
- Some plastic surgery procedures with a clear health benefit
Medicare Benefits Schedule (MBS)
The MBS lists all the medical services subsidised by the Australian government. If your procedure is listed on the MBS, Medicare will cover:
- 75% of the MBS fee for in-hospital procedures
- 85% of the MBS fee for out-of-hospital procedures
Out-of-pocket Costs
Even if your procedure is covered by Medicare, you may still have out-of-pocket expenses. These can include:
- The difference between the MBS fee and what your surgeon charges
- Hospital fees if you’re treated as a private patient in a public or private hospital
Claiming Medicare Benefits
To claim Medicare benefits:
- Ensure your procedure is eligible for Medicare coverage.
- Obtain a referral from your GP.
- Discuss with your surgeon how the claiming process will work.
Keep in mind that purely cosmetic procedures are not covered by Medicare. If you’re unsure whether your procedure qualifies for Medicare benefits, consult with your GP or plastic surgeon.
3. Out-of-pocket Payment
For many individuals considering plastic surgery, particularly for cosmetic procedures, out-of-pocket payment is the primary funding option. While this might seem daunting, there are several approaches you can take to manage the costs effectively.
Advantages of Out-of-pocket Payment
- No waiting periods or policy restrictions to navigate
- Freedom to choose any surgeon or facility without insurance network limitations
- Potential for cost savings in the long run compared to ongoing insurance premiums
If you’re considering out-of-pocket payment, here are some steps to help you budget effectively:
- Get a detailed quote: Consult with your chosen surgeon to get a comprehensive breakdown of all costs associated with your procedure.
- Factor in all expenses: Remember to include costs for consultations, anaesthesia, hospital fees, post-operative care, and any necessary medications or garments.
- Create a savings plan: Once you have a total cost, create a savings plan to reach your goal. This might involve setting aside a fixed amount each month.
- Consider a high-yield savings account: To make your savings work harder, consider storing your funds in a high-interest savings account.
Tips for Managing Out-of-pocket Payments
- Don’t rush: Take your time to save the necessary funds rather than rushing into a procedure you can’t comfortably afford.
- Be prepared for unexpected costs: It’s wise to save a bit extra to cover any unforeseen expenses or follow-up treatments.
- Discuss payment timing with your surgeon: Some surgeons may allow you to pay in instalments leading up to your surgery date.
- Consider the long-term value: While the upfront cost might be significant, consider the long-term benefits and potential savings compared to ongoing treatments for the issue you’re addressing.
4. Payment Plans
For those who prefer not to pay the entire cost of their procedure upfront, payment plans might be an option. These plans allow you to spread the cost of your surgery over time, making it more manageable for your budget.
Typically, payment plans for plastic surgery work as follows:
- Initial deposit: You pay a percentage of the total cost upfront.
- Regular payments: The remaining balance is divided into regular (often monthly) payments over a set period.
- Interest: Some plans may be interest-free for a certain period, while others may charge interest.
When exploring payment plan options, keep the following in mind:
- Interest rates: If the plan charges interest, make sure you understand the rate and how it will affect the total cost of your procedure.
- Terms and conditions: Read the fine print carefully. Understand what happens if you miss a payment or want to pay off the balance early.
- Credit checks: Some payment plans may require a credit check. Be prepared for this possibility.
- Flexibility: Inquire about the flexibility of the plan. Can payments be adjusted if your financial situation changes?
- Total cost: Calculate the total cost of the procedure when paid through the plan versus paying upfront. This will help you determine if the plan is truly beneficial for you.
5. Medical Loans
Medical loans are another option for funding your plastic surgery procedure. These are specialised personal loans designed specifically to cover medical expenses, including elective procedures like cosmetic surgery.
Medical loans function similarly to personal loans:
- You apply for a loan with a bank or specialist lender.
- If approved, you receive a lump sum to cover your medical expenses.
- You repay the loan in regular instalments over a set term, typically with interest.
Advantages of Medical Loans
- Quick access to funds: Once approved, you can typically access the money quickly to proceed with your surgery.
- Fixed repayment terms: You’ll know exactly how much you need to repay each month and for how long.
- Potentially lower interest rates: Medical loans may offer lower interest rates compared to credit cards or other forms of unsecured credit.
- Flexibility: You can often choose a repayment term that suits your budget.
Before opting for a medical loan, consider the following:
- Interest rates: Compare rates from different lenders to ensure you’re getting the best deal.
- Fees: Be aware of any application fees, ongoing fees, or early repayment fees.
- Repayment term: A longer term means lower monthly payments but more interest paid overall. Choose a term that balances affordability with minimising total interest.
- Your credit score: Your credit history will impact your ability to get approved and the interest rate you’re offered.
- Secured vs. unsecured loans: Some medical loans may be secured against an asset, potentially offering lower interest rates but putting your asset at risk if you can’t make repayments.
6. Superannuation Early Release
In certain circumstances, you may be able to access your superannuation (often referred to as ‘super’) early to pay for medical treatments, including some plastic surgery procedures. However, this option is subject to strict conditions and should be considered carefully.
Early release of superannuation for medical reasons is typically allowed in cases where:
- You or your dependant has a life-threatening illness or injury
- You or your dependant requires treatment to alleviate acute or chronic pain
- You or your dependant needs treatment to alleviate a mental illness
It’s important to note that the treatment must be deemed necessary and not readily available through the public health system.
To apply for early release of your superannuation:
- Obtain two medical practitioners’ reports (including one specialist) confirming the necessity of the treatment
- Apply to the Department of Human Services (DHS) if you have a regulated super fund, or directly to your super fund if it’s a self-managed super fund (SMSF)
- Provide detailed cost estimates for the proposed treatment
- Demonstrate that you cannot afford the treatment through other means
