Skipping the wait: health insurance for varicose veins surgery  

If you’re waiting for varicose veins surgery in a public hospital, you could be waiting months. According to the Australian Institute of Health and Welfare, more than 50% of people waited more than 133 days (4.5 months) for varicose veins surgery in a public hospital in 2024-25. If you have Hospital Cover that includes the Heart and Vascular System clinical category, you could skip the queue and go to a private hospital for faster treatment, but there may be out-of-pocket costs. Here’s everything you need to know about varicose veins and health insurance. 

Are you covered for varicose vein surgery? 

For varicose vein surgery, you’ll need Hospital Cover that includes the Heart and Vascular System clinical category, which is included on policies Silver tier and above. If you’re not covered, and you can afford it, you may be able to have the surgery privately and pay the entire costs yourself. Talk to your doctor – some won’t operate unless you have health insurance, in case there are costly complications.  

If your doctor recommends non-invasive options, such as endovenous laser ablation, which are done under local anaesthetic in private clinics, you can’t claim on Hospital Cover unless the clinic is registered as a day hospital. By law, insurers aren’t allowed to cover treatments that take place outside a hospital. If your doctor has deemed the treatment is medically necessary rather than cosmetic, you will receive a Medicare benefit. But that benefit will only apply to the doctor’s fee, not to the products used, such as the laser or medical glue – which you will have to pay for.  

If you’re having open surgery and you’re trying to decide whether to go public or private, here are the 4 factors to consider: 

1. Are you in pain or is it affecting your quality of life? 

If your quality of life is affected or you’re in pain, you might prefer not to wait on the public list, and to go with private surgery instead.  

2. Have you served the waiting period? 

If your policy is new, there will be a 2-month waiting period before you can claim for private surgery. And if you had signs of varicose veins in the 6 months before buying your policy (even if you weren’t diagnosed), you’ll have a 12-month waiting period for pre-existing conditions.  

3. Can you afford the specialist appointments?  

Specialist appointments in a private clinic are not covered by Hospital Cover, even if the appointment is to discuss surgery. There may be a Medicare benefit for the appointment, but you’ll need to pay the rest out of your own pocket.  

4. Can you afford the surgery costs?  

If you’re covered for open surgery, you will still need to pay the excess, any co-payments that apply and the out-of-pocket costs (also called Gaps): 

• Medical Gap: If your doctors (including surgeons and anaesthetists) charge more than the Medicare Benefits Schedule (MBS) Fee for the procedure, the difference will be a Medical Gap for you to pay – as explained here. The typical Medical Gap for this treatment in 2023-24 was $430, according to the government’s Medical Costs Finder site. 

• Hospital Gap: If the private hospital is not one of your insurer’s Agreement Hospitals, you will need to pay a Hospital Gap for your hospital costs, such as accommodation and theatre fees.  

How to find the best health insurance for varicose veins 

The fastest and most comprehensive way to find the best health insurance for varicose veins is using the healthslips.com.au calculator. Look for Hospital or Combined Cover which includes the Heart and Vascular System clinical category. You can look for a new policy or compare your existing policy to similar policies, without sharing your contact details. It’s free, and it searches every policy from every insurer in Australia without commercial bias, so you can trust the results. 

healthslips.com.au does not provide general or personalised advice. Your particular circumstances are likely to impact the accuracy, completeness and relevance of the information or results. Take this into account before making a decision and talk to an expert for financial advice.    

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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