What’s the best health insurance for grommets? 

If you hear the word ‘grommets’ you might think of surf lifesaving, but for many Australian families, the word means surgery. Around one in 15 kids in Australia need surgery for grommets, where a tiny tube is inserted into the eardrum to help reduce middle ear infections and glue ear. Although this procedure (known clinically as myringotomy) is sometimes done on adults, it’s far more common in kids – in fact, it’s one of the most common surgeries for children and is usually done on kids aged up to 4.  

According to data from the Australian Institute of Health and Welfare, waiting times for grommet surgery in public hospitals (which is free under Medicare) have increased since the pandemic. The average wait for grommet surgery was 88 days (almost 3 months) in 2023-24. Your child (or you) can get grommet surgery faster in the private system, so long as you have the right health insurance. Here’s what you need to know about health insurance for grommets.

How much does health insurance for grommets cost? 

To cover surgery for grommets, your health insurance will need to include the Tonsils, Adenoids and Grommets clinical category. It’s optional for insurers to include this cover in Basic, Bronze and Silver policies (it’s automatically included in Gold), so check your policy to see whether you’re covered – and if you have a Basic policy, it may be restricted, which can mean large out-of-pocket costs for you. The cheapest Family policy for 2 adults and children in NSW with unrestricted cover for grommet surgery is a Basic Plus policy for $220.49 per month, with a $750 excess. 

What do the different Hospital Cover tiers mean?

Click here to see a comparison of 4 Family policies in NSW that contain grommets. 

To claim for grommet surgery, you’ll need to pay an excess, and any co-payments or Gaps that may apply. To find out the Gap, ask your surgeon for a full breakdown of fees, and make sure it includes fees for other doctors involved in the procedure, such as anaesthetists. The government’s Medical Costs Finder says $520 is the average Gap for grommet surgery.   

What’s the best health insurance for grommets? 

The best health insurance for grommets is the one that offers the cover you need at a cost that fits your budget. To consider all of your options, head to the healthslips.com.au calculator, which searches every policy in Australia without any commercial bias. You’ll very quickly see the options available, allowing you to compare and find the best policy at the best price, with free open access to your results. Look for a new policy, or compare your current policy to find the best deal.  

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.

Read more.