Ear, Nose and Throat

Reviewed and updated 3 April 2024

basic

bronze

silver

gold

RRestricted

OOptional

Covered

What is covered under Ear, Nose and Throat?

Hospital Cover for Ear, Nose and Throat includes hospital treatment to investigate and treat the:

ear
nose
throat
middle ear
thyroid
larynx
lymph nodes
related areas of the head and neck.

Examples include:

treatment for a damaged ear drum
repair of blocked and damaged salivary glands
sinus surgery
removal of the thyroid gland due to a medical condition
tumour removal from the upper digestive tract
removal of a foreign body from the ear under anaesthetic.

This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).

Some treatments you might expect to be in the Ear, Nose and Throat clinical category are in other clinical categories. For example, treatments for:

removal or treatment of tonsils, adenoids and grommets is under Tonsils, Adenoids and Grommets
hearing aids and fitting of hearing aids are under Implantation of Hearing Devices
neck (spinal) conditions are under Back, Neck and Spine
sleep therapies and studies are under Sleep Studies
chemotherapy and radiotherapy for cancer are under Chemotherapy, Radiotherapy and Immunotherapy for cancer.

Which Hospital Cover tiers include Ear, Nose and Throat?

Tier	Clinical category covered?	Can insurers offer restricted cover?
Basic	Optional	Yes
Bronze	Yes	No
Silver	Yes	No
Gold	Yes	No

What does it mean if cover is ‘optional’?

‘Optional’ means that the Australian Government allows insurers to choose whether or not to cover the clinical category under that Hospital Cover tier.

What does ‘restricted cover’ mean?

Restricted cover means the insurer pays only limited benefits.

If insurers offer cover for Ear, Nose and Throat under Basic Hospital Cover, they can do so on a ‘restricted’ basis. If you are admitted as a private patient in a private hospital for treatments under this clinical category, you will face considerable out-of-pocket costs.

Always check with your insurer before agreeing to be treated as a private patient in a private hospital if you have restricted cover for Ear, Nose and Throat.

Does Medicare cover Ear, Nose and Throat?

Yes. Medicare includes all treatments under the Ear, Nose and Throat clinical category.

If there is an MBS item number for the treatment, Medicare covers it.

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