Does Medicare Cover Gastric Sleeve Surgery?
If you’ve been struggling with obesity and considering surgical options, you may be wondering: Does Medicare cover gastric sleeve surgery? The good news is that Medicare does offer partial cover for gastric sleeve surgery in Australia, provided certain criteria are met.
Is Gastric Sleeve Covered by Medicare in Australia?
Yes, gastric sleeve surgery is partially covered by Medicare when it is deemed medically necessary. If your procedure is performed in a public hospital under a Medicare-approved surgeon, most of the hospital and surgical costs can be subsidised. However, waiting lists in the public system can be long.
Alternatively, if you choose to have your weight loss surgery in a private hospital, Medicare will still contribute a portion, but you’ll likely face out-of-pocket costs unless you have appropriate private health coverage.
This is why many Australians opt for gastric sleeve surgery through other self-funded options, such as taking out Private health cover or through Early Release of Super.
Medicare & Weight Loss Surgery: Eligibility Criteria
To be eligible for Medicare weight loss surgery coverage, patients must meet specific health criteria. These typically include:
- A BMI of 35 or higher, especially if you have obesity-related health conditions such as diabetes, sleep apnoea, or hypertension
- Documented unsuccessful attempts at non-surgical weight loss (e.g., diet, exercise, medications)
- A comprehensive medical evaluation and referral from your GP and a specialist
Once these criteria are met, you may qualify for Medicare funding for gastric sleeve surgery or other bariatric procedures like gastric bypass.
Understanding Out-of-Pocket Costs
Even if gastric sleeve surgery is covered by Medicare, there may still be out-of-pocket expenses depending on:
- Whether your procedure is done in the public vs. private system
- The surgeon’s gap fees
- Anaesthetist and assistant surgeon fees
- Pre-operative consultations and post-op follow-ups
At Body Genesis Institute, we are transparent about all costs and work with you to explore Medicare, private health insurance, and payment plan options to suit your budget and health goals. You will be provided all financial information before you commit to any procedures with us.
To find out more about the costs of weight loss surgery and our after surgery support packages
Private Health Coverage for Weight Loss Surgery
Furthermore, private health funds will cover the hospital fees associated with any procedure that has an item number, including weight loss surgery.
Private Health Funds usually offer different levels of cover depending on your monthly premium or plan.
As is common with most procedures, there is usually an out-of-pocket ‘gap’ that the patient must pay as the rebates from Medicare and Private Health Funds are not sufficient to cover all the associated costs with our complete
Why is there a Gap payment for weight loss surgery
You may be wondering why is there an out of pocket or “Gap” cost for weight loss surgery, even though you may be having top hospital cover. The costs associated with weight loss surgery are not just due to surgeon, anaesthetist and assistant fees. A significant portion of this is dedicated to our comprehensive After Surgery Support program. Our After Surgery Support program has an outstanding reputation, and this is reflected in our testimonial’s.
Can I use my Super to pay for Gastric Sleeve Surgery done privately?
Yes, you are able to access your or your partners Super to pay for Gastric Sleeve Surgery if deemed suitable by your GP and your Surgeon. Accessing your Super for Sleeve Gastrectomy can be a lengthy process, and you may want to consider using a third-party service provider like Super Care.
SuperCare offers an easier solution for patients whereby they process the application with the ATO on your behalf. This service is generally quicker; however, a processing fee is applicable. You might also be able to use Super to cover the costs of travel expenses and accommodation if you live outside of Melbourne as well. It’s easier than you think!
The application for early super release is processed by the ATO. You will need to fill out an application form and obtain a written letter of support from both your GP and Specialist (Dr Arun Dhir will provide his letter of support to you upon request after your initial consultation). The processing time by the ATO generally takes around 2-4 weeks, and allow a further 4-6 weeks for your superannuation fund to release the funds to your personal bank account.
Quotes are based on a single individual with less than $90,000 income and living in Sydney.
Why Choose Body Genesis Institute?
At Body Genesis Institute in Melbourne, we combine expert bariatric care with personalised support, from pre-surgery education to long-term health coaching. Whether you’re navigating the Medicare system or seeking a more streamlined private surgery option, we’re here to guide you every step of the way.
We believe in empowering you with the knowledge, care, and options you need to make an informed decision for your health.
Also do not forget to download free 10 Point Checklist on things you need to do before deciding about weight loss surgery.
10 Point Checklist
Frequently Asked Questions
Yes, Medicare can partially cover gastric sleeve surgery in Melbourne if it is performed in a public hospital or through an accredited bariatric surgeon who bills under the MBS. Eligibility criteria apply.
Typically, individuals with a BMI over 35 and at least one obesity-related health condition may be eligible. A medical referral and assessment are required.
Costs vary depending on your chosen hospital, surgeon, and health fund. Expect to pay for consultations, potential hospital excess, or any non-covered professional fees.
Yes, both procedures are on the Medicare Benefits Schedule. However, clinical need, eligibility, and availability of public hospital services may impact access.
Absolutely. In many cases, using both Medicare and private insurance can significantly reduce your out-of-pocket costs, especially in private hospital settings.
