How does health insurance cover brain surgery?

What counts as brain surgery

Put simply, brain surgery is anything where you need medical surgery inside the chrome dome (aka your skull). This can include everything from biopsoes or keyhole surgery, all the way up to major surgery. If you're looking for brain surgery on your health insruance, the official treatmetn category is 'brain and nervous system' treatments.

How can I pay for brain surgery?

Both Medicare and private health insurance can contribute towards the cost of brain surgery. The biggest difference is based on whether you are treated in a public or private hosptial.

Medicare

If you're treated as a public patient in a public hospital, Medicare can cover 100% of your brain and nervous system treatment. Public hospitals will only charge the MBS fee, and that will all be covered if you have Medicare. If you have any care outside of hospital, for example a specialist or follow up rehabilitation, Medicare may not cover the whole cost, leaving you with an out of pocket cost.

Private health insurance

You can get private health insurance for brain and nervous treatment with all bronze tier hospital policies. This can cover you for care in a private hospital and can include investigation and treatment of the brain, chemotherapy, immunotherapy for cancer and more. Costs generally range from around $88 a month. Keep in mind that for private hospital treatments, you will often have out of pocket payments to pay, even after your insurance has contributed.

How does medicare cover brain surgery and treatment?

Medicare will usually cover the cost of staying and being treated as a public patient in a public hospital. You generally won't be able to choose your own doctor or choose when you want to undergo brain treatment or surgery. This is largely because public waiting times are normally longer as they're busier, so you don't have the same flexibility as you would with private health care.

Medicare will also pay a benefit towards seeing a specialist, such as a neurosurgeon. The neurosurgical consultation structure consists of an initial consultation (Medicare Benefits Schedule no. 6007) and four categories of subsequent consultations. These categories relate to both the length of consultation time and the complexity of what is being discussed. Here's a break down of some of the prices (correct as of 21st April 2025):

• Level 1. 6009 - Fee: $49.75 Benefit: 75% = $37.35, 85% = $42.30
• Level 2. 6011 - Fee: $98.95 Benefit: 75% = $74.25, 85% = $84.15
• Level 3. 6013 - Fee: $137.05 Benefit: 75% = $102.80, 85% = $116.550
• Level 4. 6015 - Fee: $174.50 Benefit: 75% = $130.90, 85% = $148.35

Medicare also provides cover for deep brain stimulation, which is sometimes required for Parkinson's disease or for treating tremors or dystonia. Because there are so many different types of brain treatment, you should consult your local Medicare office to find out exactly what you're covered for.

How does private health insurance cover treatment?

You can get private health insurance for brain and nervous treatment with all bronze tier hospital policies. You premiums will generally start around $88 a month and can help cover the cost of:

• Investigation and treatment of the brain
• Brain-related conditions
• Spinal cord and peripheral nervous system
• Chemotherapy, radiotherapy and immunotherapy for cancer (these come under a separate service but are also included in all bronze policies)

Waiting periods: You'll have to serve a waiting period of 2 months before you can make a claim

Frequently asked questions

• What is brain surgery?

  Brain surgery, also known as neurosurgery, is a medical specialty that involves the surgical treatment of conditions and disorders of the brain, spinal cord, and nervous system. This includes diagnosing and treating conditions such as brain tumors, aneurysms, hydrocephalus, and traumatic injuries. It also involves performing procedures such as deep brain stimulation and shunt placement to manage symptoms and improve function.

• What conditions can be treated with brain surgery?

  Brain surgery can be used to treat a wide range of conditions, including brain tumors, epilepsy, aneurysms, hydrocephalus, and traumatic injuries. It can also be used to perform procedures such as deep brain stimulation and shunt placement to manage symptoms and improve function.

• Is brain surgery safe?

  Brain surgery is a complex and delicate procedure, and as with any surgical procedure, there are risks involved. However, advancements in medical technology and surgical techniques have greatly improved the safety and effectiveness of brain surgery. The risks and benefits of the procedure should be discussed with a neurosurgeon before making a decision.

• Is brain surgery covered by private health insurance in Australia?

  Private health insurance policies in Australia generally cover the cost of brain surgery, including the procedure and any necessary hospital stays and follow-up care. However, the extent of coverage may vary depending on the policy and the individual's circumstances. It is important to check with your health insurer before the surgery to understand your coverage.

To make sure you get accurate and helpful information, this guide has been edited by Tim Bennett as part of our fact-checking process.

Written by

Gary Ross Hunter

Journalist

Gary Ross Hunter has over 6 years of expertise writing about insurance, including life, health, home, and car insurance. Having reviewed hundreds of product disclosure statements and published over 800 articles, he loves simplifying complex insurance topics for everyday readers. Gary has contributed to major outlets like Yahoo Finance, The Sydney Morning Herald, and news.com.au, and holds a Bachelor of Arts (Honours) in English Literature from the University of Glasgow, along with a Tier 2 General Advice certification, ensuring his work adheres to ASIC’s RG146 standards. See full bio

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