Best health insurance plans for weight loss surgery

Deciding to make a real change in your life by getting weight-loss surgery is a huge step, and having the right health insurance can make all the difference. Not sure how to get started? Let’s break down the best health insurance plans that can give you cover for weight-loss surgery.

While it’s true that private health insurance can be complex, here we’ll give you some helpful info on the different types of plans that might cover bariatric surgery. In the end, you’ll be able to make the most informed decision about your health and financial well-being – so let’s get started on your weight-loss journey!

Whether you call it weight-loss surgery or bariatric surgery, this is a type of medical intervention that’s helping everyday Australians who are struggling with obesity and the resulting complications.

There are many different types of weight-loss surgery, but in Australia, there are three primary types that most people go for:

• Lap band surgery
• Gastric bypass
• Gastric sleeve surgery

Each procedure comes with its pros and cons, so it’s important that you do your own research and figure out which option matches your needs. Here’s a little more about the specifics of each procedure so you can make the right decision for yourself – and your body.

Lap band surgery, which is better known in medical circles as ‘gastric banding’, is a weight-loss procedure that involves putting an adjustable silicone band around the upper part of your stomach. This essentially creates a smaller stomach pouch, thereby limiting the amount of food you can comfortably eat and slowing down your digestion. The band itself is connected to a ‘port’ under the skin, and this means the tightness of the band can be adjusted.

One of the biggest advantages of lap band surgery is that it’s a reversible procedure. Your doctor can also adjust the size of the band to increase or decrease the size of your stomach opening. Unlike some of the more serious surgeries, lap band doesn’t involve any cutting or stapling of the stomach, or any rerouting of your digestive tract.

While lap band surgery can be an effective way for some people to lose weight, it depends on your ability to stick to new dietary and lifestyle changes. Regular follow-up appointments for band adjustments will help you achieve more positive outcomes. And, as with any medical procedure, be aware that there are risks that should be thoroughly discussed with your healthcare professional before jumping into lap band surgery.

Gastric bypass (or Roux-en-Y) is another type of weight-loss surgery you might be interested in. This one starts by creating a small stomach pouch and redirecting the digestive tract to bypass a portion of your small intestine. During the surgery, your doctor will divide your stomach into a smaller ‘upper pouch’ and a larger ‘lower pouch’. The small intestine will then be rearranged to connect to both pouches, which means food can bypass the lower stomach and the first section of the small intestine.

The main goal of a gastric bypass is to help you achieve weight loss through both restriction and malabsorption. The smaller stomach pouch limits the amount of food you can eat, while shifting the digestive tract can minimise how many calories (and nutrients) you absorb.

Be aware that gastric bypass surgery is a more invasive and complex procedure compared to some other weight-loss surgeries like the lap band. It might indeed result in sustained weight loss, but it will also require a lifelong commitment to diet and lifestyle changes.

A gastric sleeve – or a sleeve gastrectomy – is another common weight-loss surgery in Australia. This one is all about reducing the size of your stomach to help with major weight loss. During this surgery, around 75–80% of your stomach will be removed, which leaves a smaller, banana-shaped ‘sleeve’. Since the stomach is now much smaller, it restricts the amount of food your body can hold. In other words, you feel fuller faster and are happier eating smaller portions.

The success of gastric sleeve surgery lies in its restriction of food intake. But be aware that the procedure itself can result in hormonal changes that contribute to reduced hunger. That’s not necessarily a bad thing (if managed correctly), as it can aid in your long-term weight management. Unlike having a gastric bypass, gastric sleeve surgery doesn’t involve any changes to your digestive tract.

Another positive is that this surgery is less complicated than gastric bypass, but it’s still a helpful intervention. It’s recommended for people who are dealing with serious obesity or obesity-related health issues, and those who haven’t achieved sustainable weight loss through traditional methods.

The cost of weight-loss surgery in Australia can vary based on things like the type of surgery you want, your preferred hospital or surgery facility, as well as your doctor. As of early 2024, lap-band surgery can start at approximately $14,000, while a sleeve gastrectomy can begin at around $19,000. Bear in mind that these figures are indicative only, and the actual cost may be higher depending on your circumstances.

If you are seriously considering weight-loss surgery, having private health insurance could be an avenue to explore. Many policies cover certain weight-loss surgeries, but you’ll need to carefully review the PDS to understand the specific inclusions and limitations.

Yes, Medicare can partially cover the costs of some weight-loss surgeries. You can find out more on the bariatric surgery Medicare Benefits Schedule page.

However, you will need to qualify for this coverage by being determined to have “clinically severe obesity”. Otherwise, you may need to rely on your private health insurance cover – or pay for everything out of pocket.

Make sure you speak to Medicare if you are unsure, and also have a chat with your health insurer to see exactly what is and isn’t covered under your current policy.

While most private health insurers do cover many bariatric and weight-loss surgery procedures, that doesn’t mean they are included in every policy.

If you are on a lower hospital tier like Basic or Bronze, then it’s unlikely weight-loss surgery will be part of your benefits. However, a Gold policy for many providers may indeed cover these surgeries. Just make sure you read the policy in full as well as the PDS so you know exactly what you are covered for.

That depends on your insurer and the type of policy you have. It also may change if you’ve recently switched to a similar (or lower) level of cover and have already seen out the existing policy’s waiting period.

Generally, you’ll need to serve a 12-month waiting period on your private health insurance before you can make a claim on weight-loss surgery.

Deciding to follow through with weight-loss surgery is a big decision that should factor in many things, including the type of surgery you want, the amount you can afford, your level of insurance, your preferred doctor and hospital, and more.

The most important thing is that you speak to your doctor or surgeon first, and thoroughly review your insurance policy to make sure you are covered. While your journey to weight loss can be time-consuming, it’s most important to be informed so you can achieve your long-term goals.