Cataract surgery
What is cataract surgery? 1
A cataract is a condition that clouds the lens of your eye, making it difficult to see. Cataract surgery removes the clouded lens and replaces it with a permanent, artificial, clear plastic lens. Cataracts can occur in one or both eyes.
The surgery is an outpatient procedure and takes no more than 45 minutes under a local anaesthetic and light sedation. Occasionally a general anaesthetic may be used instead.
Cataract surgery is usually performed by an ophthalmologist.
The medical term for cataract surgery is phacoemulsification.
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Public and private hospital options
It’s important to understand how getting your procedure in a public or private hospital differs.
| Question | Public system (Without health insurance) | Private system (With health insurance) |
|---|---|---|
| Will I avoid public hospital waiting lists? |
No. |
Yes. |
| Will I be able to choose my hospital? |
No. |
Yes. |
| Will I be able to choose my doctor or surgeon? |
No. |
Yes. |
| Will I have out-of-pocket costs? |
No. |
Yes. |
What's covered as an outpatient procedure?
Cataract surgery is sometimes done as an outpatient procedure – and this can have a big impact on your cost and coverage.
Health insurance usually won’t cover outpatient procedures, and Medicare coverage may vary.
How do I know if I’m an outpatient?
Our best recommendation is to ask your GP, specialist or hospital about it.
An ‘outpatient’ is someone who is not formally admitted to hospital. It’s easy to tell you’re an outpatient if your surgery isn’t done in a hospital. But sometimes even a surgery done in a hospital is considered an outpatient procedure. The rules can be confusing, so it’s worth asking about.
What’s covered in a public hospital?
In a public hospital, cataract surgery is covered by Medicare for eligible residents.
Once you are discharged from hospital, you may still need to pay out-of-pocket for things like medicines and health services (like physiotherapy or occupational therapy).
What’s covered in a private hospital?
In a private hospital, private health insurance can cover some costs of cataract surgery.
You may have an out-of-pocket cost if you use private hospital cover when you get treatment. You can minimise some of these costs by choosing a hospital and specialist that have agreements with your health insurer.
If you have an excess on your cover, you will have to pay for that out of pocket.
What is hospital excess?
Hospital excess is the amount of money you contribute upfront (out of your own pocket) before you can claim a benefit on hospital treatment. With HBF hospital cover, you choose a set excess option when you first get hospital cover, but you can change your excess at any time.
With HBF, you only pay hospital excess once per person, per calendar year (to a maximum of twice on a family policy) when you’re admitted to hospital.
Are you an HBF member? You can check your excess in myHBF or the HBF App. This is the set amount you’ll pay when you’re admitted.
What is an out-of-pocket cost?
A hospital out-of-pocket cost is the portion of a hospital bill that you pay from your own pocket for which you won’t be reimbursed – by either health insurance or Medicare.
How to find health cover for cataract surgery
If you want private health insurance cover for cataract surgery, look for HBF hospital cover (not extras cover) that includes a category called ‘Cataracts’.
You need to hold hospital cover that includes cataracts for two months before you can claim for cataract surgery (or 12 months if you need cataract surgery due to a pre-existing condition).
Ask your GP for an open referral
Your GP is the one who’ll most likely refer you to a specialist – but you may want the option to choose your own specialist.
Asking for an open referral can let you:
- Choose your own specialist.
- Find a specialist with good availability who can perform treatment at the hospital you prefer.
- Find a specialist that you trust to perform your surgery.
- Find a specialist with minimum out-of-pocket expenses for you.
Find an ophthalmologist with minimum out-of-pocket costs
To find ophthalmologists who have an agreement with HBF, just search for ‘ophthalmologist’ in our find a provider tool.
- Look for the “Full Cover” tick mark or “Access Gap Cover” tick mark.
- These specialists will help minimise your out-of-pocket cost.
If you’ve already started working with a specialist
If you’ve already got a specialist, ask them these questions:
- Do you have a Full Cover or No Gap agreement with HBF?
If they don’t, you may need to consider if their fees work with your budget. - What hospital(s) do you operate in?
You can then check if the hospital has a Full Cover or No Gap agreement with HBF.
Alternatives to cataract surgery3
Surgery is currently the only effective way to remove a cataract. There are currently no other known non-surgical treatments, medications or dietary supplements that will prevent or cure a cataract.
That said, there are some things you can do to slow down the progression of developing cataracts:
- Regular eye examinations.
- Wearing UVB blocking sunglasses.
- Drinking alcohol within recommended guidelines.
- Quitting smoking.
- Maintaining a healthy weight.
- Long term corticosteroid use is linked to increased risk for developing cataracts.
- If you have diabetes, maintaining good control of your blood sugar levels can reduce the risk.
Cataract surgery recovery1
No overnight stay is required following cataract surgery, but full recovery takes a few weeks.
- There may be some initial pain or discomfort in the eye, which can be treated with medication.
- Eye drops will be required for a brief period.
- Avoid rubbing the eye and any strenuous activity for a few weeks after the operation.
- If the eye becomes red and painful, fluid comes from the eye, or vision deteriorates, medical attention is required – however, this is rare.
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Further reading
1 Health Direct - Cataract Surgery (2023)
2 CERA - Cataract (2023)
3 Better Health - Treatment for Cataracts (2023)