Is your heart covered? Why private health insurance matters
Heart health is one of the most important things to keep in check, but it’s easy to take it for granted – especially if you feel young at heart.
Every year, 57,000 heart attacks happen in Australia and coronary heart disease is responsible for around one in ten deaths. In fact, one person is hospitalised for coronary heart disease every 3-4 minutes.
So, the big question is: Can you afford not to have private health cover for one of your body’s most vital organs – the heart?
What are the risk factors for heart disease
If you’re over 45 years old, you may be at a higher risk for heart disease. Key risk factors [KS1] include:
High blood pressure
High cholesterol
Smoking
Obesity
Diabetes
Nine in 10 Australians have at least one of these risk factors. So it’s a good idea to get familiar with the signs and symptoms of heart disease and take proactive steps to stay healthy. For the full list of risk factors, visit the Heart Foundation.
Why your heart needs more cover
Private health cover means you get to make important choices about your care. You’ll decide when your operation happens, who your surgeon is and which hospital you visit.
While Medicare gives Australian residents (as well as certain visitors to Australia) access to medical and public hospital services, if you require heart surgery in the public system, you’ll be waiting 20 days on average to have the operation. Plus, you may not be given a choice about which hospital you’ll be visiting, the surgeon who will be operating on you or the rehab options you’ll have.
With nib, you could also be eligible for one of our Heart Health Management Programs, which are designed to assist those who have been diagnosed with, or are at high risk of, coronary heart disease. These programs aim to help you get in shape[KS2] , keep you out of hospital, improve your physical and mental wellbeing and aid a quicker recovery post-hospitalisation.
What does heart surgery actually cost?
Heart surgery costs depend on your level of cover and how much control you want to have over your care. Going through the public system is generally free, but gives you less choice in where or when the surgery takes place.
Depending on your hospital cover, heart surgery and other cardiovascular support options may be included, often with just a $500-$750 excess fee for hospital stays. Self-funding your procedure is another option, but with the average price of heart surgery in a private hospital at $52,000, it’s a costly endeavour.
Category | Public System (Medicare) | Private Health Insurance | Self-Funding (No Insurance) |
Wait Times | 3–12+ months (non-urgent cases) | 1–6 weeks (often faster, esp. for elective surgery) | 1–6 weeks (subject to surgeon/hospital availability) |
Out-of-Pocket Costs | Usually $0 (if done in public hospital) | $500–$7,000+ depending on cover, excess and gap fees | $20,000–$60,000+ depending on surgery and hospital fees |
Hospital Choice | No choice (allocated based on availability) | Choose your hospital (private hospitals available) | Full choice (public or private hospitals accepting private pay) |
Doctor/Specialist | No choice (assigned in public system) | You choose your surgeon and specialist | Full choice |
Post-Op Rehab | Limited and hospital-based only | Often includes private rehab or outpatient programs | Must pay out-of-pocket or arrange separately |
Follow-Up Care | Through public outpatient clinics (can have long waits) | Often faster access to specialists for follow-ups and Health Management programs for extra support | Depends on out-of-pocket ability |
Ideal For | Low-income patients, non-urgent cases, emergency treatment | People who want choice, faster treatment and added peace of mind | Those who are uninsured but want fast access and can afford it |
Time for a private health cover review?
At nib, we believe that understanding your health cover should be simple. If you are over 45 and not sure if you’re covered for heart related procedures and surgery, it might be time to give us a call on 13 16 42 or contact us online. We’re here to help.
The information on this page is general information and should not be used to diagnose or treat a health problem or disease. Do not use the information found on this page as a substitute for professional health care advice. Any information you find on this page or on external sites which are linked to on this page should be verified with your professional healthcare provider.