Glaucoma Surgery Cost in Australia: What to Expect

If your ophthalmologist has recommended glaucoma surgery, cost is usually one of the first questions that follows. It is also one of the harder ones to answer simply, because what you pay depends on the procedure, where it is performed and how you are covered.

This guide explains what makes up the cost of glaucoma surgery in Australia, how Medicare and private health insurance apply, and how to get an accurate figure for your own situation before you commit.

For an overview of the procedures themselves, see our guide to glaucoma treatment options. For what happens on the day and during recovery, see before and after glaucoma surgery.

Why there is no single price

Glaucoma surgery is not one procedure. A laser treatment performed in a clinic and a trabeculectomy performed in a private hospital sit at opposite ends of the cost range, and much of the difference comes down to the facility and the theatre time rather than the surgeon.

Several providers also bill you separately. The surgeon, the anaesthetist and the hospital each issue their own account, which is why a single advertised price is rarely meaningful.

Any fixed national figure you find online is a generalisation. The number that matters is the one your surgeon’s rooms give you in writing, based on the procedure you are having and the cover you hold.

What makes up the cost

Five components typically make up the total:

• Surgeon’s fee. Covers the procedure itself and, depending on the practice, some post-operative appointments. Varies with the complexity of the case.
• Anaesthetist’s fee. Billed separately by the anaesthetist, not by your surgeon. Depends on the type of anaesthesia and how long the procedure takes.
• Hospital or day facility fee. Often the largest single variable. Private hospitals charge more than public, and an overnight stay costs more than a day procedure.
• Consultations. The initial assessment, pre-operative testing and follow-up visits. Some follow-up is usually included in the surgical fee, and the rest is billed as you go.
• Medications and aftercare. Post-operative drops, particularly anti-inflammatories and antibiotics, plus any additional treatment needed during healing.

Public and private pathways

Where you have surgery affects both what you pay and how long you wait.

As a public patient in a public hospital, glaucoma surgery is generally provided at no cost to you. You do not choose your surgeon, and waiting times vary depending on how urgent your case is assessed to be. Urgent cases are prioritised.

As a private patient, you choose your surgeon and your timing, and you meet the out-of-pocket costs that Medicare and your health fund do not cover. For a condition where pressure control is time-sensitive, a shorter wait is part of what people are weighing up.

Both are legitimate paths. Your ophthalmologist can advise which is appropriate given how advanced your glaucoma is.

How Medicare applies

Medicare subsidises glaucoma procedures listed on the Medicare Benefits Schedule (MBS), and most glaucoma surgeries are listed.

As a public patient in a public hospital, Medicare covers the cost of your treatment.

As a private patient, Medicare pays a set benefit toward the surgeon’s and anaesthetist’s fees. Where your surgeon charges above the scheduled fee, which is common, the difference is yours to pay. Medicare does not contribute to private hospital accommodation or theatre fees.

Consultations with your ophthalmologist attract a Medicare rebate, though most specialists charge above the rebate amount.

The Australian Government’s Medical Costs Finder publishes typical fees and out-of-pocket costs by procedure and specialty, which is a useful reference point before you speak to your surgeon’s rooms.

Private health insurance and gap payments

If you are treated as a private patient, hospital cover typically pays for accommodation and theatre fees, subject to your policy and any excess.

A few things are worth checking with your fund before booking:

• Whether glaucoma surgery is included at your level of cover. Eye surgery is not always covered on basic policies.
• Waiting periods. Funds generally apply a waiting period for pre-existing conditions, commonly twelve months.
• Your excess. This is payable per hospital admission.
• Gap cover arrangements. Check whether your surgeon and anaesthetist participate in your fund’s scheme. Where they do, your out-of-pocket cost is reduced or removed.

The gap is the difference between what your providers charge and what Medicare and your fund pay between them. It is the number most people actually want, and it is specific to your surgeon and your policy.

Getting an accurate estimate before surgery

You are entitled to know what you will pay before you agree to surgery. This is known as informed financial consent, and your surgeon’s rooms should provide it in writing.

A complete estimate should cover:

•   the surgeon’s fee and the MBS item numbers being billed
•   the expected Medicare benefit and health fund contribution
•   your estimated out-of-pocket cost
•   the anaesthetist’s fee, or a note that you will be quoted separately
•   the hospital or facility fee, or a note that the hospital will quote you directly
•   which post-operative appointments are included

If any component is missing, ask. Requesting a written estimate is routine, and any practice should be comfortable providing one.

If cost is a barrier

Cost should not stop you from having treatment that protects your sight. A few options are worth raising:

• Public hospital treatment. Ask your ophthalmologist about referral into the public system if a private out-of-pocket cost is not manageable.
• Payment plans. Some practices and hospitals offer instalment arrangements. Ask the rooms directly.
• Department of Veterans’ Affairs. Eligible veterans may have treatment covered through DVA.
• Concession and safety net support. Some fees and medication costs are reduced for concession card holders, and PBS safety net thresholds apply to prescription drops.

Speak to your surgeon’s rooms early rather than delaying treatment. Glaucoma damage is not recoverable, so timing matters.

Frequently asked questions about glaucoma surgery costs

Does Medicare cover glaucoma surgery?

Medicare subsidises glaucoma procedures listed on the MBS. As a public patient in a public hospital, your treatment is covered. As a private patient, Medicare pays a set benefit toward the surgeon’s and anaesthetist’s fees, and you pay the difference along with any hospital costs your fund does not meet.

Will private health insurance cover the full cost?

Not usually. Hospital cover generally handles accommodation and theatre fees, subject to your excess, but out-of-pocket costs for the surgeon and anaesthetist are common unless both participate in your fund’s gap arrangement.

What is a gap payment?

The gap is the difference between what your providers charge and the combined amount paid by Medicare and your health fund. Some funds have no-gap or known-gap arrangements with participating specialists, which reduce or remove it.

Can I have glaucoma surgery in a public hospital?

Yes. Glaucoma surgery is available through the public system. You will not choose your surgeon, and waiting times vary with clinical urgency.

Why can I not be given an exact price upfront?

Because several providers bill separately and the final figure depends on your procedure, your facility and your cover. Your surgeon’s rooms can give you a written estimate once the procedure is confirmed.

Talk to us about costs

What glaucoma surgery costs in Australia depends on the procedure, the setting and your cover, which is why a written estimate from your surgeon’s rooms is worth more than any published range.

If you would like to discuss glaucoma surgery and what it would involve for you, call Mornington Peninsula Eye Clinic on (03) 9070 3580 to arrange a consultation with a glaucoma specialist. Our rooms can talk you through the fees that apply to your situation.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

References 

1. Services Australia. Medicare Benefits Schedule. Available from: https://www.servicesaustralia.gov.au/medicare
2. Australian Government Department of Health and Aged Care. Medical Costs Finder. Available from: https://medicalcostsfinder.health.gov.au/
3. Glaucoma Australia. Available from: https://glaucoma.org.au/
4. healthdirect Australia. Glaucoma. Available from: https://www.healthdirect.gov.au/glaucoma