Niggling injuries and general wear and tear can prevent you from kicking those health goals. With physio private health insurance, you can save money and get back to 100% in no time.
Complaining about ongoing muscular or joint pain? Have limited movement thanks to an injury or generally feel a little stiff and sore? Physiotherapists treat a variety of complaints through manipulation, joint mobilisation, massage and therapeutic exercise to reduce stiffness and elevate the pain.
A consultation with a physiotherapist could be all you need to get your health back on track and doing the things you love without feeling every bit of your age. The downside is that Medicare only covers the cost of seeing a physio if you’re an inpatient in a public hospital.
That’s why physio health insurance is one of the most popular forms of private health cover. Depending on the extras cover you take out, you may pay next to nothing for your physio treatment plan. Sound appealing to you? This guide will share with you all the details you need to know to find the best physio extras insurance for your needs.
Why get physio health cover?
One of the top reasons people get physio private health insurance is to save money. They see value in protecting their best asset: their health. However, paying for ongoing physio treatments to improve mobility and activity out of your own pocket doesn’t come cheap.
That’s where physiotherapy health cover comes in. When you take out an extras policy, even when combined with hospital cover, you can significantly save on ancillary services like physio. That means more money to spend enjoying your health and less money keeping your body in tip top condition.
Who can benefit from physio health insurance?
Physio insurance isn’t just for AFL athletes or those who have a chronic movement disorder. Almost everyone at some point can benefit from physiotherapy health cover. Whether you’re young and fit or in the later stage of your life, there are plenty of reasons why you might benefit from extras cover for physiotherapy.
If you struggle with any of these health issues, you’re likely to benefit from physio health cover:
- If you’re recovering from an accident or injury
- If you suffer from a movement disorder
- If you have a chronic illness
- If you have a neurological disorder like a stroke or multiple sclerosis
- If you play a sport with a high risk of injury
- If you work in a labour-intensive job
- If you’ve suffered from pregnancy complications
- If you suffer from postural neck and back pain
There’s only one way of finding the best private health insurance for physiotherapy and that’s to compare policies. Our Members Own online comparison tool helps you find the right hospital cover and extras cover for your needs from a range of not-for-profit and mutual health funds.
That means you’ll be comparing policies that offer higher benefits and better coverage.
Common conditions that require ongoing physiotherapy
Some health insurance funds will cover all types of physiotherapy treatments - musculoskeletal, cardiothoracic and neurological conditions - under their extras policy but others won’t. That’s why understanding what’s included and comparing the policies is important if you want to get the most from your cover.
The common conditions requiring ongoing physiotherapy treatments are:
These conditions involve your muscles, joints and bones. Some of the typical musculoskeletal conditions are arthritis, muscle strains, sprains, sports injuries and back pain.
Neurological conditions are debilitating conditions that affect the brain. Conditions such as stroke, multiple sclerosis, cerebral palsy, head and spinal injuries and Parkinson’s disease fall under this category.
These conditions include asthma, chronic bronchitis and emphysema. People who struggle with shortness of breath and decreased endurance often require ongoing physio treatment.
Common physiotherapy expenses covered
A percentage or annual dollar amount of your physiotherapy expenses are covered under an extras policy. The level of your extras cover will determine what physio-related treatments and services you can claim. For example, some basic extras policies will have a very limited number of services available or exclude things like physio, osteo and remedial massage altogether. On the other hand, top or comprehensive extras cover will have a greater variety of options you can choose from.
Some of the most common physiotherapy services covered on extras policies include:
The initial consultation and diagnosis of your health complaint
The development of a treatment plan
Antenatal treatment and exercise classes
Pilates, if deemed medically necessary
Hydrotherapy, if deemed medically necessary
Dry needling, if deemed medically necessary
Electrotherapy, if deemed medically necessary
Compression recovery wear
How much can you claim back with physio private health insurance?
As you probably know, extras cover works a little differently to hospital cover or ambulance cover. The amount you can claim back for physio-related treatments will depend on your policy and your health fund provider.
The benefit amount is calculated by the insurer using one of two methods:
1. Percentage Benefits
As the name suggests, percentage benefits are calculated as a percentage. For example, you might receive 50% back from your physio treatment. So if the treatment cost $100, you will get $50 back. The percentage benefit structure allows you to know what you’ll be reimbursed from your health fund regardless of the cost of the treatment.
However, there is a downside to percentage benefits which is that it applies to all extra services under your policy. That means you’re unable to prioritise the types of treatments and services that are most important to you. If you’re able to, paying a higher premium may result in a higher percentage rebate.
2. Set Benefits
With a set benefit, your rebates will be in the form of a fixed dollar amount for eligible services claimed. For example, you may receive $70 back from your initial physio consultation, leaving you to pay the remaining $50 of a $120 bill. The advantage of set benefits is that you can customise your cover to select a policy that offers higher benefits for services you need most.
The downside of set benefits is that calculating your out-of-pocket expenses is more challenging. Unless you know how much your physio session will cost you, you won’t be able to work out how much you need to pay.
Do annual limits apply to physiotherapy?
Yes, annual limits will apply to the maximum rebate the you’re able to claim per person insured in each calendar year.
The annual limit on physiotherapy will depend on your chosen health fund and the level of extras cover. Typically, a higher level of cover will give you higher annual limits.
Limits on your extras cover are generally broken down into two categories:
1. Combined Limits
If your extras policy specifies combined limits, this means several services fall under the one limit. For example, your physiotherapy cover may be grouped with chiropractic treatments and remedial massage under the banner of physical therapy. So if you max out your limit on physio treatments you won’t have any benefits remaining for the other combined services.
Extras cover with sub-limits means specific treatments under the one category will have individual benefits. For example, if your extras cover offers physical therapy benefits, you may receive a limit of $200 for physio and $80 for remedial massage.
Lifetime limits is another limits category however it’s rarely used and typically applies to orthodontic treatments. With a lifetime limit, your benefit limits aren’t renewed annually.
Other limits to consider
Extras cover can have other limits you should consider when comparing policies.
These include the following:
1. Time limits
If time limits are applied to your extras cover, you must lodge your claim within two years of the date you received treatment.
2. Service limits
There may also be a service limit applied to your extras cover. This means there will be a limit on the number of times you can claim for the same service. For example, there may be a limit on the number of times in a calendar year you can claim on an initial consultation with a physiotherapist.
3. Benefit limits
It’s common for your new health insurer to apply a limit on the benefits you can claim per day. For example, if you receive two services within the one consultation, such as general dental, you may only be able to claim on one service.
How long will I have to wait to claim for physio health services?
The waiting periods for extras cover are set by each individual fund, not by the government. As a general rule of thumb, you can expect to wait 2 months before you can claim on your physiotherapy treatments.
Provided you maintain the same level of cover, once you’ve served the waiting period, you can switch policies without worrying about having to re-serve the waiting period.
It’s not uncommon for health funds to run promotions offering extras cover with no waiting periods to attract new members, which may be combined with basic hospital cover. These are sometimes specifically targeted at certain customers, like single parents, couples and seniors.
It’s worth keeping your eye out for these offers so you can claim sooner rather than later on health services.
Does Medicare cover the cost of physio?
Generally, physiotherapy costs are not covered by the federal government’s Medicare. There are a few exceptions where Medicare will provide benefits for physio-related services.
1. Public hospital admittance
For patients requiring physio or rehabilitation whilst they are in a public hospital, Medicare provides some benefits. It’s likely they won’t cover you for ongoing treatments delivered outside of the hospital.
2. Chronic Disease Management
For patients who are requiring physio-related treatments as part of their Chronic Disease Management, Medicare may provide benefits. Some of the eligible diseases include diabetes, arthritis, cancer, stroke and certain musculoskeletal conditions. To receive Medicare benefits, the treatment must be recommended by a GP and at least two allied health professionals.
An overview of eligibility and requirements for Chronic Disease Management can be found here, including how the referral works with allied health professionals.
Other benefits you can enjoy with extras cover
While it’s one of the most popular benefits Aussies enjoy, physiotherapy isn’t just the only service you can claim under extras cover. Depending on your fund and the level of cover, you may be able to enjoy the benefits of:
Dental treatment including dental check-ups, major dental and orthodontic treatment
Occupational and speech therapy
Optical including eye check-ups, glasses and contact lenses
Medical aids such as glucose monitor and hearing aids
Pharmaceuticals not covered by the PBS
Alternative and natural therapies such as acupuncture, naturopathy and remedial massage
Key factors to consider when you’re comparing extras cover
Comparing extras cover couldn’t be any easier with the Members Own online comparison tool. While price is an important factor to consider, it’s not the only feature of health insurance you should take into account.
When you’re considering extras cover, here are a few additional factors to consider:
Consider the health of you and your family
When looking into extras cover, consider your current health as well as your family history. If there is a complicated health history in your immediate family, perhaps it’s worth considering a more comprehensive policy.
Compare the percentage or set benefit
You’ll want to make sure you understand how much you’ll get back from a particular treatment. The last thing you want is to realise you’re paying considerably more in premiums than you are receiving in benefits. Also factor in the dollar limit of what you can claim annually.
Know the limits
If you’re taking out extras cover mainly to receive physio-related treatments, understanding the amount you can claim will help you get the most out of your policy. Determine whether your cover specifies limits on individual treatments or if they’re grouped together and share the same annual limits.
Turning 31 soon?
Getting your private health insurance sorted sooner rather than later can also help you avoid paying the Lifetime Health Cover loading.
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