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General Cover from Private Health Insurance vs. Medicare

Sally Aquire February 16th, 2012 0 comments
Health insurance extras

Australians can benefit from a great public health care system in the form of Medicare but there are some restrictions in terms of what it will pay benefits for. For services that aren’t covered by Medicare, you’ll need private health insurance.

Some common extras that are offered through private health insurance include:

  • ambulance cover
  • general dental benefits
  • optical benefits
  • physiotherapy benefits
  • chiropractic benefits
  • osteopathy benefits
  • natural remedies

It’s important to compare extras for private health insurance, as the level of coverage will vary between private health funds.

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Medicare Benefits

Through Medicare, you can receive benefits for:

  • Eye tests from a qualified optical specialist
  • Some surgical procedures performed by approved dentists
  • Acupuncture, if it forms part of a doctor’s consultation

Ambulance cover

This varies depending on where you live. For example, Queensland and Tasmania have emergency ambulance services provided free by the State Government, but in New South Wales and Australian Capital Territory, free ambulance cover applies only to pensioners and those on a low income. Medicare doesn’t cover ambulance costs, so you may need to arrange private health insurance with ambulance benefits to make sure that you’re covered.

Dental benefits

There are two types of dental benefits:

General dental

 This includes diagnostic and preventative procedures such as cleaning, plaque removal, x-rays and small fillings. Dental examinations and treatments aren’t usually available as Medicare benefits, unless they are specified items introduced for allied health services as part of the Chronic Disease Management program. There is a two month waiting period for most general dental benefits.

Major dental

This includes orthodontics and braces, wisdom teeth removal, crowns, bridges and dentures. There is a twelve month waiting period for most major dental benefits.

Optical benefits

Medicare covers eye tests with a qualified optician, but if you need vision correction such as glasses or contact lenses, you’ll need to pay for it yourself unless you have private health insurance with optical cover. Optical cover only pays benefits for vision correction. There is typically a two month waiting period for optical benefits.

Podiatry benefits

Podiatry is used to diagnose, treat and prevent problems with the feet and lower limbs. There is generally a two month waiting period for podiatry benefits.

Mental Healthcare benefits

Treatment for stress, anxiety, depression and other mental health issues is only available through Medicare in certain circumstances. If you want  more extensive insurance cover, you’ll need to compare private health insurance policies that include mental health care benefits. There is a two month waiting period for mental health care benefits.

Physiotherapy benefits

Physiotherapy is used to treat muscle and joint problems and can improve symptoms arising from arthritis, neck and back pain, breathing difficulties, sports injuries and neurological problems. Normally, there is a two month waiting period for physiotherapy benefits.

Chiropractic benefits

This treats problems with the musculoskeletal system, particularly with the spine. It may be used to treat back and neck pain, headaches, migraines, arthritis, carpel tunnel syndrome, injuries, muscle spasms, posture problems and even chronic fatigue. Chiropractic treatment isn’t available through Medicare so you’ll need to arrange private health insurance with chiropractic benefits to be covered. There is a two month waiting period for chiropractic cover.

Naturopathy benefits

This involves a holistic approach to health which focuses on nutrition, dietetics, herbal medicine and massage to encourage the body to heal itself. It can be used to treat a wide range of conditions such as fatigue, anxiety disorders, arthritis, allergies, digestive disorders, headaches and skin complaints. Naturopathy is not generally available through Medicare, but can be arranged as an added extra on private health insurance policies. The typical waiting period is two months.

Non-PBS pharmaceuticals benefits

Some drugs aren’t listed on the Pharmaceutical Benefits Scheme (PBS) so if you want to be covered for these, you’ll need to arrange private health insurance with non-PBS pharmaceuticals cover. There is usually a two month waiting period before this cover may be used.

How do I know if I’m covered for extras?

Health funds are legally obliged to state in their Standard Information Sheets whether the policy covers the following extras:

  • Acupuncture
  • Chiropractic
  • Dental features
  • Glucose monitors
  • Hearing aids
  • Naturopathy
  • Non-PBS pharmaceuticals
  • Optical benefits
  • Physiotherapy
  • Podiatry
  • Psychology
  • Remedial massage

If you want to be covered for benefits that aren’t available through Medicare, you’ll need to arrange private health insurance with your desired optional extras attached. Be sure to compare health funds for general cover as extras can vary a lot between health funds.

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