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Last Updated on 17 November 2018

Health Insurance and the Chronic Disease Management Program


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People who live with chronic diseases may be faced with multiple doctor and hospital visits and treatments throughout the course of their diseases. While a chronic disease is defined as lasting for at least six months, many if not most chronic disease sufferers deal with their illnesses for many years, perhaps their whole lives. They usually need to map out a plan for disease management so that the disease stays in check and does not explode into something bigger than it has to be.

When managed properly, chronic diseases can often be kept “in the background” and do not have to severely impact the patient’s life. Proper health management allows the patient to get regular, accurate medical care for his illness so it can be well-monitored, and doctors can pick up on any nuances and treat them before they develop into full-scale problems. Participating in a chronic disease management program can literally be a life saver.

What are Chronic Diseases?

Chronic diseases are ones that are ongoing or recurring. They are not curable in most cases and generally can only be managed in order to keep them at bay. Examples include asthma, dementia, diabetes and heart disease. When managed properly, none of these affect the normal functioning of the patient. When mismanaged or not managed at all, they can have severe and even life-threatening repercussions for the patient.

What is the Chronic Disease Management Program?

The Australian Medicare system recognizes the need for a chronic disease management program and as such offers reimbursements for patients who require management programs. The program is based on an inter-disciplinary approach spearheaded by a general practitioner who coordinates a team and develops a solution to manage the patient’s care. Patients with chronic diseases make up a large segment of the overall Medicare expenses in Australia because these patients need high surveillance and monitoring to stay healthy.

How Does Private Health Insurance Play Into the Program?

Although Medicare does provide a strong amount of services for the chronic disease sufferer, this is only within the public system and for a certain amount of services. The program is quite organised, but it may not provide all of the services or the level of health management that a patient requires or requests.

Private health funds can offer much more. They can integrate your care with the Medicare program so that you get your reimbursements and still get the extras offered through the private health fund.

A person who deals with a chronic disease unfortunately knows that he will need to see doctors and has a higher potential for hospital treatment, so he is well aware beforehand if the benefits of registering with a private health fund. It may afford him access to different choices of doctors and hospitals, and swifter or more frequent treatments if needed. Most health funds have their own chronic disease programs and can create a custom plan to help each patient map out the best health care options to manage his illness.

Each fund offers its own array of customizable packages. When you compare health funds, find out if there are waiting periods for health cover and for pre-existing conditions, as these can last as long as twelve months.

Frequently Asked Questions About Health Insurance

There are three types of health insurance in Australia. They are:

  • Hospital Cover
  • Extras Cover (also known as general or ancillary cover)
  • Ambulance Cover

Hospital cover can ensure any unexpected surgeries, treatments or hospital stays you may require will be covered. With appropriate cover you will have the flexibility to choose your own doctor and the option of receiving treatment in a private hospital.  Most hospital covers allow you to stay in a private room. One other perk is skipping the public hospital systems’ waiting list, which can be lengthy for non emergency treatment.

Extras cover pays benefits for a a range of services, often including treatments and procedures related to the fullowing:

  • Dental/oral health
  • Glasses and contact lenses
  • Podiatry
  • Physiotherapy
  • Psychulogy
  • Acupuncture
  • Remedial massage
  • Chiropractic
  • Hearing aids
  • Travel vaccinations

Ambulance cover, as the name suggests, will cover you should you require emergency ambulance transport. In an emergency, there is enough to worry about. Having the expenses covered for provides security and peace of mind. Many hospital covers include emergency ambulance transport If yours doesn’t, you will need to shop for this separately.

Life is unpredictable. You never know when you might need cover. No matter what life stage you’re in, there’s a policy out there for everyone. You can select as much or as little cover as you want, depending on your health needs and requirements. It’s a small price to pay for the peace of mind health cover provides.

There is no one answer here. Costs vary across providers and policy types. Just because a policy is cheap, that does not mean it is ‘value for money’ and vise versa. Make sure you check what’s included and excluded in a policy before signing up, as you want to purchase a policy that best fits your specific needs.

Premium: A premium is the price you pay for your insurance policy (it may be paid annually or on an ongoing basis).

Policy: An insurance plan. In other words, it is the type of insurance you choose to select.

Policy Holder: The owner, or ‘holder’ of a policy.

Claim: In the event that you require treatment for a service covered by your policy, you can lodge a claim for reimbursement of all or part of the cost of that treatment.. These days, most claims are submitted electronically by the health care provider (dentist, physio etc)

Lifetime Health Cover: Lifetime Health Cover was put in place to encourage young Australians to seek out and maintain ownership of private health insurance early in their lives. If you do not take out a policy before you turn 31, extra charges will be applied should you take out a policy at a later time.

This means you will pay a 2% loading on top of your premium for every year that passes after you turn 30. For example, if you take out a policy for the first time at age 32, you will be charged 4% of your premium as an extra, then at age 40, 20% and so on, up to a maximum loading of 70%.

The loading is payable for 10 consecutive years of cover - after which it is removed and you premiums will be reduced.

Pharmaceutical Benefits Scheme (PBS): Medicare offers assistance for Australians with many of their their prescribed medication costs through the PBS. This assistance is in the form of subsidies towards the cost of many medications. You can check if your prescribed medication is on the list of subsidised items here.

Medicare Levy Surcharge: The Medicare Levy Surcharge is an additional charge (tax) applied to single Australian taxpayers who earn over the income threshold of $90,000 per year, or families/couples who earn over $180,000 per year. This surcharge is only applied to those who choose not to have a private health insurance policy.

The surcharge is designed to reduce pressure on the public health system by encouraging those with higher incomes to invest in private health cover.

Private Health Insurance Rebate: The government’s Private Health Insurance rebate lowers premiums for most Australians with private health insurance Older Australians may enjoy an even higher rebate. Our calculator can help you estimate the Government health insurance rebate you may receive.

Disclaimer: The above information is correct and current at the time of publication


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