Best health insurance for physio

Physiotherapy is a popular type of treatment in Australia, with everyday people using it to help manage pain, recover from injuries and improve their overall physical function. But as it’s not an essential service, the cost of physiotherapy can add up over time – especially if you need to use it regularly. That’s why it’s a good idea to take out private health insurance.

Let’s break down all the considerations to find the best health insurance for physiotherapy in Australia, including the level of cover provided under Medicare, how private health insurance works for physio, different types of physiotherapy and the waiting periods.

While it’s true that Medicare does offer some limited cover for physiotherapy (e.g. consultations/appointments), you need to meet all the eligibility criteria. In general, physio services aren’t covered unless they are part of a Chronic Disease Management (CDM) plan, which is only something that patients with chronic medical conditions have, as they require complex care.

Under the CDM plan, patients may be able to receive up to five allied health services per calendar year, which can include physiotherapy. However, as this is likely to be far fewer sessions than you’ll need for ongoing treatment, the best option is to get private health insurance for broader physiotherapy coverage.

Yes, private health insurance policies here in Australia tend to include physiotherapy under extras cover. This is a different type of cover than standard hospital cover, so you’ll need to take out a separate policy or bundle these services into a combined hospital and extras cover.

The good news is it’ll give you all the benefits for non-hospital treatments that aren’t covered by Medicare. Most health insurance providers have extras policies that include physiotherapy, but just be aware that the extent of the cover will be different from plan to plan.

Private health insurance policies generally cover a percentage of the physiotherapy costs, up to a certain limit. For example, one policy might cover 50–80% of the cost of each session, with an annual limit of $1,000. Other policies might have more or less benefits. Some policies might also cover initial consultations at a higher rate compared to subsequent sessions.

When you’re starting to whittle down your list of providers for your health insurance plan, it’s important to take into consideration a few things for physio:

• Benefit limits: Annual limits for physiotherapy can differ greatly between providers. Choose a plan with higher limits if you expect to take fairly frequent trips to the physio.
• Gap payments: The difference between the physiotherapy fee and the amount covered by insurance, known as a gap fee, should be front-and-centre in your plans. Some policies could have lower gap payments, so do your research beforehand.
• Network providers: Some insurers have agreements with specific physiotherapy providers, offering higher benefits if you use their network.

In the most basic terms, it operates on a reimbursement or direct payment basis, depending on your insurer and healthcare provider. Here’s a closer look at how it works in general:

1. Reimbursement: After paying for your physiotherapy session, you lodge a claim to your health insurer along with the receipt. Your insurer then reimburses a percentage of the cost, as outlined in your policy.
2. Direct billing: Some physiotherapists will allow direct billing, where your insurer pays the provider directly, and you only pay the gap fee at the appointment.

Your private health policy will have benefit limits and caps for physiotherapy – these lay out the maximum amount you can claim within a year. If your policy has an annual limit of $600 for physiotherapy, once you reach this limit then you’ll have to cover any extra costs out-of-pocket until the new policy year begins.

Some policies might specify the exact number of sessions that will be covered per year (or the benefit amount per session). Having these figures upfront can be helpful for planning your treatment schedule and managing your budget.

Some policies might even include cover for related services – anything from hydrotherapy to exercise physiology to group physio sessions.

There are lots of different treatment modalities that make up physiotherapy, and different activities will address different conditions and physical health needs. It doesn’t matter whether you’re a young adult or approaching retirement, it’s very likely you’ll need some form of physio during your life, such as:

• Musculoskeletal physiotherapy: Focuses on treating injuries and conditions that affect your muscles, bones and joints. It’s best for treating back pain, sports injuries, arthritis and post-surgical rehabilitation. Techniques used include manual therapy and dry needling.
• Neurological physiotherapy: This is for patients who are dealing with neurological conditions as a result of stroke, multiple sclerosis, Parkinson’s disease and spinal cord injuries. Treatment is intended to improve mobility, balance and coordination.
• Cardiovascular and pulmonary physiotherapy: This type is for conditions related to the heart and lungs, such as chronic obstructive pulmonary disease (COPD) and post-heart surgery rehab. It’s more about improving cardiovascular fitness, respiratory function and overall endurance.
• Paediatric physiotherapy: Catered to children with developmental, neurological or musculoskeletal issues. It includes treatments for conditions like cerebral palsy and congenital disorders. Therapists tend to use play-based activities and exercises to improve motor skills and physical function.
• Geriatric physiotherapy: Targeted to those aged 65 and older, this type of physio revolves around age-related issues such as osteoporosis, arthritis, balance disorders and post-surgical recovery. Treatments can help with mobility, strength, independence and more.

Waiting periods are a standard feature of every health insurance policy, including extras cover, which is where you’ll find physiotherapy. For things like dental, optical and physio, you can expect the waiting periods to range from two to six months. Thankfully, when you take out an extras policy, most providers will only make you wait two months before you can start claiming benefits for physio.

Be aware that some insurers might impose longer waiting periods for certain pre-existing conditions or treatments, particularly if they are part of a broader rehabilitation program. Post-surgical physio, for example, might have a longer waiting period compared to regular physio sessions.

If you are switching from one health insurer to another, you might be able to carry over the waiting periods you have already served. This is known as continuity of cover and can help reduce (or eliminate entirely) the waiting period with your new insurer.

While it would be amazing to have unlimited physiotherapy cover, you’ll find that pretty much every health insurance policy comes with annual and lifetime limits. Unlimited physio health insurance isn’t really something you can get in Australia.

However, some high-level extras policies will have very generous annual limits and higher benefit amounts per session, which can really minimise your out-of-pocket expenses.

Choosing the best health insurance for physiotherapy isn’t rocket science. Ultimately, it comes down to things like the level of cover you want, the benefit limits and waiting periods, and how much you can budget for any gap fees. So start comparing policies today and take advantage of the amazing benefits of private health insurance for physiotherapy.