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Does Health Insurance Cover Long Covid?
Countless doctors’ appointments and mounting medical bills: living with a chronic health condition takes a lot more out of you than just your quality of life.
Especially when it’s a new virus like long Covid that medical experts are still figuring out.
Its estimated 5% to 12% of Covid patients can go on to develop chronic Covid symptoms.
This adds to the 11.6 million Australians who have lived with a chronic health condition at one point or another - close to half of the entire population
Health insurance does provide some support for chronic conditions, but there's not a consistent approach from every health fund when it comes to long Covid.
Let's go deeper into this by taking a quick look at how insurers handle chronic conditions.
What’s considered a chronic condition?
First off, here's how health insurance tackles conditions that last well beyond the initial point of diagnosis.
To be officially classified as a chronic condition, usually need to last at least six months, and can often cause other medical complications.
Some of the most common chronic conditions in Australia include:
Cancer
Heart diseases
Diabetes
Endometriosis
Mental conditions
Lung and respiratory conditions
Are chronic conditions covered by health insurance?
People with chronic health conditions usually face a lot of doctor and specialist visits - which can add up, cost wise.
Some conditions aren't always curable, meaning it’s more about keeping things at bay to help patients live their lives as normal and comfortable as possible.
Medicare has a chronic disease management program to help people manage the expenses of keeping their condition in check
Be aware: not all conditions are covered by Medicare, and reimbursements may get capped.
When it comes to private health insurance providers it’s all about finding the policy that's best fitted to your body - not every provider may offer the right coverage for your specific condition.
Many funds do offer extra support programmes for common conditions such as mental health, cancer, and diabetes.
People with chronic conditions might want to consider health insurance items such as care-at-home or rehabilitation
Check the detail: It's important to get into the fine print when it comes to additional support from your insurer. It can vary from programmes being available for any member with hospital cover or restricted to those with a higher level of cover.
A red flag: Insurers will generally insist you serve waiting periods for pre-existing conditions if you're adding items onto your policy for the first time.
Expert help: Chronic conditions are complicated. Speak to a Compare Club expert if you need help navigating what's covered in certain policies.
So what does this mean for long Covid and health insurance?
Technically, long Covid fits the bill of a chronic health condition as it falls into the categories of neurological, and lung and respiratory diseases.
That said.. it’s still a relatively new condition, so medical professionals are still in the process of studying the virus and its various treatment options.
The World Health Organisation (WHO) defines long Covid as symptoms that are present for more than three months after infection.
Some health funds have temporarily added items such as lung and chest conditions to lower levels of hospital cover to account for more acute Covid infections.
There are very few long-Covid clinics in Australia and waiting times for a spot can average about six months.
At present, Medicare doesn’t cover cognitive diagnostics, which is necessary for most long-Covid cases. Paying out of pocket could cost around $1,500.
Be aware: there's still a lot of ambiguity in insurers' wordings over whether long Covid is considered a pre-existing condition or not. The line below is relatively common in health fund FAQs around Covid:
"Any future claims for complications arising from COVID-19 will be assessed in line with the pre-existing condition rules, where a fund-appointed Medical Practitioner will make a determination as to whether there were any signs or symptoms of the condition that existed at any time in the six-month period ending on the day on which the member became insured under the policy or changed their cover. "
In plain English, that's a very wordy, legal way of saying it depends. The key takeout here is to tell your insurer if your doctor or another medical professional thinks you have long Covid.
And at the moment, there are very few long-Covid clinics, meaning waiting times for a spot can average about six months.
The bottom line
Long Covid is still a bit of an unknown quality, which makes it hard for insurers to have a clear view on what they should or shouldn't cover.
Long Covid has a lot of symptoms and can affect a lot of different areas of your body.
Some - like lung and chest, or heart complications - are more likely to be covered under the items in an existing policy.
Other elements such as fatigue are harder to pinpoint, treat, and cover and don't naturally fall into any specific item in a policy.
This is one instance when you'll almost certainly want to speak to your insurer and see how they classify long Covid conditions.
It's unlikely any insurer will cover all symptoms exhaustively but some will be more suitable for you than others.
