Private Health Insurance for Orthotics & Podiatry

Health insurance for orthotics is covered under extras cover

What are orthotics?

Orthotics, as defined by the Australian Orthotic Prosthetic Association, involve the assessment and treatment of physical and functional limitations resulting from illnesses and disabilities, including limb amputations.

Orthotists are allied health professionals. They have the expertise to prescribe, design, fit, and monitor the performance of orthotic and prosthetic devices.

Orthotics, also referred to as orthoses, encompass specially crafted braces, appliances, and inserts designed for fitting to the body. These devices cater to various body parts, including the knees, ankles, and feet (e.g., shoe inserts), as well as those designed for fracture protection and spinal support. 

Orthotics serve several purposes, such as: 

• aiding in rehabilitation

• controlling biomechanical alignment

• correcting deformities

• alleviating pain

• enhancing mobility and independence, 

• and preventing or protecting injuries during the healing process.

Does health insurance cover orthotics?

It’s encouraging to note that numerous Australian private health funds incorporate orthotics cover into specific higher level extras policies, though orthotics are commonly excluded from basic extras policies.

It’s important to ask your health fund how orthotics are classified in their policies. Some funds categorise orthotics separately, assigning a specific annual benefit limit for claims related to orthoses and treatments by your orthotist. 

Other funds may consolidate orthotics with other appliances under a broader category, such as health aids, sharing a collective annual benefit limit, which can impact your out of pocket costs.  Under many extras policies, orthotics must be custom made by a podiatrist or orthotist to qualify for benefits

Can I use my private health insurance for podiatry?

Yes, as long as your specific policy covers this. Most health funds include orthotics specialists and podiatric treatments in their higher level extras policies.

Are orthotists the same as podiatrists?

While there are certain overlaps in their scope of practice, orthotists and podiatrists represent two distinct health professions.

Orthotists specialise in working with orthoses, which are the external devices tailored to your body to address a physical limitation. Their work entails using orthotics to rectify abnormalities, prevent further injuries, and enhance the functions of your lower limbs and feet.

Podiatrists concentrate specifically on disorders of the lower limbs. While podiatrists may occasionally use orthotic devices in their treatments, their practice includes the removal of calluses, warts, corns, and addressing ingrown toenails as well as other foot related conditions.

What should I be aware of when claiming for orthotics through private health insurance?

• Certified Supplier: Before filing an orthotic appliance claim, ensure your items are provided by a registered orthotist, orthotic supplier, or podiatrist. Confirm that your chosen supplier is covered by your health fund before making any appliance payment.

• Waiting Periods: There are different waiting periods applicable to different types of orthotics. Some health funds impose a general waiting period (e.g., 12 months), while others may have separate waiting periods for repair, maintenance, hire, and replacement of orthotic equipment.

• Check your policy fine print before signing up to a fund that might not be your best fit.

• Annual Benefit Limits: Examine your benefit limits, including an annual benefit limit for orthotics. Verify if there are dollar limits for certain orthotic devices or if your health fund covers a percentage of your bill for your orthotic appliances. Important Note: Check whether any listed annual limit includes benefits for other health aids and appliances, or will only be applied to your orthotic devices.

Orthotics is also grouped with physiotherapy, occupational therapy, dental and other allied health services, so if you regularly use more than one allied health service, it can be worth a higher level of cover.

Andrew G. Bull - Sports Podiatrist from Sydney Sports Podiatry

Can my hospital cover pay for my orthotics?

Hospital cover only pays benefits for in-patient care, so if you're scheduled for foot or lower limb surgery in a hospital, your health fund may cover you, if your level of cover includes your surgery.

How much do orthotics cost In Australia?

The cost of orthotics can vary significantly between orthotists, and the type of orthotic device you require. Another impact to the cost of your orthotics is whether your orthotics can be off the shelf, or need to be tailored. For example:

• Custom Orthotics: $400 – $1000+

• Off-the-Shelf Orthotics: $100 – $500+

Types of Orthotics:

Orthotics are categorised into five types, each with different price ranges as recognised by the podiatry association.  Many insurers will only pay benefits towards custom made orthotics supplied through a podiatrist or orthotist.

• Custom Functional Orthotics: Made from a cast, impression, or foot scan.

• Moulded Cast Orthotics: Pre-formed moulded to a cast or a non-functional design moulded to a cast.

• Moulded Non-cast Orthotics: Directly moulded to the foot and customised.

• Off-the-Shelf Orthotics: May be customised or not.

• Ankle Foot Orthotics (AFO): Orthotic for the foot and above the ankle.

Orthotic consultations can also contribute significantly towards the total expense of your orthotic treatment, as there is often a prolonged aftercare period. Some clinics charge for each consult, whereas others may include a certain number of follow-ups in your initial fees.

For comparison purposes, assuming you are a new patient, the inclusive total cost of orthotics typically includes:

Frequently Asked Questions

Is podiatry covered by Medibank Private?

Where members have selected podiatry as a covered service, Medibank Private covers up to 70% of your consultation cost, but only if you use a Member's Choice provider under the Medibank My Choice Extras Support and Medibank My Choice Extras Complete plans.

Further consultations come with additional out-of-pocket costs. You’ll also be subject to standard waiting periods and annual benefit limits, which may not always be suitable for you. Find out more about this here.

Is podiatry covered by BUPA?

Bupa provides cover for some podiatry services (but not hospital treatments) under their extras policy. Their hospital cover offers limited benefits if you require podiatric surgery, though these fall under their hospital cover, not their extras policy. Read more here.

Does Medicare cover podiatry surgery?

Foot surgery by a podiatrist isn’t covered by Medicare, so it can mean a major hit to your bank balance, if you’re not covered. There may be an exception to this rule if you’re suffering with conditions such as diabetes. In this case, if your GP has put you on a CDM (Chronic Disease Management) Plan for your condition, then the Medicare Benefits Schedule (MBS) may cover part of your podiatry treatment.

Sources:

https://entirepodiatry.com.au

https://powerpodiatry.com.au/orthotics-cost-orthotics-price-guide/

https://www.news.com.au/best-of/money/silver-health-insurance/news-story/8d0e6f0fc6f2313729a228cfb00f61fd

https://www.ombudsman.gov.au

https://www.hif.com.au

Note: Some clinics may include fitting in the orthotics' price, while others may charge a separate fee for subsequent consultations. It's essential to inquire about aftercare, potential additional fees, and satisfaction guarantees.

Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

• 1

  Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.

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  An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.

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  Family health cover means your children are covered under the same policy as you.

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  Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).