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Health Insurance for Physiotherapy

Chris Stanley

Updated 19/12/2023

Health

Private Health Insurance For Physiotherapy

Key Points

Physiotherapy is only covered by Medicare under very specific conditions, and only for up to 5 sessions. If you don’t require a chronic pain management program, you’re unlikely to be eligible.
Private health cover often includes physiotherapy under extras cover.
Extras health cover also includes other services not covered by Medicare, such as dental and remedial massage.
Without insurance, the cost of a standard consultation can range from $80 to $150 or more.
It’s possible to skip the waiting period for extras-only cover, though this depends on your insurer.

Physiotherapy is a versatile and essential healthcare service that addresses a wide range of physical conditions and concerns. Specific reasons you might need physiotherapy include:

Pain Management
Prevention and Maintenance
Chronic Disease Management
Posture and Ergonomics

A qualified physiotherapist can improve your mobility, reduce your pain, enhance motor skills and function, and assist you in developing an overall higher quality of life.

Can you claim physiotherapy on Medicare?

While Medicare doesn’t generally provide cover for most out-of-hospital physiotherapy services, there are two situations where benefits may be available:

Public Hospital Admittance: Medicare provides benefits for inpatient physio treatment and rehabilitation during a public hospital stay.

Chronic Disease Management Program (CDM): Medicare may cover up to 5 physio-related services recommended by at least two allied health professionals and a GP as part of a CDM for eligible chronic diseases such as arthritis, diabetes, cancer, stroke, and musculoskeletal conditions.

Important Note: Not all physiotherapists accept Medicare referrals. You’ll need to discuss where you can go with your GP in order to get the right referral, and consider the closest participating practitioner to your location. This can be of particular importance if you live in a regional or rural area with few options for physiotherapeutic care.

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Does health insurance cover physiotherapy?

Physiotherapy is included in most basic extras policies, ensuring that you have affordable access to this essential healthcare service.

Without insurance, the cost of a standard consultation can range from $80 to $150 or more. The right health cover protects you from high out-of-pocket expenses for your physio.

"If you see a physiotherapist regularly, it's important to know how much of the consultation cost your insurance will cover as costs can add up." - Andrew Huynh, ESPR Therapy & Training

Below are 3 relevant Bronze policies for a Single, living in NSW, aged 35 with an annual income of $97,001-$108,000 (Tier 1)

Policy	HCF Hospital Bronze Plus and Starter Extras (with Optical)	AHM Starter Bronze Hospital and Value Extras	Bupa Bronze Plus Simple Hospital with Freedom 60 Extras NSW
Cover Tier	Bronze	Bronze	Bronze
Excess	$250	$500	$500
Current Pricing (Fortnightly)	$66.58	$64.39	$67.99
Physiotherapy Extras	per person limit: $200 per policy limit: $400 initial visit: $42 subsequent visit: $36 waiting period: 2 months	per person limit: $200 per policy limit: $400 per family initial visit: $34 subsequent visit: $26 waiting period: None additional info: Group or class (hydrotherapy, antenatal and rehabilitation) - $12 All classes must be provided by an ahm recognised physiotherapist.	per person limit: $700 per policy limit: $1400 initial visit: 60% of charge up to limit subsequent visit: 60% of charge up to limit waiting period: 2 month combined limits: Combined limit for General Dental, Physiotherapy, Chiropractic and osteopathy.

*Policies accurate as of 07-08-2024

What’s the best health insurance for physiotherapy?

Private health insurance not only covers physiotherapy but also offers cover for other essential healthcare services, such as dental, optical, and chiropractic care. By choosing a policy that includes physiotherapy, you’ll enjoy the added benefits of a comprehensive healthcare plan.

Private health insurance for physiotherapy:

The types of physio treatments covered with an extras policy can vary depending on your private insurance provider and the level of extras coverage you have. If you have a basic extras policy, your cover may be limited to certain procedures only. A more comprehensive extras plan includes broader cover, and a higher premium.

If your extras policy includes physiotherapy, you may be able to claim the following:

Initial Consultation and Health Diagnosis: Your first visit to the physio where they assess your condition and create a treatment plan.

Follow-Up Consultations: Ongoing visits to track progress and adjust your treatment. Treatment Plan Development: The creation of a structured plan tailored to your specific healthcare needs.

Rehabilitation: Exercises and therapies to aid in your recovery. Dry Needling: Some policies may cover specialised treatments like dry needling. By comparing the features and costs of different policies, you can find the one that best suits your needs and budget.

What Are The Waiting Periods For Physiotherapy?

The waiting period for physiotherapy falls under your general treatment extras cover. These waiting periods are determined by your specific private health insurance provider and typically range from two to six months.

Some insurers allow you to skip your waiting periods when you take out extras-only cover.

How much does a physiotherapy appointment cost with private health insurance?

Without insurance, the cost of physiotherapy varies depending on the type of appointment you need.

While some treatments may only require a single visit, most issues require multiple sessions with your physiotherapist.

Here’s a breakdown of the typical costs for common physiotherapy appointment types in Australia:

Initial Consultation: $100 - $150
Standard Consultation: $80 - $130
Group Physiotherapy: $25 - $42
Remedial Massage: $100 - $140
Taping Only: $20 - $35

Rebates for physiotherapy:

As of 2022, under the Medicare Benefits Schedule (MBS), the Medicare rebate for eligible patients will cover you for $56.00 towards a physiotherapy session. If your practitioner charges more than this (and as per the above, they usually do), you’ll need to pay the difference.

The best extras cover for physiotherapy

This comes down to knowing your benefits and claiming all you’re entitled to claim. The amount you can claim back for physiotherapy services depends on your health fund and the specific extras policy you choose. There are two common ways that benefits are calculated:

Set Benefit: Your rebate will be a fixed dollar amount, such as $40 or $50, for eligible services. Percentage Benefit: Your rebate will be a percentage of the total fee charged for the service, such as 50% or 75%.

Important Note: There’s usually an annual limit to the maximum amount you can claim per person per year. However, the good news is that your extras benefits reset each year, allowing you to continue receiving the benefits you need.

Determining the best extras cover means digging into the benefit limits, and whether they’re set or percentage-based. Percentage-based benefits better protect you when your physiotherapist puts up their fees. You can ask a health cover expert to sort through these details with you, and find you the best for your budget.

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Covered Physiotherapy Expenses:

Health funds typically cover a range of physiotherapy services on extras policies. However, the level of cover varies with the policy you choose. Some of the commonly covered physiotherapy-related services include:

Initial and follow-up consultations
Development of treatment plans
Pilates or hydrotherapy sessions
Antenatal exercise classes
Compression recovery items
Rehabilitation services
Physiotherapy-related items, such as foam rollers, trigger balls, and sports tape, may not be covered by your fund.

Additionally, the specific services, items, and types of session you can claim may vary between health funds and even different levels of extras cover offered by the same insurer. Comparing the features of each policy closely before making a purchase is wise. When it comes to whether physiotherapy is covered by your private health insurance, it depends on your extras cover. Each policy is unique, so it's important to research and select the right plan for your physiotherapy needs.

Frequently Asked Questions

What health insurance will cover physiotherapy? To receive cover for your physiotherapy, you’ll need extras health cover. Policies start from as little as $3.

Sources:

Over 50s Health Insurance: Your Essential Guide

Guide to Private Health Insurance for Chiropractic Care

Do Pensioners or Seniors Need Private Health Insurance?

Things You Should Know

*As our customer you'll be provided with quotes directly from the insurer for the product you intend to purchase. We manage the application and deal with the administration work and insurer. We do not charge you a fee for the service we provide, the insurer simply remunerates us in return for setting up your policy. The financial and insurance products compared on this website do not necessarily compare all features that may be relevant to you. Comparisons are made on the basis of price only and different products may have different features and different levels of coverage. Compare Club does not compare all policies available in Australia and our partner insurers may not make all policies available to Compare Club.

This guide is opinion only and should not be taken as medical or financial advice. Check with a financial/medical professional before making any decisions.

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

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