You can get health insurance for orthotics and orthopaedic shoes with top tier extras insurance, generally included under podiatry.
Top extras cover with orthotics starts at around $45 per month, or $11 per week.
The waiting period for orthotics cover is generally around 2 months.
Compare extras that covers orthotics
Here are some extras policies from Finder partners that cover orthotics. All prices are based on a single individual with less than $93,000 income and living in Sydney.
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What are orthotics?
An orthotist is an allied health professional who can, according to the Australian Orthotic Prosthetic Association, "Assess and treat the physical and functional limitations of people resulting from illnesses and disabilities, including limb amputations." Orthotists can prescribe, design, fit and monitor the performance of orthotic and prosthetic devices.
Orthotics, which are also called orthoses, are specially designed braces, appliances and inserts that can be fitted to the body. There are orthoses available for knees, ankles and feet – for example, shoe inserts – plus orthoses to protect fractures and spinal orthoses. These appliances are used to:
Assist in rehabilitation
Control biomechanical alignment
Correct deformities
Reduce pain
Increase mobility and independence
Prevent injury or protect an injury while it heals
Are orthotic services covered by health insurance?
The good news is that many Australian private health funds include cover for orthotics as part of some extras policies. However, you will usually need to take out a comprehensive extras cover in order to receive benefits for orthotics, as it is commonly excluded from basic extras policies.
It is also important to be aware that health funds classify orthotics differently. Some funds will list orthotics in its own section with a single annual benefit limit you can claim for orthoses and treatment by an orthotist. Other health funds will combine orthotics with other appliances under a health aids with a shared annual benefit limit.
*The policies listed in this table are extras only. However, in most cases these can be combined with hospital cover.
Are orthotists the same as podiatrists?
Although there are some similarities between the work they do, orthotists and podiatrists are two very different types of health professionals.
Orthotists. Work exclusively with orthoses, which are devices fitted externally to the body to treat a wide variety of physical limitations resulting from illnesses, disabilities and deformities. In some cases this involves using orthotics to treat abnormalities, prevent injuries and improve normal functions of the lower limbs and feet.
Podiatrists. Concentrate solely on the disorders of the lower limbs. Treatment from a podiatrist may sometimes involve the fitting of orthotic devices, but it can also involve more palliative treatment such as the removal of calluses, warts, corns and ingrown toenails.
What should I be aware of when claiming for orthotics?
Certified supplier. Before you lodge a claim for orthotic appliances, be aware that the items will need to be provided by a registered orthotist, orthotic supplier or podiatrist. Make sure your health fund will cover your orthotics purchase from your chosen supplier before you pay for your appliance.
Waiting periods. Familiarise yourself with the different waiting periods that apply to orthotics under your policy. Some health funds will impose a blanket waiting period on all orthotics claims, such as 12 months. However, some health funds will impose separate waiting periods on the repair, maintenance, hire and replacement of orthotic equipment, so be sure to check the fine print before taking out cover.
Annual benefit limits. Check the limits that apply to your cover. In addition to an annual benefit limit for orthotics, your health fund may impose limits on the amount it will pay for specific orthotic devices, or it may agree to cover a certain percentage of your bill for specific orthotic appliances. Remember that any annual limit listed may also include any benefits you receive for other health aids and appliances.
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Frequently asked questions
No, Medicare does not subsidise orthotic treatments.
Yes - some health funds may place a limit on the number of orthotic repairs they will cover, such as limits claims to one repair per person per calendar year.
Unfortunately, the HICAPS electronic claiming system is not yet available for use by orthotists in Australia. You will instead need to forward your receipt onto your health fund to ensure that your claim is processed.
While you do not need a referral to see an orthotist, your health fund will usually only process your claim if you have a referral.
Although waiting periods differ between health funds, you will usually have to serve a waiting period of 12 months before you can make a claim for orthotics.
A comprehensive extras policy will also include cover for general and major dental, endodontic, orthodontic, optical, non-PBS pharmaceuticals, physiotherapy, podiatry and many other benefits.
Richard Laycock is Finder’s insights editor after spending the last five years writing and editing articles about insurance. His musings can be found across the web including on MoneyMag, Yahoo Finance and Travel Weekly. Richard studied Media at Macquarie University and The Missouri School of Journalism and has a Tier 1 Certification in General Advice for Life Insurance.
While COVID-19 vaccinations are free in Australia, other vaccines with out-of-pocket costs can be covered by private health insurance with some extras policies.
If you're wondering what pharmaceutical costs are covered by private health insurance, we've got a guide to health cover for non-PBS pharmaceuticals here.
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