How does health insurance cover chronic pain?

Find out what Medicare and private health cover.

Since chronic pain is generally a condition you learn to live with, getting treatment that properly manages your illness is essential. Both Medicare and private health insurance can provide different levels of care and treatment. Read on to see how they compare.

What is chronic pain?

Pain that has lasted beyond the time expected for healing (around 3 months) following diagnosis, surgery or trauma, is often considered a chronic illness. Common conditions include osteoporosis, arthritis and other musculoskeletal ailments but there are several uncommon chronic pain conditions as well. Other chronic conditions can include kidney failure, heart disease and sleep apnoea. Acute pain can become chronic pain if it is left untreated. This happens if a change occurs in the nervous system, which makes the body more sensitive to pain.

How can you treat chronic pain?

Chronic pain treatment generally involves managing and alleviating pain as opposed to eliminating it entirely. Depending on your condition, it can be treated in a number of ways. Doctors can administer different forms of pain management to alleviate chronic pain. Some may require devices, such as an infusion pump, while others don't, like treatment of nerve pain by injection of a nerve block. Treatment can include:

  • Medication. Such as nerve pain medication and nonsteroidal anti-inflammatory drugs
  • Therapies. Including physical therapy, physiotherapy and acupuncture
  • Specialists. GP consultations, occupational therapy, pain management and rehabilitation
  • Self-care. Exercise, relaxation techniques and stress management

How does Medicare support chronic pain treatment?

If you've lived with chronic pain for at least six months, you may be eligible for a rebate through Medicare's allied health service. First, you will need to speak to your GP, who can prepare a Chronic Disease Management Plan for you. You are only eligible for this care if your GP feels you need it to deal with your chronic pain.

Depending on whether or not a provider accepts the Medicare benefit, you might have to pay the difference between the fee charged and the Medicare rebate. Otherwise, you should have no out of pocket expenses.

Management of chronic pain varies greatly so it's difficult to say exactly how much you'll be out of pocket if you opt for public care only. For instance, you may receive non-pharmacotherapy (treatment focussed on concentration to better manage and reduce pain) care such as physiotherapy or acupuncture. In general, Medicare does not cover most physiotherapy and occupational therapy or psychology services. It might cover acupuncture if it is part of your doctor's consultation but generally these out of hospital services are not included with Medicare. If you want to ensure you're not out of pocket for these services, speak to your doctor to make sure specific items for allied health services are included as part of the Chronic Disease Management Plan.

How does private health insurance cover chronic pain?

If you want comprehensive cover for chronic pain, you can buy a policy for around $35 a week. This gives you gold-level hospital cover. Policies usually come with a 2 month waiting period or 12 months if your chronic pain is a pre-existing condition. Gold hospital health insurance provides benefits for a range of services related to chronic conditions including:

  • Dialysis for chronic kidney failure
  • Insulin pumps
  • Pain management with device
  • Pain management
  • Sleep studies
  • Weight loss surgery

With public care, you will have to go to a GP who will then refer you to a specialist. With private health care, you'll probably be able to bypass this process and receive care quicker. Waiting times for private health insurance are generally shorter, especially if you suffer from a rare chronic illness. There have been cases where some patients have waited more than two years to see a chronic pain specialist at a public hospital.

Quotes from Finder Partners for Chronic Pain

Brand Policy Benefit Excess Price Apply
ahm logo Classic Silver Plus Pain management with device - Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain. $500 $101.60 Go to Site
Medibank logo Medibank Bronze Everyday Pain management - Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain. $500 $83.40 Go to Site
HCF health insurance HCF Hospital Bronze Plus Pain management with device - Treatment of nerve pain and chest pain due to cancer by injection of a nerve block $500 $91.60 Go to Site
nib helath insurance logo Bronze Hospital Plus Pain management - Hospital treatment for pain management that does not require the insertion or surgical management of a device. $500 $89.48 Go to Site
Bronze Hospital Pain management - Hospital treatment for pain management that does not require the insertion or surgical management of a device. $500 $85.89 Go to Site

Other things to know

Keep in mind that you'll probably need extras cover for chronic pain care done outside of hospital. While hospital cover helps pay for treatment and accommodation in a hospital during an illness or injury, extras cover helps cover the costs of ancillary health services you might need if you suffer from chronic pain. Services like physiotherapy, remedial massage and natural therapies are included in extras cover and can be a really important part of chronic pain treatment. Personal circumstances will dictate whether you feel you need extras on top of hospital cover. However, it's worth keeping in mind that if you don't have combined hospital and extras cover, you might be out of pocket for any care you receive outside of hospital.

Compare more options

If you're ready to find a policy, just pop your details in and hit search policies. To make sure you get the treatment you need, select the services you need from the 38 clinical categories offered by health funds to filter your options.

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