Close view of male feet making a step over home-like background.

Health Insurance for Podiatry

Looking to get cover for podiatric treatment? Compare cover from leading funds.

People say all over the world that your feet come first, and it’s for a good reason. A sore foot or ankle can be a painful experience. Often it’s the cost associated with funding treatments and surgical procedures, and the time taken to heal that leaves many walking backwards when thinking about seeing a specialist.

A Podiatric surgeon is qualified to care for bone, joint, ligament, muscle and tendon pathology of the foot and ankle. This article will explore how podiatric surgery is covered by private health insurance.

Find extras cover with protection for podiatry

Details Features
Active Life Extras
Active Life Extras
Straightforward extras that covers you for vital out of hospital services while keeping premiums low. Treatments include general dental and optical, as well as healthy lifestyle benefits.
  • $500 general and major dental combined limit
  • $400 chiro and osteo annual limit
  • $400 physio annual limit
  • $400 alternate therapies annual limit
Get Quote More info
Extras 50
Extras 50
With the Extras 50 policy health.com.au will pay 50% of the provider's fee.
  • From $10.58 weekly
  • 50% back on extras
  • Unlimited emergency ambulance transport cover
  • $500 general dental limit
Enquire Now More info
Super
Super
Super Extras is the highest level of extras cover available from AHM and provides cover for services ranging from major dental to diet and nutrition to health improvement benefits.
  • No family limits
  • Orthodontics
  • Outpatient care
  • Pre and postnatal
Enquire Now More info
Premium Options
Premium Options
Premium extras cover for all everyday healthcare services. Save 4% when you pay for 12 months of your cover upfront.
  • Dental and chiropractic cover
  • Osteopathy and optical
  • Occupational therapy
  • Orthoptic
Get Quote More info
Platinum 80%
Platinum 80%
Platinum 80% provides you with 80% back on all included extras.
  • Claim up to $8500 on extras
  • General, complex and major dental and orthodontics
  • Pharmacy
  • Travel vaccinations
Enquire Now More info
Top Extras
Top Extras
Comprehensive extras cover that includes a wide range of non-hospital related treatments and services. Restricted fund: Only current and former employees of the Commonwealth Bank of Australia Group and their eligible families can join.
  • Generous overall limits on services
  • Major dental including orthodontics
  • Unlimited preventative dental
  • Hearing aids
Enquire Now More info
Gold Extras Set Benefits
Gold Extras Set Benefits
Top level extras cover including cover for a wide range of popular services including orthodontics, physiotherapy and optical.
  • Podiatry
  • Nursing
  • Pressure garments
  • Weight loss program
Enquire Now More info
Platinum Extras Cover
Platinum Extras Cover
Top level extras cover with highes range of cover for therapies and serivces.
  • 100% back on up to 2 dental visits per year
  • 100% back on initial chiro, physio, osteo
  • General therapies cover
  • Vaccinations and immunisations cover
Enquire Now More info
Top Extras
Top Extras
NIB's premier extras cover with up to $1,000 in General dental covered annually and cover for a range of therapies including Chiro & Osteo.
  • $1,000 general dental cover annual limit
  • $600 physiotherapy annual limit
  • Unlimited ambulance cover
  • $350 optical annual limit
Enquire Now More info
Top Extras
Top Extras
Top level extras cover with highest percentage back.
  • 60 - 100% back
  • $800 dental annual limit per person
  • $850 physiotherapy annual limit per person
  • $300 optical annual limit per person
Enquire Now More info

What podiatric service costs will my health fund cover?

If podiatry services are included on your hospital policy, your private health insurer is required by law to pay the minimum default benefit for your treatment. If your surgery goes over this cost, you’ll have to pay the difference.

What does the default benefit cover?

The default benefit covers the accommodation cost of you being treated as a private patient in a public hospital. This treatment is done in a shared room, but only covers a portion of the accommodation, and none of your theatre fees in a private hospital. If you choose a private room, you could be whacked with an added out-of-pocket expense.

Your health fund doesn’t have to pay benefits for the cost of podiatric services unless it’s included under your policy as there is no Medicare item number. This means Medicare won’t pay any benefits toward the cost for a surgeon or anaesthetist’s fees.

Certain health funds may consider paying benefits for medical costs from their own hospital policy, but this is up to your fund. Your insurer may also cover the cost of a prosthesis, but your podiatrist must be listed on the Government approved Prostheses list for this to happen.

It’s important to note that if your podiatrist isn’t accredited with the government, your health fund will only be able to pay a benefit under General Treatment (Extras) cover, and no Hospital Cover benefit will apply.

What is covered by the funds in finder.com.au panel?

Health fundExtras policies that cover podiatry Annual benefit limit*Find out more
HIF Logo
  • Premier Options
  • Super Options
  • Special Options
  • Saver Options
  • $382 per person
  • $354 per person
  • $450 per person
  • $350 per person
More info
health.com.aulogo
  • High (combined hospital + extras policy)
  • Heart High (combined hospital + extras policy)
  • $200 per person
  • $200 per person
More info
ahm
  • Super Extras
  • Family Extras
  • $300 per person
  • $250 per person
More info
Australian Unity
  • Gold Extras
  • Silver Extras
  • $350 per person
  • $300 per person
More info
GMHBA
  • Gold Extras
  • Silver Extras
  • $300 per person
  • $250 per person
More info
HCF
  • Premier Extras (benefit limit increases for each year you hold the policy. Caps at year 6)
  • Gold Extras (benefit limit increases for each year you hold the policy. Caps at year 6)
  • $250 per person initially up to a maximum of $500
  • $200 per person initially up to a maximum of $400
More info
nib
  • Top Extras
  • Core Family Extras
  • Core Young at Heart Extras
  • $400 per person
  • $200 per person
  • $200 per person
More info
Transport Health Logo
  • Top Extras
  • Healthy Choice Extras
  • $850 per person
  • $400 per person
More info

*Annual benefit limit amount is based on singles policies only. Limits may be higher for couples and family policies.


Where is podiatry treatment performed and how is it covered?

Podiatric surgery is performed in private practice, community health centres, day

surgery centres and some private and public hospitals within Australia. To achieve adequate cover, you’ll need to take out a combination of cover with your private health provider:

  • Combined Cover. Private Health Funds cover you for around half the cost of your treatment expense, but you’ll need Hospital and General Treatment (Extras) cover. Your fund offers rebates for aspects of surgical services provided by podiatrists aligned to the Australasian College of Podiatric Surgeons (ACPS). These rebates cover theatre fees, bed stays in private hospitals and the costs of implantable prostheses such as pins, screws and plates.

Is podiatry covered by Medicare or Private Health insurance?

Professional fees of medical practitioners undertaking foot surgeries are rebated under the Medicare system, but they aren’t applicable to podiatric surgery. Medicare will pay a percentage of your podiatry fees if you have a referral from your GP and have been put on an Enhanced Primary Care (EPC) Plan, but you must fall into the following categories:

  • You are a chronically ill patient.
  • You have Diabetes or suffer from Vascular Disease.

Most private health funds cover about half (50%) the cost of your podiatry expense, given you have some form of Hospital and General Treatment (extras) cover. These rebates cover theatre fees, bed stays in private hospitals and the costs of implantable prostheses such as pins, screws and plates.

The Department of Veteran’s Affairs covers you for podiatry treatment but you must obtain a (D904) Referral from your GP prior to your first visit.

Work Cover Queensland will cover your Podiatry expenses if you’re injured on-site, but you’ll need a referral from your GP and a valid Claim Number specifically related to your injury.


Who can benefit from podiatry?

There are a range of reasons why you could choose to see a podiatric specialist. Here’s a list:

  • Structural deformities, including bunions, hammertoes, painful flat foot and high arch deformity, bone spurs
  • Heel pain
  • Nerve entrapments
  • Degeneration and arthrosis of the joints of the foot and ankle
  • Skin and nail conditions
  • Congenital deformities
  • Trauma-related injuries, including fracture and dislocations and post traumatic arthrosis

Individuals, couples, families and single parent families all have the ability to receive cover through a private health insurer. You can choose a range of options, and pay monthly installments ranging from $19AUD, anywhere up to $30AUD to see you covered. This is achieved through a mix of Hospital Cover and General Treatment (Extras) cover.

If you choose the lesser form of cover and receive treatment in a private hospital, or in a single room in a public or private hospital, you’ll have to pay for the cost of the surgery yourself.


How do I claim podiatry on my health insurance?

You have two options to claim benefits after your podiatric treatment. This is ultimately through your private health provider, or for those with exceptional circumstances, through Medicare.

For your Medicare claim to be successful you must have the following:

  • You have a doctor’s referral. In order for Medicare to pay for a percentage of your medical costs for your surgery, you must ensure you have a referral from your GP, showing you have been placed on a health management plan, which determines you to be chronically ill, or have diabetes or vascular disease.

Without a doctor’s referral, you’ll be required to pay for your surgery, out of your own pocket. Once your medical procedure is complete, follow these steps to receive a Medicare rebate:

  • Fill out a claim form. You must do this before you can receive your benefits.
  • Lodge your medical claim at a Medicare office. Here the department will process and send your claim to your private health insurer for further processing. Once your claim is received and processed, it will be paid directly as a credit, and into your chosen account.

If you don’t fall into the exceptional circumstances category, you need to pursue your private health fund. A claim form can be found online, via your health fund providers home page.

Here’s what you need to do before you claim benefits from your private health fund via your Hospital and General Treatment (Extras) Cover:

  • Private practice provider certification. In order to claim benefits from your fund, ensure your treatment was undertaken by a private practice provider who is recognised and registered with your fund.
  • Contact your fund. Do this before making a booking to confirm how much you can claim, and to check that your chosen provider is registered with your insurer.

Wording to look out for around podiatric surgery

You need to fully understand certain wording surrounding podiatric services and what you will be covered for under your respective insurance. One to note is differences between the cost and cover associated with Inpatient and Outpatient treatment:

  • Inpatient services. These are hospital treatments that result in a hospital admission.
  • Outpatient services. Are dealt with in a private capacity in private rooms at a local specialist centre.
  • Out-of-pocket fee. The cost you could be slapped with, if your doctor charges more than the Medicare Benefits Schedule service fee.
  • Known Gap. This is where your fund will pay up to the minimum benefit, as set out in the government’s Prostheses List. This list includes pacemakers, defibrillators, cardiac stents, joint replacements, intraocular lenses and other devices that are surgically implanted, during a stay in hospital.
  • No Gap. This is when your treatment is undertaken as part of your hospital treatment and you won’t have any out-of pocket expenses.
  • Prosthesis. This is an artificial substitute for a missing body part, used for functional or cosmetic reasons or both. Surgically implanted prostheses are sometimes required during a medical procedure, such as a replacement lens for a cataract surgery, an artificial hip joint, a pacemaker, or a heart valve.

Cover for podiatric treatment come with strict conditions, so, putting your feet first can be a costly exercise. This is down to podiatry not being recognised under Medicare (unless you fall into the exceptional circumstances categories), and you’ll need a combination of cover to receive benefits from your private health fund.

It’s important to seek advice from your GP to see if you qualify for Medicare’s rebates and fully understand what kind of private health insurance or General Treatment (Extras) cover you can take out to ensure you don’t brunt the full cost of your surgery.

Compare extras policies from Australian health funds

Health fundExtras policies that cover podiatry Annual benefit limit*Find out more
ahm
  • Super Extras
  • Family Extras
  • $300 per person
  • $250 per person
More info
Australian Unity
  • Gold Extras
  • Silver Extras
  • $350 per person
  • $300 per person
More info
Bupa
  • Platinum Extras
  • Gold Extras
  • Silver Extras
  • Your Choice Extras (annual benefit increases each year by 20%. Caps at year 6)
  • $750 per person
  • $500 per person
  • $400 per person
  • $350 per person initially up to a maximum of $700
More info
cdhlogo
  • Gold Extras
  • Silver Extras
  • $600 per policy
  • $400 per policy
More info
cua
  • Gold Extras
  • Silver Extras
  • $600 per person
  • $400 per person
More info
GMHBA
  • Gold Extras
  • Silver Extras
  • $300 per person
  • $250 per person
More info
Frank
  • Lots Extras Cover
  • $400 per person
More info
gmflogo
  • Complete Extras
  • Mid Extras
  • Lite Extras
  • $500 per person
  • $450 per person
  • $450 per person
More info
HBF
  • Flexi Extras Plus (benefit increases by $50 each year until it caps)
  • Flexi Extras Mid (benefit increases by $50 each year until it caps)
  • Flexi Extras (benefit increases by $50 each year until it caps)
  • Saver Flexi Extras Plus (benefit increases by $50 each year until it caps)
  • Saver Flexi Extras Mid (benefit increases by $50 each year until it caps)
  • Saver Flexi Extras (benefit increases by $50 each year until it caps)
  • $500 per person initially. Caps at $700
  • $400 per person initially. Caps at $600
  • $300 per person initially. Caps at $500
  • $250 per person initially. Caps at $450
  • $200 per person initially. Caps at $400
  • $150 per person initially. Caps at $350
More info
HCF
  • Premier Extras (benefit limit increases for each year you hold the policy. Caps at year 6)
  • Gold Extras (benefit limit increases for each year you hold the policy. Caps at year 6)
  • $250 per person initially capping at $500
  • $200 per person initially capping at $400
More info
health.com.aulogo
  • High (combined hospital + extras policy)
  • Heart High (combined hospital + extras policy)
  • $200 per person
  • $200 per person
More info
hcilogo
  • Premier Extras
  • $300 per person
More info
logo health partners
  • Gold Extras
  • Silver Extras 
  • $350
  • $60
More info
HIF Logo
  • Premier Options
  • Super Options
  • Special Options
  • Saver Options
  • $382 per person
  • $354 per person
  • $450 per person
  • $350 per person
More info
latrobehealthlogo
  • Premier Gold
  • Premier Silver
  • Premier
  • Premier Plus
  • Premier Family (benefit limit is combined with other services)
  • Family Care Gold
  • $600 per person
  • $300 per person
  • $300 per person
  • $300 per person
  • $250 per person, $500 total membership limit
  • $600 per person
More info
 medibank
  • Top Extras
  • Growing Family
  • $200 per person
  • $300 per person
More info
mildurahealthfundlogo
  • Five Star
  • Ancillary Plus
  • Basic Ancillary
  • $650 per person
  • $540 per person
  • $390 per person
More info
onemedifundlogo
  • Extras Plus
  • Basic Extras
  • $435 per person
  • $350 per person
More info
nib
  • Top Extras
  • Core Family Extras
  • Core Young at Heart Extras
  • $400 per person
  • $200 per person
  • $200 per person
More info
peoplecare provider page link
  • Premium Extras
  • High Extras
  • Mid Extras
  • $500 per person
  • $400 per person
  • $200 per person
More info
phoenix health fund provider link
  • Top Extras
  • Mid Extras
  • $400 per person
  • $200 per person
More info
queensland country health fund provider link
  • Premium Extras
  • Essential Extras
  • Young Extras
  • $600 per person
  • $400 per person
  • $300 per person
More info
St. Lukes Health Logo
  • Super Extras
  • $400 per policy
More info
Transport Health Logo
  • Top Extras
  • Healthy Choice Extras
  • $850 per person
  • $400 per person
More info
westfund provider link
  • Platinum Extras
  • Gold Extras
  • $225 per person
  • $150 per person
More info
acahealthlogo
Restricted fund**
  • Complete Ancillary
  • $300 per person
More info
CBHS Health Fund LogoRestricted fund**
  • Top Extras
  • Intermediate Extras
  • $400 per person
  • $250 per person
More info
defencehealthlogoRestricted fund**
  • Premier Extras
  • Value Extras
  • $400 per person
  • $300 per person
More info
navyhealthlogoRestricted fund**
  • Premium Extras
  • Healthy Living Extras
  • $500 per person
  • $300 per person
More info
doctorshealthfundlogoRestricted fund**
  • Total Extras
  • Essential Extras
  • Basic Extras
  • $600 per person
  • $500 per person
  • $400 per person
More info
policehealthlogoRestricted fund**
  • SureCover Extras (Rollover Benefit allows you to add unused benefits from the previous year to your current year's limit)
  • $700 per person, Rollover Benefit caps at $1,400 per person
More info
rthealthlogoRestricted fund**
  • Premium Extras
  • Smart Extras
  • $500 per person
  • $400 per person
More info
rbhslogoRestricted fund**
  • Extras Only
  • $750 per person
More info
teachersRestricted fund**
  • Top Extras
  • Essential Extras
  • $400 per person
  • $200 per person
More info
tuhRestricted fund**
  • Comprehensive Extras (benefit limit increases every two years. Caps at year 7)
  • Mid Range Extras
  • Healthy Options (60%) Extras (benefit limit is combined with other services)
  • $400 per person initially capping at $480
  • $250 per person
  • $500 per person combined benefit limit
More info

*Annual benefit limit amount is based on singles policies only. Limits may be higher for couples and family policies.
**Restricted funds only provide cover to members of specific industries, groups and organisations. In some cases family members may also be eligible to join.

Compare extras policies from Australian health funds

Picture: Shutterstock

William Eve

Will is a personal finance writer for finder.com.au specialising in content on insurance. While he cannot give personal advice to clients, Will enjoys explaining the intricacies of different types of protective cover to help individuals and businesses find affordable cover that won't leave them underinsured.

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