Health insurance for psychiatric care

How does health insurance cover mental health?

Hospital (psychiatric services)

All health funds will cover psychiatric care costs in their hospital policies. This is generally referred to as a restricted benefit which means that no matter what level of hospital cover you have, it will pay a benefit towards the cost of being treated as a private patient in a public hospital. If you want psychiatric care with no restrictions, gold tier hospital cover is the only tier that must offer full cover. Private health insurance won't cover you for out of hospital psychiatric services though.

Extras (psychology and counselling)

Comprehensive extras policies can give you access to therapy or counselling sessions with a psychologist without the need for a referral. It can also cover you for other out-of-hospital services including dental, optical and physio.

What psychiatric services does health insurance cover?

Hospital insurance covers inpatient care. This means you're covered when you check into a mental health facility to be in the direct care of medical professionals. A policy can pay for your hospital accommodation and a portion of your medical fees. It can cover the treatment of the following:

How mental health is covered by Medicare

Medicare offers cover for some mental health services but there there are limits:

• You get up to 10 individual and 10 group allied mental health services each year. (During the COVID-19 pandemic, an extra 10 sessions is available until 30 June 2022 for people who have a mental health treatment plan in place.)
• You will need to be referred to specialist care by your GP and get a mental health treatment plan from your GP.
• The rebate is only available to people with a diagnosed mental disorder. This can include depression and anxiety.

Health insurance with psychiatric cover

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Name	Product	Treatments	Price	Apply
Medibank Gold Complete Hospital Gold$750 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$169.56 per month	Go to Site All treatments	Compare	loading Fetching your data...
Medibank Gold Complete Hospital Gold$500 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$176.68 per month	Go to Site All treatments	Compare	loading Fetching your data...
Gold Hospital $750 Gold$750 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$179.21 per month	Go to Site All treatments	Compare	loading Fetching your data...
Qantas Gold Hospital $750 Excess Gold$750 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$193.76 per month	Go to Site All treatments	Compare	loading Fetching your data...
Medibank Gold Complete Hospital Gold$250 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$199.94 per month	Go to Site All treatments	Compare	loading Fetching your data...
Qantas Gold Hospital $500 Excess Gold$500 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$201.49 per month	Go to Site All treatments	Compare	loading Fetching your data...
Gold Top Hospital $750 Excess Gold$750 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$210.09 per month	Go to Site All treatments	Compare	loading Fetching your data...
HCF HOSPITAL PREMIUM GOLD $750 EXCESS Gold$750 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$214.04 per month	Go to Site All treatments	Compare	loading Fetching your data...
Qantas Gold Hospital $250 Excess Gold$250 excess		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$218.77 per month	Go to Site All treatments	Compare	loading Fetching your data...
Medibank Gold Complete Hospital Gold		Cataracts Joint replacements Palliative care Pregnancy and birth Sleep studies Weight loss surgery Rehabilitation Insulin pumps +30 other treatments covered	$219.35 per month	Go to Site All treatments	Compare	loading Fetching your data...

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All prices are based on a single individual with less than $90,000 income and living in Sydney.

Things you should know about health insurance for psychiatric treatment

Looking for the right policy can be tricky. Here are some things worth looking out for that'll make searching easier.

• Waiting periods. You'll usually have to serve a 2-month waiting period for psychiatric services and rehabilitation, even if your condition is pre-existing.
• Out-of-pocket expenses. Even with Medicare and health insurance, you might still have gap costs – that is, whatever is left after Medicare and your health insurer pays the benefit you're entitled to, if your doctor charges more than MBS.
• Restricted benefits. This means the policy only pays the minimum benefits that are legally required. Because these minimum benefits are laid out by the government, it will be practically the same with every fund.
• Exclusions. These are conditions or circumstances in which the fund will not pay a benefit. Common exclusions can include undergoing treatment outside of Australia, claims made for treatments carried out by unlicensed practitioners and medically unnecessary procedures. It is important to be aware of all exclusions that apply to your health insurance policy.
• Annual benefit limits. These are the maximum amounts that can be claimed for certain treatments in a given year. For example, a policy may apply a benefit limit of up to $400 for psychological treatments. This means the maximum you can claim per year is $400 regardless of whether your benefits are paid as a set fee or as a percentage of costs covered.

Psychiatric support

There are several places and resources that can provide mental health services and psychiatric support in Australia. We've listed some below:

• Australian Government: AIHW MHSA. The Australian Government website provides information on mental health services in Australia.
• beyondblue Support Service - Support. Advice. Action. Help for depression and anxiety related matters.
• Black Dog Institute. Help for mood disorders like depression and bipolar disorder.
• Gambling Helpline. Help for various gambling issues.
• Mindframe-Media. Information about suicide in Australia.
• PANDA - National Perinatal Depression Helpline. Helpline for any new parent struggling during pregnancy or after the birth of their baby.
• SANE Australia. A national charity that helps all Australians affected by mental illness lead a better life.

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Frequently asked questions

• Am I covered for inpatient mental health services?

  Yes, inpatient care comes under hospital cover and all gold tiered policies must offer inpatient psychiatric care.

  Medicare, on the other hand, will cover you for treatment in a public hospital if you require hospitalisation for mental health care. This includes up to 10 individual and 10 group sessions of psychiatric treatment per year.

• Am I covered for outpatient mental health services?

  Private health insurance generally won't cover you for out-of-hospital psychiatric services. However, extras cover can pay for some therapy or counselling sessions outside of hospital with a psychologist. You also don't need a referral from your GP.

• Are psychiatrists covered by health insurance?

  Yes, but only for in-hospital treatment. You can get cover on a restricted basis with basic, bronze and silver policies (meaning you will have out of pocket expenses) or you can get a gold policy with little or no additional expenses.

• Will I have out of pocket expenses?

  Additional out-of-pocket expenses you may incur can include:

  • Any private hospital or psychiatric facility fees above the equivalent public hospital costs.
  • Additional fees for treatments or pharmaceuticals.
  • Extra costs associated with particular treatment regimes or optional inclusions.

• Will I have to serve a waiting period for psychiatric care?

  Yes, but it's only 2 months, even if you have a pre-existing condition. The Mental Health waiver also allows you to upgrade your policy without serving the usual 2-month waiting period to access in-hospital psychiatric services.