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Health insurance for psychiatric care
Compare health insurance for inpatient mental health services.
Psychiatric services can include treatment for conditions like mood and personality disorders, eating disorders, addiction and other mental health issues. In Australia, private health funds are legally obligated to offer cover for in hospital treatment and you can also get cover with Medicare, though certain rules and restrictions apply.
How psychiatric treatment is covered by Medicare
Medicare offers cover for some hospital psychiatric treatment, but only up to certain limits and under certain conditions.
- Up to ten individual and ten group sessions of psychiatric treatment are covered per year.
- Patients must be referred to specialist care by their GP, psychiatrist or pediatric, or they must be under a valid psychiatric treatment and management plan.
- All treatments must be carried out by appropriately qualified practitioners.
Medicare will cover costs related to diagnosis, focused psychological strategies, some medications and treatment assessments as long as they are connected to clinically diagnosable disorders that significantly interfere with a person's cognitive, emotional or social abilities. Keep in mind that health professionals set their own fees, which means Medicare may only be able to cover some, but not all, of the costs.
How does private cover 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. 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.
If you want psychiatric care with no restrictions, gold tier hospital cover is the only tier that must offer full cover.
Inpatient vs outpatient mental health services
Both Medicare and private health insurance provide different services for mental health services. Keep in mind that waiting times apply.
Inpatient care comes under hospital cover as it requires you to check into a mental health facility to be in the direct care of medical professionals. Treatments can include therapy, addiction treatment, psychological evaluation and other inpatient services. By April 2020, all gold tiered policies will 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. As stated previously, this includes up to ten individual and ten group sessions of psychiatric treatment per year.
Are psychiatrists covered by health insurance?
Appointments with a private psychiatrist outside a hospital are generally not covered by private health insurance - you will need Medicare for this.
However, private hospital insurance can cover psychiatric treatment for inpatient services. Cover generally includes paying for the cost of hospital accommodation and a portion of the medical fees. Services can include help for psychiatric, mental, addiction, behavioural disorders and more.
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 comprehensive cover with a gold policy with little or no additional expenses. Keep in mind that policies which provide cover on a restricted basis may not cover much of the costs of hospital treatment as a private patient.
Finder Partners Health insurance with psychiatric coverage
|Entry Hospital (Basic+)||$500||$62.63||Go to Site|
|Medibank Gold Complete||$500||$154.75||Go to Site|
|Hospital Gold||$500||$164.05||Go to Site|
|Top Hospital Gold||$750||$168.90||Go to Site|
|Gold Hospital||$500||$172.14||Go to Site|
|Premium Hospital (Gold)||$500||$176.73|
|Gold Hospital||$500||$186.98||Go to Site|
|Gold Hospital||$500||$186.98||Go to Site|
*Quotes are based on 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. Thanks to new reforms, psychiatric services and rehabilitation only require a 2 month waiting period, even if your condition is pre-existing. In the past, you would have had a 12 month waiting period.
- Out-of-pocket expenses. This can include medical services outside of a hospital, such as psychiatric consultations. You can generally claim most of these costs back on Medicare though. Other expenses can include gap costs - that is, whatever is left after Medicare and your health insurer pays the benefit you're entitled to - and excess payments, which will depend on the policy you took. You will generally have to pay an excess when you're admitted to hospital.
- Restricted benefits. You may encounter this caveat next to psychiatric treatments in the vast majority of policies. Once again, 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.
When it comes to getting the mental care and psychiatric support you need, there are several places and resources that could help:
- 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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