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Disability and health insurance

Private health insurance can offer more flexibility and coverage for people with disability

What you need to know

  • People with disabilities have complex health needs, which can make using Medicare and private health insurance more complex.
  • Having a disability does not result in any private health exclusions, though some treatments may need a 12 month waiting period.
  • People with a disability are slightly less likely to have private health isurance.

Can people with a disability get private health insurance?

In Australia, having a disability doesn't stop you from taking out private health insurance. Unlike some developed nations (looking at you America) Australian health funds are required to cover people with pre-existing conditions. That means disability doesn't rule anyone out.

In fact, of the over 4 million Australians with a disability, 47% of those aged 15-64 have private health insurance. That's a bit lower than the general population. We also tend to see people with more severe disabilities even less likely to have private health insurance. This could be for a few reasons, but it's likely the association with disability and lower socio-economic status has something to do with it.

That said, pre-existing conditions do come with a different waiting period for hospital cover. Depending on what disability you have, you may have to wait 12 months to make a claim on some treatment categories, rather than the typical 2 month waiting period for health insurance.

Medical care for people with a disability

People with disabilities will generally get their medical care the same way as everyone else, through Medicare or private health insurance. However, because people with a disability have more complex care needs, there are some additional government support schemes out there to help them. We don't have space here to list them all, but here are a few place to get more information:

How can private health insurance help people with disability?

While the government provides some assistance to people with disability both financially and through community support services, private health insurance can also help to relieve the burden for both people with disability and their families. Ways in which private health insurance can help can be seen in the following case studies:

  • Paying for non-PBS medicines. Jay has a debilitating spinal disease that requires regular medication to treat the chronic pain associated with the condition. Jay’s private health extras cover helps him to cover the cost of these medicines, some of which are not listed with the Pharmaceutical Benefits Scheme (PBS) and therefore are not subsidised.
  • Paying for diagnosis of a disability. Peter and Sue’s son Alex exhibited signs of profound deafness at an early age and he was referred for specialist diagnosis and treatment. His parents were able to pay for most of these appointments thanks to government assistance, and their private health extras cover paid for Alex’s hearing aids after an initial waiting period.
  • Paying for hospital treatment of a disability. Karen was badly injured in a car accident and became unable to walk again. She needed extensive follow-up surgery to treat her condition and between Medicare and her no-gap hospital cover, she had no out-of-pocket expenses for any of her hospital visits.

What health insurance options are available for people with disability?

Health insurance falls into two main categories, Hospital cover and Extras cover. Here are the key differences:

  • Hospital cover pays for your treatment and accommodation in a public or private hospital, treatment by a doctor of your choice, the option of a private or shared room and little or no waiting periods for elective surgery.
  • Extras cover helps pay for ancillary services not covered by Medicare such as optical, dental, physiotherapy and chiropractic services.

Both types of health insurance can be taken out separately or, as is more often the case, combined in a single policy. Combined policies are typically offered with a choice of three main levels of cover:

  • Basic covers basic hospital treatment with a lot of procedures excluded and at least one ancillary service included such as general dental or optical.
  • Medium covers more than basic but less than top, offering a mid-range level of protection.
  • Top cover provides comprehensive hospital cover, with most or all services and treatments included and generous extras cover including major dental and orthodontics.

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