A sophisticated MRI Scanner at hospital.

Does health insurance cover MRI?

What is an MRI scan and does health insurance cover it?

Magnetic resonance imaging (MRI) scans are a sophisticated type of diagnostic technology. MRI machines emit a strong magnetic field around the body part being scanned, which can be used to see inside the body and identify certain health issues and abnormalities.

Compare health insurance with cover for MRI from 35 funds

What treatments are MRI scans covered under?

Private health funds are most often used to cover the gap when having an MRI done at a private hospital, or to pay for MRI scans that are not strictly medically necessary, such as for the purposes of a health screening or if it has otherwise not been recommended by a doctor. Other treatments that may include MRI are:

TreatmentsPurpose of the MRI scan
Joint investigations
  • If you need an MRI for limb joint analysis or preparation for surgery it can be claimed under the joint investigation component of your health insurance policy.
Gastroscopy
  • An MRI may be recommended by your doctor for diagnosing health issues affecting digestive system, including the bowels and oesophagus.
Diagnostic imaging
  • A general term for procedures like X-rays, CT scans, MRIs and other imaging techniques, and requires a doctors referral in order to claim.
Health screenings
  • Health screenings are preventative measures used to identify potential health issues. Some extras cover include MRI health screening benefits.

Terms and conditions to look for in health insurance policies

When comparing health insurance policies to cover MRI scans, there are some terms, conditions and phrasings to look out for:

  • Sections that include MRI. Look for joint investigation, gastroscopy, diagnostic imaging, health screenings and similar terms. Depending on your particular health issues, you might be able to claim the MRI costs against these features.
  • Annual benefit limits. This s the highest dollar amount that can be claimed per year for a certain procedure. They might also be per person, or per family if there are multiple people covered by your policy.
  • Exclusions. This refers to conditions under which claims won't be paid. Common exclusions include overseas treatment (covered by travel insurance), medically unnecessary scans and scans performed without a doctor’s referral.
  • Pre-existing conditions. This can be a particular concern for seniors, as such conditions may accumulate over the years, slowly limiting your options. You may wish to look at health insurance options for baby boomers if you are over 65.

How to claim MRIs on Medicare

Medicare is Australia’s public health system, automatically available to all permanent residents. It almost always covers MRI scans, as long as it has been ordered by a GP or a recognised medical specialist. Physiotherapists might recommend MRIs, but because they are not actual medical doctors you'll be unable to claim these on Medicare.

The process for claiming and the amount covered by Medicare both depend on whether you are a public or a private patient, and whether you are visiting a public or a private hospital:

  • Public hospitals. You can claim 75-85% (between $150 to $500) of the entire fee if you are a public patient, meaning you don't need to pay any of the cost yourself. If you are a private patient who has chosen to use a public hospital then you'll need to pay the gap, either out of pocket or with private health insurance.
  • Private hospitals. Depending on your location and the hospital, you either won't be able to claim on Medicare, or you'll be required you to pay “the gap” (the remaining 15-25% of the fee) yourself or through private health insurance. You cannot be admitted to a private hospital as a public patient.

Compare policies from 35 Australian health funds

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Andrew Munro

Andrew writes for finder.com.au, comparing products, writing guides, sniffing out deals and looking for new ways to help people get the most out of their money.

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