Medicare Vs Health Insurance for Kids Therapies

In collaboration with Health Insurance Comparison

As a parent of kids with special needs I know that I have struggled with the question of Medicare vs health insurance, particularly when it comes to therapies and ancillary/extras costs for the kids. I admit that I held out as long as possible before taking up private health insurance as I was genuinely unsure of the real benefits attached to it. 

Nearly 10 years on and I’m grateful that we did take the leap and take up private health insurance as it has subsidised specialist services that we would still be waiting to access via the public system. Every experience is different but, for us, taking out health insurance has been worth the cost. But more on that from me in a future post…

Today I want to welcome Health Insurance Comparison who are a current sponsor of the blog. They have shared some really useful information about Medicare vs private health insurance for families below. I hope it helps you make a decision if you are considering your options, particularly taking into account kids with special needs.

Medicare v Health Insurance

Knowing that your child is going to need to have any kind of therapy can be difficult, especially if you are also wondering what kind of support is available.

Unfortunately, Medicare does not cover the likes of speech therapy or occupational therapy (except in specific circumstances), which means that having private health insurance will be crucial to avoid out-of-pocket costs if your family need to access these type of services.

In this post, we look at the type of support that you can expect to receive from Medicare versus the situation if you buy private health insurance.

Does Medicare Offer Any Support?

For the most part, Medicare does not cover the likes of speech therapy or occupational therapy. There is one notable exception to this: children with certain disabilities can access some allied health services through theBetter Start for Children With Disability initiative.

Eligible children can be referred by a GP, specialist or consultant physician and can then access a limited number of allied health services. This includes up to 4 diagnostic/assessment services and up to 20 treatment services for speech therapy, occupational therapy, audiology, physiotherapy and a small number of other therapies. To be eligible, these services need to be deemed crucial for a diagnosis to be made or must form part of a treatment/management plan for the child’s disability.

Children with autism may also be eligible for some help through Medicare, provided that they have not accessed support through the Better Start for Children With Disability initiative. The Helping Children With Autism program entitles eligible children to some allied health services for diagnostic and treatment purposes. As with the Better Start for Children With Disability program, eligible children can receive up to 4 diagnostic/assessment services and a maximum of 2o treatment services. Both speech therapy and occupational therapy are included in this, along with, audiology, physiotherapy and a select few other therapies.

How Can Health Insurance Help?

Private health insurance can be invaluable for young families in general but this is especially true if your child will need speech therapy or occupational therapy and is not eligible for any support through Medicare. You’ll need to have private health insurance to cover the costs of accessing kids therapies. In particular, you’ll need to have ancillary/extras cover that includes these services.

Not all extras policies will necessarily include kids therapies so you’ll need to spend some time comparing your options to make sure that you pick an appropriate policy. Speech therapy and occupational therapy are often excluded from basic extras policies. You’ll therefore usually need to have a mid to top level extras policy to be sure that you’re covered.

Bear in mind that broader extras policies will almost always have more generous annual limits, and this is something that may be important if you know or suspect that your child may be needing at least one type of therapy on a regular basis. In this scenario, you may want to look at buying top level extras cover to limit the potential for out-of-pocket costs (if your budget can stretch this far).

Be aware that you won’t be covered straight away; waiting periods will usually need to be served before any claim can be made. Fortunately, the waiting times for speech therapy and occupational therapy are not too extensive. For most health funds, it will be around a two month wait. is not just a comparison site; we aim to take the confusion out of buying health insurance. Whether you’re just wanting to see what’s out there or you already have a good idea of the type of cover you want, we’ll give you the knowledge and confidence to compare health insurance policies with confidence.

Do you have private health insurance? Has it been a worthwhile investment for you?

Linking up with Grace, Ann and Bron.

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7 Responses

  1. Thankfully bub hasn’t needed any of these yet, but we have had our fair share of health problems with her. We’re still having an ongoing discussion about whether we’ll be getting private insurance or not. She’s covered under T’s private dental plan, but thats all we have at the moment.
    Toni @ Finding Myself Young recently posted..Learning to love reading (Leap Frog LeapReader Junior review)

  2. My 2 year old has just (last week) been diagnosed as autistic, and we are right now in the bewildering limbo land of trying to work out the way forward. For us this involves the NDIS, as we live in one of the launching sites. We are not really sure how much speech, psychological and occupational therapy will be covered with this yet. We do have private cover, but it only covers up to $200 per year for the areas that we are looking at. I am a bit confused really, as I know that we can up our cover to include more extras and then that will cover up to $1000 a year for those areas, but I wonder if we will end up spending that amount on the insurance!
    Sigh, it all seems very hard right now, but your post is helpful to me, as perhaps I need to change providers as well as plans. A few bloggers have pointed me in your direction last week by the way, and I have been meaning to come over and say hi 🙂 No doubt I will be seeing more of you, I’ve been looking through some old posts from you.
    Dani x
    Dani @ sand has no home recently posted..Reviews of Love and Kindness

  3. Lee says:

    This post is really helpful Kirsty. We’ve managed to avoid private health insurance. We were overseas when that whole join before you are 30 thing came in. We feel now it’s something we should sort out, but it felt a bit overwhelming.
    Lee recently posted..Join me for Flourish in February

  4. We have health insurance and so far we haven’t had big returns, well apart from babies and tonsils etc. In saying that it’s a nice backup to have for when things don’t go as we expect them to.
    Emily @ Have A Laugh On Me recently posted..Are you a conversation hacker?

  5. Maxabella says:

    We’ve always had top private cover. I’m not even sure why, it’s just one of those things that I always carried on with after my parents set me free. x
    Maxabella recently posted..Weekend rewind 70 | Back in the saddle

  6. Grace says:

    Private insurance has given us huge returns – especially as my pregnancy has been high risk. Also, we’ve had all sorts of issues that haven’t been threatening but because we have top cover we’re not holding back on getting the best medical care. I think private insurance is something all families should add in their annual budget.
    Grace recently posted..The Year of Getting School Ready

  7. Sally says:

    Thanks for having us on the blog, Kirsty! So glad that the post has proved useful!

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