What health support can you get if you have a chronic condition?

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It is estimated that 50 per cent of all Australians suffer from some form of chronic condition, but many are unaware how private health insurance could improve their quality of life – and save them money in the process.

Whether your chronic condition is ongoing back pain or diabetes, the right cover could help ease the cost of specialised care and procedures.

The good news is you can check if you have suitable cover for your needs and if you’re paying too much under your current policy by using our free comparison tool.

What is a chronic condition?
When you think of chronic conditions you may immediately think of serious, life-threatening conditions. But a chronic condition is defined as a long-term and persistent condition that can often lead to a gradual deterioration of your health and quality of life if not managed properly. Common chronic conditions include cancer, heart disease and diabetes.

There is no list of eligible conditions, but they are generally categorised into the following groups:

  • arthritis
  • asthma
  • back pain
  • cancer
  • cardiovascular disease
  • chronic obstructive pulmonary disease
  • diabetes
  • mental health conditions.

How are these conditions managed?
If you have a chronic condition, your general practitioner will provide one of two care plan options:

General Practitioner Medical Plan (GPMP)
This identifies your health and care needs, sets out the services to be provided by your GP and lists the actions you can take to manage your condition

Team Care Arrangement (TCA)
If your condition requires care from more than one health care provider, a TCA will be prepared to effectively coordinate your care between practitioners

Often your care plan will include treatment from allied health services.

What are allied health services?
Allied health services are a network of practitioners who assess issues and provide treatment while minimising medical interventions where possible. These services include:

  • Aboriginal health workers
  • Aboriginal and Torres Strait Islander health practitioners
  • audiologists
  • chiropractors
  • diabetes educators
  • dietitians
  • exercise physiologists
  • mental health workers
  • occupational therapists
  • osteopaths
  • physiotherapists
  • podiatrists
  • psychologists
  • speech pathologists.

These services are generally not covered by Medicare unless your care is being coordinated by a GP, and you can only receive a rebate for a maximum of five appointments each calendar year. You will also be out of pocket if the allied health provider charges more than the Medicare benefit.

How can private insurance help?
Private health insurance can help you access ongoing allied healthcare beyond what is possible under the Medicare system.

Private health insurance providers cover many of the specialised surgical procedures associated with chronic health conditions that may be deemed elective surgery, and as such may be subject to very long waiting lists in the public health system.

Your health fund can also enable affordable access to allied health services via extras cover. Many health insurers offer a range of extras covers, so you mostly pay for the services you are likely to use. The top levels of extras insurance will give you a wide range of services to choose from, whereas basic plans may limit the types of services you can access.

As well as providing access to allied health services, extras cover can also include approved:

  • alternative and natural therapy
  • gym memberships
  • medical appliances and glasses
  • pharmaceuticals not covered by the Pharmaceuticals Benefit Scheme (PBS).

If you have a chronic health condition, comparing health insurance funds can help you save on your ongoing treatment costs and ensure you don’t pay for extra levels of cover that are not relevant to your condition.

Chronic conditions and COVID-19
The spread of coronavirus or COVID-19 continues to be an ongoing concern for all Australians. It is now well documented that the risk of becoming seriously unwell if you contract coronavirus is significantly increased if you:

  • are 65 years of age or older
  • suffer from a chronic health condition
  • are undergoing certain medical treatments.

The government as well as health insurers are aware of the increased risk faced by those with chronic illnesses and are offering additional support to protect vulnerable Australians.

What services can I access without leaving my house?
The Department of Health is overseeing the following initiatives to ensure you can continue to receive care without leaving your house:

Telehealth medical services
You can now schedule an appointment with a doctor via a phone or video call. Bulk billing applies to these appointments.

Electronic prescriptions
Your doctor can now securely send your prescription directly to a pharmacist electronically at no additional cost.

Medicine delivery
You may be able to have your medicines delivered to you, you can check your eligibility by visiting the Home Medicines Service website

Grocery delivery
The government is working with Meals on Wheels and other organisations to prioritise home delivery for senior Australians registered with My Aged Care

How can I choose the level of cover that is best for me?
Choosing a health insurance fund can be a complicated and time-consuming process. We take the hassle out of comparing by researching policies from our panel of trusted Australian insurers and tabling the limits of each health fund, allowing you to easily choose a policy that best suits your needs and budget.

Last year, Aussies saved on average $380.79 on health cover when they compared with us.

Are you getting the most out of your health insurance? Compare now.

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