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Last Updated on 7 October 2019

Health Insurance and Mental Health Issues

If you’re one of the 1 in 5 Australians who will experience mental health problems at some point in their lives, you’ll want to how your situation is likely to be treated by private health funds. As anyone who has suffered from mental health problems will know, it can be extremely distressing, especially if you’re also unaware of the type of treatment that may be available to help you recover.

Is anything available through Medicare?

You may not realise that some or all of your treatment may be available through Medicare depending on the severity of your mental health issues and the intensity of treatment that your GP has agreed that you would benefit from. Here is an overview of what you may be eligible for through Medicare:

Treatment with a psychiatrist is covered by Medicare, although how much you’ll have to pay yourself depends on where you receive the treatment. If you choose to be treated as a public patient (for example in a public hospital or community health centre), you’ll usually be fully covered, but if you choose to be treated as a private patient, you may not be covered in full.

Treatment with a psychologist may also be covered through Medicare if you’re referred through your GP or psychiatrist. Ask your GP if you’re not sure whether you would be eligible for Medicare rebates. If you’re not eligible, or would prefer to be treated privately, many private health funds may cover visits to a psychologist as a policy “optional extra”. Be aware that the level of cover can vary between health funds, though, so it pays to compare health insurance for mental health issues to see what your options are.

Treatment with a counsellor or psychotherapist may be covered through Medicare, but only if the practitioner in question is a psychologist or social worker with a Medicare provider number.

What about private health insurance?

Although Medicare can provide a good starting point for getting vital treatment for mental health issues, you may need more support than you’re offered under Medicare, or you may want greater choice over who treats you. In this scenario, you may be more comfortable receiving mental health treatment through your private health insurance instead.

Treatments with practitioners who are not covered by Medicare rebates may be covered by some private health funds, so it’s worth looking into this if you’ve got a specific practitioner in mind.

Private psychiatric services and rehabilitation

If you need to be admitted to hospital as part of your treatment (or you suspect that you may need to be), private hospital cover may allow you to be covered as a private patient for day admissions (with a same-day discharge as well as overnight or longer stays) for psychiatric services and rehabilitation. This should help to cover the cost of hospital accommodation and some of the medical fees.

The typical waiting period for psychiatric services and rehabilitation is two months – even for pre-existing mental health conditions – compared to the average wait of around 12 months for most other pre-existing conditions. As long as you don’t have a policy which restricts or excludes these services, you may be able to upgrade your policy and serve the two months waiting period if hospital admission is to form part of your treatment plan.

Policy extras for mental health treatment

Depending on the health insurance policy in question, optional extras may include psychology services and counselling, for which your health fund may pay either a set benefit amount or a set percentage of the cost (and you must bridge the gap between this payment and the actual fee).

It may be the case that the provider that you use must be part of a pre-agreed treatment network with your health fund for you to be covered by your insurance, so you may not have complete choice over who you see. There may be different waiting periods and restriction variations between health funds, so take the time to compare your options.

If your GP doesn’t feel that you need extensive support for mental health issues, treatment available through Medicare may help you to get back on your feet. For some people, these sessions may not offer sufficient support, so you may find it useful to compare health insurance for mental health issues and find a private health insurance policy that offers cover for the support that you need. Not all private health insurance policies will offer cover for mental health treatment, so be cautious about choosing a policy which restricts or excludes  mental health support services if you may be likely to use them.

Disclaimer: The above information is correct and current at the time of publication

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