If you live in Australia, you have health insurance. You might not realise it, but you do.
At the very least, you are insured through our public health system, Medicare. Medicare ensures every Australian (and some permanent and temporary residents) has access to a level of health care. Your insurer is the Department of Human Services, who administers Medicare on behalf of the Department of Health. Your premiums are paid through taxes, and in return you are entitled to have the costs of your care subsidised, or in some cases, completely covered (though this is likely to change). Unfortunately, some services – like physiotherapy – are only covered in certain circumstances. Others aren’t covered at all.
According to the statistics from the Private Health Insurance Administration Council for the December quarter of 2013, 55% of Australians are also insured for non-hospital based health services through private insurers.This generally includes allied health (eg: physiotherapy) and some complementary health services. The range and limitations of cover vary from insurer to insurer and policy to policy, however in my experience most insurers will cover 65% to 85% of costs for services, and in some cases can cover up to the full amount for specific services or items.
This means that 1 in 2 Australians potentially have a considerable amount of their health care needs covered by insurance. And the beauty of it is, you don’t actually have to be sick or injured in order to make a claim. Medicare does not require you to be ill to see a doctor, nor do private health insurers require you to have a condition or injury to see an allied health practitioner. In fact when considered carefully, health insurance is the perfect means by which people can engage in preventative health measures, and potentially avoid becoming sick or injured. Yet as someone who has worked in the health care industry for eleven years, and half of that in private practice, it’s been my observation that very few people use their health insurance – public or private – for preventative health.
I’m sure there’s numerous possible answers, however in my view it comes down to this: we don’t do preventative health care very well in Australia. Our approach to health is a very reactive one, as opposed to proactive. This is not to say that our healthcare professionals aren’t all for preventative health; in fact I’m sure in the majority the opposite is true. The main problem, as I see it, is what I’ve come to term the, “she’ll be right, mate” attitude towards health. In my experience, Australians – in general – do not see a health practitioner unless there is an absolute or urgent need to. As a physiotherapist, I’ve seen this over and over again. The number of patients I’ve seen who’ve had their injury or condition for weeks, months, sometimes even years, and never sought treatment before, is staggering. What’s even more staggering is the number of patients who, after having seen me and received my advice to return should their symptoms start to return again, wait to return until they have deteriorated back to their pre-treatment presentation.
This is a discussion in and of itself. My point is, with the options available to us through private and public insurances, at least 1 in 2 of us do not have to be in this situation. Health insurance is something we pay for, however, unlike many other types of insurance, we can claim a benefit through this on a regular basis. Those with private policies are likely spending significant amounts of money every year to ensure they are covered for a variety of health services, whether they use them or not. So shouldn’t we all make the most of it?
Here are three things you can do straight away to start making the most of your health insurance:
1. Understand Your Policy
The key to getting the most out of your health insurance is to first understand what you’re policy covers you for, and just as important, what it does not cover. If you have private health insurance you should at the very least have read and be familiar with your product disclosure statement. This will tell you everything you need to know about what your policy does and does not cover you for, what you can claim against, how to make a claim, and so forth. Not only will this help you understand what you can use your insurance for, it will also help you consider whether you are covered for the things you feel you need.
This is also true if all you are covered by is a public policy, such as Medicare or, for veterans, the Department of Veterans Affairs. We assume we know what these services do and don’t cover, but how many of us really know? For example, it wasn’t until I researched for this article that I discovered Medicare can be used in eleven other countries to subsidise the cost of essential medical treatment under Reciprocal Health Care Agreements. Useful knowledge if you’re travelling to New Zealand or certain parts of Europe.
2. Start Using Your Insurance
If you have a private insurance policy with ancillary (non-hospital) cover, and you are not using the services you are covered for, you are not getting what you are paying for. Most policies will at the very least enable you to have routine checkups for your teeth, your eyes, and your hearing. If you have or have had problems with you neck, back, shoulders, feet, or just about any other part of your body, you can check in with a physiotherapist or podiatrist. Want to get fit? Check in with a dietician and exercise physiologist. Feeling stressed? Go see a registered massage therapist. Once you are familiar with what your policy covers, you’ll realise there are a lot of things you can do to benefit your health and well-being without having to be sick or injured first.
Even if you’re in the half of the population that does not have private health insurance, you can still schedule a regular check-up with your doctor using Medicare or, if you’re a veteran, veterans benefits. In most cases this won’t cost you anything except some time. When you consider the many health problems that we know can be addressed through prevention and early detection, and the fact that you are effectively already paying for compulsory health insurance through your taxes, it becomes nonsensical to not go and have a regular health check with your doctor.
3. Review Your Policy Regularly
Policy on public health, and consequently what is or isn’t covered by Medicare and DVA, changes often enough that it is important to keep up-to-date on what services are accessible through Medicare and veterans benefits, the process for doing this, and what your out-of-pocket expenses may be as a result. This is especially important if you are in the half of the population that does not also have private health insurance, as this is what you are relying on should you require medical treatment.
Private policy holders are effectively making an additional investment in their health. Like any good investment, you should be confident you are getting a good return on your investment. Your return on your investment is essentially whether you are covered for the services you need (or will need), and whether you are using them. This needs to be considered in terms of both present and future needs: what you need today may be quite different to what you needed five years ago, and what you might need in five years time. Many health insurers recognise this, and offer ‘tailor-made’ packages to help you choose what you do and don’t want to be covered for. It comes back to what you feel will be beneficial to maintain your health, well-being, and quality of life.
One way or another, you are paying for health insurance, whether you want to or not. Unlike other forms of insurance, where you are essentially covering yourself ‘just-in-case’ something happens, health insurance gives you the direct ability to reduce the risk of something happening. Isn’t it therefore in your best interest to make the most of it?
How do you make the most of your health insurance? Do you feel you are getting a good return on your investment? Please feel free to share your thoughts in the comments section below.