Health insurance for podiatry

In general, podiatry services are not covered by Medicare. But some services can be accessed under enhanced primary care plans, such as for chronic conditions like osteoarthritis.
A number of private health policies will help with the cost of in-hospital podiatric services, including accommodation and some prostheses costs. Cheaper policies include some bronze plus and silver plans.
For general podiatry, an extras policy can cover you for around $60 a month.

Compare podiatry health insurance policies

Below you'll find a selection of policies from Finder partners that include podiatry. Each comes with a 2-month waiting period, and different conditions for orthotics. All prices are based on a single individual with less than $97,000 income and living in Sydney.

Finder survey: What extras are the most important to Australians?

Response	Male	Female
Podiatry	4.17%	2.49%

Source: Finder survey by Pure Profile of 1006 Australians, December 2023

Finder Score - Health Insurance Extras

Each month we analyse over 10,000 extras insurance products and rate each one on price and features. What we end up with is a nice round number out of 10 that helps you compare extras cover a bit faster.

We want to compare apples to apples, not apples to apple pie. It doesn't make sense to compare a top extras policy with coverage for hearing aids and braces against a policy designed only for dental. So we've separated all the extras policies on the market into pools and categories. Once in their pools and categories, each product gets a price score and a features score, which are then combined to give the Final Score.

Read the full Finder Score methodology

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What is podiatry surgery?

Podiatry surgery involves the surgical treatment of conditions and issues affecting the foot and ankle in hospital. Surgeries are wide-ranging and some are more complex than others. Podiatrists perform surgery on bone, joint, ligament, tendon and muscle problems of the foot or ankle.

What are my options for meeting the cost of podiatry treatment?

Podiatric surgery is performed in private practice, community health centres, day surgery centres and some private and public hospitals within Australia. To find adequate cover from a health fund, look for:

Combined Cover. Broadly, private Health Funds may cover you for around half the cost of your treatment expense. But you’ll need Hospital and General Treatment (Extras) cover.

Your fund offers rebates for aspects of surgical services provided by podiatrists aligned to the Australasian College of Podiatric Surgeons (ACPS). These rebates cover theatre fees, bed stays in private hospitals and the costs of implantable prostheses such as pins, screws and plates.

Medicare vs Private Health insurance

Professional fees of medical practitioners undertaking foot surgeries are rebated under the Medicare system, but they aren’t applicable to podiatric surgery. Medicare will pay a percentage of your podiatry fees if you have a referral from your GP and have been put on an Enhanced Primary Care (EPC) Plan.

However, to be eligible you typically have to fall into one of the following categories:

You are a chronically ill patient.
You have diabetes or suffer from vascular disease.

Medicare rebates may apply only to a consultation fee in some cases; any additional services incur an out-of-pocket expense. That's why many people opt for private health insurance - which can help with things like footwear modifications and orthotics - to help them manage the overall cost of their treatments.

"Podiatry issues can start very suddenly and cause a lot of pain and disruption to everyday life. Two of my children very suddenly developed issues related to having a growth spurt, which required the treatment of a podiatrist that would have been very cost prohibitive without extras cover. "

Kate Boddington

Finder crew member

What does podiatry surgery involve?

Surgery often involves going under general anaesthesia. While many are performed as day case surgeries, overnight stay is sometimes necessary.

Podiatrists may perform surgery for a variety of reasons, including:

- Structural deformities such as bunions, hammertoes, flat foot or high arched foot.
- Bone spurs
- Heel pain
- Nerve and tendon problems
- Nail conditions
- Trauma related injuries, such as fractures and breaks.

How long is the recovery time for Podiatry Surgery?

In general, you can expect to spend around 6-8 weeks in a cast or special post-op shoe after surgery. However, recovery time varies massively. A simple ingrown toe procedure can have you back to normal in a couple of weeks.

For more complicated procedures, such as rearfoot surgery, you may be required to keep pressure off the foot for as long as two months. Recovery can take around 6 months, with intense physical therapy sometimes necessary. Depending on the severity of your condition then, depends on the level of cover you will need.

How is podiatry covered outside of the hospital?

While podiatry surgery is covered under your hospital policy, podiatry care can be covered in a comprehensive extras plan.
Cover can be found on a mid-ranging or a high-level policy, such as gold. But with this, you'll receive a rebate on podiatry appointments outside of the hospital.

For anyone with diabetes or elderly individuals, it's really important you take care of your feet. It could even prevent you from needing surgery in the long run. That's why it can be important to have both podiatry and podiatry surgery cover.

Frequently asked questions

There are a range of reasons why you could choose to see a podiatric specialist. Here's a list:
- Structural deformities, including bunions, hammertoes, painful flat foot and high arch deformity, bone spurs
- Heel pain
- Nerve entrapments
- Degeneration and arthrosis of the joints of the foot and ankle
- Skin and nail conditions
- Congenital deformities
- Trauma-related injuries, including fracture and dislocations and post traumatic arthrosis
If you choose the lesser form of cover and receive treatment in a private hospital, or in a single room in a public or private hospital, you may have to pay for the cost of the surgery yourself.
You need to fully understand certain wording surrounding podiatric services and what you will be covered for under your respective insurance. One to note is differences between the cost and cover associated with Inpatient and Outpatient treatment:
- Inpatient services. These are hospital treatments that result in a hospital admission.
- Outpatient services. Are dealt with in a private capacity in private rooms at a local specialist centre.
- Out-of-pocket fee. The cost you could be slapped with, if your doctor charges more than the Medicare Benefits Schedule service fee.
- Known Gap. This is where your fund will pay up to the minimum beneﬁt, as set out in the government's Prostheses List. This list includes pacemakers, defibrillators, cardiac stents, joint replacements, intraocular lenses and other devices that are surgically implanted, during a stay in hospital.
- No Gap. This is when your treatment is undertaken as part of your hospital treatment and you won't have any out-of pocket expenses.
- Prosthesis. This is an artificial substitute for a missing body part, used for functional or cosmetic reasons or both. Surgically implanted prostheses are sometimes required during a medical procedure, such as a replacement lens for a cataract surgery, an artificial hip joint, a pacemaker, or a heart valve.
Cover for podiatric treatment come with strict conditions, so, putting your feet first can be a costly exercise. This is down to podiatry not being recognised under Medicare (unless you fall into the exceptional circumstances categories), and you'll need a combination of cover to receive benefits from your private health fund.
It's important to seek advice from your GP to see if you qualify for Medicare's rebates and fully understand what kind of private health insurance or General Treatment (Extras) cover you can take out to ensure you don't brunt the full cost of your surgery.
You have two options to claim benefits after your podiatric treatment. This is ultimately through your health fund, or for those with exceptional circumstances, through Medicare.
For your Medicare claim to be successful, you must have the following:
- You have a doctor's referral. In order for Medicare to pay for a percentage of your medical costs for your surgery, you must ensure you have a referral from your GP, showing you have been placed on a health management plan, which determines you to be chronically ill, or have diabetes or vascular disease.
Without a doctor's referral, you'll be required to pay for your surgery, out of your own pocket. Once your medical procedure is complete, follow these steps to receive a Medicare rebate:
- Fill out a claim form. You must do this before you can receive your benefits.
- Lodge your medical claim at a Medicare office. Here the department will process and send your claim to your health fund for further processing. Once your claim is received and processed, it will be paid directly as a credit, and into your chosen account.
If you don't fall into the exceptional circumstances category, you need to pursue your private health fund. A claim form can be found online, via your health fund's home page.
Here's what you need to do before you claim benefits from your private health fund via your Hospital and General Treatment (Extras) Cover:
- Private practice provider certification. In order to claim benefits from your fund, ensure your treatment was undertaken by a private practice provider who is recognised and registered with your fund.
- Contact your fund. Do this before making a booking to confirm how much you can claim, and to check that your chosen provider is registered with your fund.

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Written by

James Martin

Editor

James Martin was the insurance editor at Finder. He has written on a range of insurance and finance topics for over 7 years. James often shares his insurance expertise as a media spokesperson and has appeared on Prime 7 News, WIN News, Insurance News, 7NEWS and The Guardian. He holds a Tier 1 General Insurance (General Advice) certification and a Tier 1 Generic Knowledge certification, both of which meet the requirements of ASIC Regulatory Guide 146 (RG146). See full bio

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Health insurance for podiatry

Medicare won’t fully cover you, but you can get health insurance for podiatry to lower the overall costs - compare plans from as little as $21 per week.

Key takeaways