Podiatry is an important service many people need to access. Whether you have a chronic condition, foot injury or infection, podiatrists can help you find the right treatment.
Health concerns often come with a price tag. Medicare is a system designed to help people get access to health care services. But is podiatry covered under this system? The answer to this is yes and no. Some conditions are not covered by Medicare and some are. In this article, we’ll explain which ones apply.
For personalised advice, contact our team at the Foot and Leg Pain Centre today.
Does Medicare Cover Podiatry
The Medicare Benefits Schedule does provide coverage for podiatry under specific plans if you meet certain requirements. The Enhanced Primary Care plan, also known as the Chronic Disease Management plan, outlines that you must have a chronic condition to qualify for a Medicare rebate. Having a chronic medical condition does not mean having a condition for years or terminally. A chronic condition qualifies as any condition you have had for more than three months. Common conditions which may meet these requirements include Diabetes, Gout, Arthritis, chronic musculoskeletal pain such as arch and heel pain, lower back pain or children’s growing pains.
The next step is to get a referral for several podiatry visits from your GP. If you are living with a chronic condition and have a referral, you will most likely qualify for the EPC Program. The EPC Program will allow for up to five rebated podiatry visits every year.
With access to this rebate, you may be able to partially or fully cover your podiatry costs. However, you need to get reassessed every year to keep your Medicare rebate up to date.
What is an Allied Health Professional?
Allied health professionals are highly-trained individuals in a variety of related fields. Podiatrists, chiropractors and even psychologists are just a few. For a podiatrist to be an allied health professional they must be registered with AHPRA, Australian Health Practitioner Regulation Agency. AHPRA is the key regulatory body that ensures members are qualified to practice so patients can get the best care.
Conditions Medicare may Cover for Podiatry
You may be wondering which chronic or terminal conditions are more likely to be covered by the EPC program. Here we’ll explain which chronic health conditions usually qualify and how a podiatrist can help.
Diabetes
Diabetes is a chronic condition that is characterised by the development of too much glucose in the blood. Likewise, diabetics do not produce enough natural insulin to regulate these glucose levels.
Diabetes can often come with foot complications that require a podiatrist. It can often cause lower circulation which can damage the nerves of your feet. Diabetes Australia guidelines recommend yearly foot assessments with a Podiatrist for the proactive and preventative management of foot and lower limb conditions. Regular podiatry consultations can help to identify issues before they worsen, allowing your podiatrist to determine the best treatments or prevention plans that preserve foot health. As a chronic illness, this condition is often covered by Medicare with the EPC program.
Osteoarthritis
Osteoarthritis is a degenerative joint condition. When located around the feet or ankles this can cause pain, stiffness and swelling. As a chronic condition, the EPC program often covers this condition for podiatry. Many podiatrists prescribe orthotics to help unload arthritic foot joints to stabilise the joints and offer relief. Relief of chronic knee and lower back conditions may also be achieved with custom foot orthotics as foot posture and function is known to be directly related to knee, hip and lower symptoms.
Plantar Fasciitis
Plantar fasciitis is when the tendon on the bottom of your foot, connecting your heel to your toes has been damaged. This tendon is known as the plantar fascia. Though not always a chronic condition, this damage can often take anywhere from a few weeks to a few months to recover from.
If left untreated plantar fasciitis can become a recurring condition that weakens the plantar fascia. A podiatrist can treat plantar fasciitis with a range of methods including prescribing orthotics and medication.
Achilles Tendinopathy
Achilles Tendinopathy is when your Achilles tendon has been injured. This is a painful injury located at the back of the heel that is often caused by overuse or over-exercise. Achilles tendinopathy can range from a mild to a more severe injury such as tendon ruptures that can impact your ability to walk.
The recovery process for this condition is expedited with Podiatric treatments where relief is achieved from the first visit. Ignoring Achilles symptoms can lead to ongoing symptoms and in some cases complete rupture. A podiatrist can guide you through rehabilitation for these kinds of injuries. If you are experiencing severe Achilles tendinopathy your podiatry visits will most likely be covered by Medicare.
How to Use Your Medicare Rebates
If you have met the above criteria you might be wondering how you can access your rebate. The Medicare rebate process is fairly straightforward and easy for patients to access. It usually happens when you have an appointment with your podiatrist.
Once you’ve had your appointment and go to pay, your Medicare card will be taken on file. They can then use this to automatically reduce the cost of up to five of your appointments per year.
Bulk Bill Medicare
With the EPC Program, you are entitled to a little over $63 in rebates per appointment. As long as you qualify for a Medicare rebate for podiatry, you can bulk bill these services. Bulk billing is when your Medicare rebate is accepted as full coverage for your appointments. However, if your podiatry services are not covered fully by the amount outlined you may have to pay out of pocket to cover the gap.
Private Health Insurance
Private health insurance can help you access private health care and cover medical costs that are not covered by Medicare. However what your insurance covers is dictated by your plan, which in turn is dictated by your insurance company and your level of insurance, or the amount you pay.
Most private health insurance plans come with ‘extras’, this is what podiatry normally falls under. To understand if your insurance will cover your podiatry appointments, you will have to check your individual plan.
Finding the Right Care
If you have experienced a foot injury or condition, a podiatrist can help assess your problem and determine the right treatments. Though Medicare only covers certain individuals, that does not mean your needs are less important. Whether you qualify for a Medicare rebate or not, our enthusiastic team is ready to help.
Understanding how to navigate health costs and rebates can be difficult on your own. If you’re unsure if you qualify for Medicare coverage we can let you know. Contact our team today at the Foot and Leg Pain Centre to get the treatment you need.
