Can I use health insurance for heart disease treatment? 

If you’ve been diagnosed with heart disease, your doctors have probably given you lots of information about how to manage your condition. The good news is that some of the lifestyle changes to manage heart disease, and many heart disease treatments, are covered by Private Health Insurance. 

There are 2 main types of health insurance – Hospital Cover, which will cover your surgeries and in-hospital treatments, and Extras Cover, which will support you with lifestyle changes for heart disease. 

What’s the difference between Hospital Cover and Extras Cover – and do I need both? 

Here’s the lowdown on health insurance for heart disease. 

Hospital Cover for heart disease 

If you’re admitted to a public hospital for heart disease treatment including heart surgery, your costs will be covered under Medicare. If you choose to go to a private hospital for heart disease treatment and you have Hospital Cover, your costs will be covered by your insurer, depending on your policy. There may be out-of-pocket costs, so talk to your insurer to find out what you’re covered for. 

Heart disease treatments are covered under the Heart and Vascular System Clinical Category of Hospital Cover. This includes hospitalisation to investigate or treat a heart attack, varicose veins and heart failure.  

You’ll need a Silver or Gold tier policy to get cover for these treatments and services. It’s optional for insurers to include Heart and Vascular System cover on Basic and Bronze policies, but at the time of writing we could only find one insurer offering this on a Bronze policy, and none on Basic cover.  

What are the Clinical Categories of Hospital Cover, and how do I choose the right level of cover for me?  

If you have heart surgery, your time spent recovering in hospital will be covered under the Rehabilitation Clinical Category. This is included in all tiers of Hospital Cover however it may be restricted on Basic, Bronze or Silver policies, which could mean significant out-of-pocket costs.   

Keep in mind that if you already have heart disease before taking out your policy, you’ll have to serve a waiting period (usually 12 months) before you can claim.  

Extras Cover for heart disease 

If you need expert help changing your lifestyle to manage heart disease, your Extras Cover may cover some of your costs, depending on your policy. Make sure you check your policy limits and waiting periods – especially if you’ve taken out your policy after you developed heart disease (pre-existing conditions are generally subject to waiting periods). Check with your insurer to find out more. 

Extras Cover for heart disease includes: 

Nutrition support 

Eating a healthy diet will help keep your heart healthy. There’s lots of helpful information about eating a heart-healthy diet on the Heart Foundation website, but for personalised support, talk to an accredited practising dietitian. The cost of dietitian sessions may be partly or fully covered by your Extras Cover if your policy includes Dietetics/Dietary Advice. 

Exercise advice 

While physical activity is important for a healthy heart, you’ll need an expert to guide you on the safest forms of exercise for you. Talk to your doctor, and consider seeing an accredited exercise physiologist for a safe workout regimen that’s tailored to your health needs and lifestyle. If your Extras policy includes Exercise Physiology, the costs of accredited exercise physiologist appointments may be covered in part or full (depending on the policy conditions).  

Heart disease education 

When you’re living with a chronic illness like heart disease, a little knowledge can go a long way. If your Extras Cover includes the Health Management/Healthy Lifestyle category, you may be covered for classes or therapies that will help you manage your condition better. This includes heart-disease management programs and support to help you quit smoking (which is essential for heart health), and it might also cover the costs of your gym membership – check with your insurer. 

Mental health support 

Experts say anxiety and depression can be common after heart surgery, so if you’re struggling mentally, seek support from your GP or a health professional. A psychologist can help you develop strategies to cope with what you’re feeling, so ask your GP about a Mental Health Treatment Plan, which will get you 10 psychologist sessions under Medicare. Alternatively, if you have Extras Cover that includes Psychology, your insurer may pay for some or all of the cost of your sessions. 

Which health insurance covers heart disease? 

If you’re living with heart disease, there’s a wide range of Private Health Insurance policies that will meet your needs and budget. If you don’t have cover already, visit the healthslips.com.au Calculator to find the best Hospital and/or Extras Cover policies for you. If you already have a health insurance policy but it isn’t going far enough for your needs, try our existing policy comparison Calculator.  

Our calculator includes every health insurance policy in Australia without any bias, and you won’t have to enter any contact details to use it. We’re not selling insurance so you can be sure the results you get are truly impartial. It’ll help you find the best deal for you. 

Find out more about the healthslips.com.au Calculator.