Assistive Technologies Frequently Covered by Health Insurance

Assistive Technologies Frequently Covered by Health Insurance

Roughly 10% of the Australian population relies on assistive technology (AT) to improve their quality of life. This isn’t just older adults, either. The World Health Organization has defined AT as an encompassing term to describe “any device or system that allows individuals to perform tasks they would otherwise be unable to do or increase the ease and safety with which tasks can be performed.” This umbrella term refers to medical devices for people of all ages. Let’s take a look at what assistive technologies will typically be covered by your insurance plan.

Understanding Your Health Coverage and How That Affects Your Access to AT

Unlike the United States, every Australian citizen has access to Medicare. This means that, no matter your financial situation, you have health care. The federal government encourages people who make a higher earning—often over $50,000 as a single—to seek private insurers.

There are several great options for health insurance in the private sector. These private insurers offer a variety of different health plans. You are able to select a health care option that is right for you and cover items like a hearing aid if you need it. You don’t have to use private insurers, but you will be subject to the levy if your earnings are too high. Your health insurer will play a significant role in what assistive technologies are or are not covered.

The Three-Tier AT pyramid and What It Means

Since AT refers to so many devices, your insurance coverage often breaks them down into three categories: basic, moderate complexity, and high complexity. The basic AT devices include those which are less complicated, and often cheaper, such as hearing aid access. Health care coverage recognizes items like crutches, a hearing aid, standard wheelchairs, ramps, and other simple items these as basic assistive technologies.

At the moderate level, you’ll find electric wheelchairs, patient lifters, scooters, electric home care beds, and other items that typically have an electrical or motorized component to them. The highest level includes all of the equipment that is highly specialized or highly advanced in terms of the technology and mechanics necessary to operate them. The majority of cases are for people who need a basic AT.

Receiving Coverage for an AT and What You Can Expect

Now that you have a better understanding of how assistive technologies are viewed in the eyes of the insurance company, you can better understand what you can expect to receive coverage for with little to no hassle. If you have public health insurance, you will most likely be covered by the National Disability Insurance Scheme (NDIS). This scheme helps reduce out-of-pocket costs for an individual with federal, state, and/or territory funding. There is not a national regulator of AT devices. Whether or not an individual who needs one receives funding is determined by the state or territory.

This decision is predicated heavily on the availability of the product. If there is an abundance of retail clinics able to meet the demand, you should be able to receive coverage. Often, this would include wheelchairs, hearing aids, crutches, and other highly produced items. If you are over the age of 65, there are several schemes that would manage your aid dispenser. The major difference is that many of the schemes covering seniors will not only cover issues like hearing loss, but other devices to assist with aging. If the complexity of the device you’re requesting funding for increases, it doesn’t mean that your health coverage won’t help pay for it. It all leads back to the availability of the product and what your scheme dictates.

Additionally, there are a wide variety of private health care providers. They each have unique criteria and systems they use for exclusions and coverage. You’ll want to check with your individual health insurer if you no longer use the federal health care system.