NDIS VS Medicare VS Private Health
What’s the difference when accessing speech therapy for your child?
If your child has been referred to a speech pathologist, one of the first questions many families ask is:
“Can we use NDIS, Medicare, or private health insurance?”
The short answer is: Yes—depending on your child’s needs, eligibility, and your funding arrangements.
This guide explains the differences between the three most common funding options for paediatric speech therapy in Australia so you can feel confident about the best pathway for your family.
1. NDIS (National Disability Insurance Scheme)
Best for: Children with a permanent or significant developmental delay or disability
The National Disability Insurance Scheme (NDIS) provides funding for supports that help children build functional skills and participate more fully in everyday life.
What it covers :
If your child is eligible for the NDIS, funding may cover:
Speech therapy sessions
Assessments and NDIS progress reports
Parent coaching and upskilling sessions
Home or school support strategies
Who is Eligible?
Children may be eligible if they have:
A permanent disability, or
A significant developmental delay (particularly under age 9)
Eligibility is based on how your child’s challenges impact their daily life, not solely on whether they have a diagnosis.
Key things for parents to know
You need to apply, and eligibility is based on your child’s needs—not diagnoses alone.
For younger children, support may come through the Early Childhood Approach (ages under 9).
To access funding under the Early Childhood Approach, the child must demonstrate a need for support in at least 2 areas of communication (e.g. articulation, language)
Plans can be self-managed, plan-managed, or NDIA-managed, and it’s important to choose what’s right for your family
NDIS policies around access, eligibility and what is funding have been changing throughout this year, please refer to the NDIS website for further details and updates.
Helpful summary
✅ Covers ongoing and long-term support
✅ Flexible and tailored to your child
❗ Requires eligibility and an approved plan
2. Medicare
Best for: Children requiring short-term support or an initial assessment.
Medicare may provide rebates for speech therapy through specific referral pathways.
What it covers
Through a GP, your child may be eligible for:
A Chronic Disease Management (CDM) Plan (often called a care plan) which provides a rebate for up to 5 allied health sessions per year, which can include speech therapy
An MBS M10 service which provides a rebate for up to 20 allied health sessions per year. From the 1st of March, 2026 this was expanded to include speech therapy for stuttering, speech sound disorders, cleft lip/palate without further diagnosis.
Key things for parents to know
You’ll need a referral from your GP
The 5-session limit is shared across all allied health services (e.g., OT, physio, speech)
The M10 20-session limit can be used for both assessment and therapy sessions
There is usually a gap fee (out-of-pocket cost)
Rebates are paid after each session.
Helpful summary
✅ Easy to access through your GP
✅ Good for short-term or initial support
❗ Limited number of sessions per year/lifetime
3. Private Health Insurance
Best for: Families who already have extras cover
Many private health funds offer rebates for speech pathology under extras or ancillary cover.
What it covers
Depending on your policy, you may receive a partial rebate for each speech therapy session.
Key things for parents to know
Cover varies between insurers and policy levels.
Annual limits and per-session caps apply.
Waiting periods may apply.
Some insurers have specific eligibility criteria.
Helpful summary
✅ Can help reduce out-of-pocket costs
✅ Flexible—no referral always needed
❗ Benefits vary widely between policies – Check the diagnoses covered with your insurance company
Can You Use More Than Once Funding Source?
Sometimes, yes.
For example, families may use:
Medicare rebates for some sessions, and
Private health insurance for other sessions.
However, you cannot claim two funding sources for the same session.
Your speech pathology provider can help explain how your available funding options may work together.
So… which option is right for your child?
Here’s a simple way to think about it:
How to Access Speech Therapy Funding in Australia?
Speak with your child’s GP or paediatrician.
Contact your private health insurer to check your extras cover.
Explore NDIS eligibility if your child has significant support needs.
Reach out to a speech pathology clinic for guidance.
Frequently Asked Questions
Can my child receive speech therapy without a diagnosis?
Yes. Many children access speech therapy privately or through Medicare referrals without a formal diagnosis.
Does NDIS require a diagnosis?
Not always. Eligibility is based on functional impact and support needs.
Can I use Medicare and private health insurance together?
Not for the same session, but you may use them across different sessions.
Is speech therapy covered by private health insurance?
Often yes, if your policy includes extras cover for speech pathology.
We’re Here to Help
Every child’s journey is different—and navigating systems like NDIS or Medicare can feel overwhelming at first. You’re not expected to have all the answers.
The most important step is simply starting the conversation. A GP, early childhood professional, or speech pathologist can help guide you toward the right pathway for your child. If you’re unsure where to begin or what your child may be eligible for, you’re not alone. We’re here to answer your questions clearly and with care—so you can feel supported every step of the way.
At Eat Speak Play, our team of paediatric speech pathologists can help you understand your options and guide you toward the funding pathway that best fits your child’s needs.
Looking for a Paediatric Speech Therapist in Sydney?
We support families across the Eastern Suburbs, St George area and Sutherland Shire in Sydney.
Our therapist also offer online speech therapy who prefer or require flexible access to support.
If you’re considering speech therapy for your child, we’d love to support you.
👉 Book a Free Discovery Call with one of our speech therapists.