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* ADHD assessments with a psychiatrist or paediatrician are partially covered by Medicare but not by private health insurance * Extras Cover policies may pay part of the cost of a psychologist’s ADHD assessment on health insurance * You may be able to claim some ADHD medication costs on Extras Cover
Whether you’re looking for an ADHD assessment for yourself or your child, you might be wondering whether health insurance can help with your costs. Here, we guide you through each step of the ADHD (attention deficit hyperactivity disorder) diagnosis process, and let you know whether you can claim on health insurance or you’re covered by Medicare.
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Is ADHD assessment in Australia covered by Medicare?
Yes, but not for the full cost. It’s difficult to get an ADHD assessment or diagnosis through the public health system so you’ll need to see a specialist in a private clinic (in most cases).
ADHD is diagnosed by a psychiatrist, clinical psychologist or paediatrician (for children). Currently in some states and territories, GPs who have completed ADHD training can diagnose ADHD and prescribe medication. Whether you’re seeing a specialist or a GP, you’ll get a Medicare benefit for part of the cost of your appointment but you will need to pay the rest of the fee out of pocket – and you may need multiple appointments to complete the ADHD assessment.
An ADHD diagnosis can be expensive. A 2026 University of Wollongong study found the total ADHD assessment cost (over multiple appointments) averaged nearly $1,400, sometimes reaching almost $4,000. As at October 2026, Medicare pays $467.45 towards the cost of your first psychiatrist appointment for an ADHD assessment, if you’re referred by a GP. If you need subsequent appointments, the benefit for those sessions will be lower.
You may be able to go straight to a psychiatrist without seeing a GP, but this generally means you won’t be eligible for a Medicare benefit.
Here’s a rundown of the process.
See your GP for a referral to a specialist, so that you qualify for a Medicare benefit. (If you’re in a state or territory where your GP provides ADHD diagnoses, you might not need to see a specialist.)
Book with a psychiatrist or paediatrician for an ADHD assessment. You’ll get a Medicare benefit but will need to pay the rest out of pocket. (Note: If you see a psychologist for an ADHD assessment, you generally won’t get a Medicare benefit.)
Can I claim an ADHD assessment on health insurance?
You can’t claim ADHD assessments with psychiatrists or paediatricians on Hospital Cover, because consultations aren’t covered unless you’re admitted to hospital. GP appointments are not covered by health insurance either.
Psychologists are different. If you have Extras Cover that includes the Psychology treatment category you may be able to claim back a portion of the consultation. A few points to keep in mind:
Every insurer has different rules, so check with your insurer about whether ADHD assessment with a psychologist is covered on your policy
Most insurers don’t cover the full diagnostic package
You can’t claim both the Medicare benefit and health insurance for the same appointment
If you have a Mental Health Treatment Plan from your GP for subsidised psychology sessions, you can’t use this for an ADHD assessment.
After an ADHD diagnosis, you may be able to claim the cost of follow-up psychology sessions on your Extras Cover policy. Remember there is a waiting period before you can claim on Extras Cover – usually 2 months for psychology.
Yes, you may be able to claim part of the cost on your Extras Cover, if you are prescribed medication for ADHD that is not subsidised by the Pharmaceutical Benefits Scheme (PBS).
However, many common ADHD medications – including methylphenidate (Ritalin), lisdexamfetamine (Vyvanse) and atomoxetine (Strattera) – are listed on the PBS so they won’t qualify for a health insurance claim.
Check whether your policy includes the Non PBS Pharmaceuticals treatment category, which is usually only on mid or top level Extras Cover policies. If it does, ask your insurer whether your medication qualifies – there are lots of conditions around eligibility so it’s best to check with your insurer. Remember that there’s a limit per claim and per year.
If your medication is subsidised by the PBS, the maximum you’ll pay is $25, with a concession price of $7.70. You can’t use Extras Cover to pay these costs.
If you’re prescribed ADHD medication that’s not subsidised by the PBS, an Extras Cover policy can reduce your medication costs – but medication alone is unlikely to make an Extras policy worth the premium. To find an Extras Cover policy that offers value, total the cost of all treatments you’re likely to claim, including dental, optical, physio and others. If the amount you would claim back in a year is more than the premium, that policy could be good value for you. Use the healthslips.com.au calculator to find a policy that meets your budget. It searches every policy from every insurer in minutes – and you don’t have to enter your contact details to see your results including cheapest policy.
healthslips.com.au does not provide general or personalised advice. Your particular circumstances are likely to impact the accuracy, completeness and relevance of the information or results. Take this into account before making a decision and talk to an expert for financial advice.
Trudie McConnochie
Writer and Researcher
Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.
Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.
Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.
