Medicare Funded Psychology Services

What are Medicare Funded Psychology Services

Medicare funds psychological services in Australia through several programs, making mental health care more accessible and affordable. 

The main avenue through which these services are funded is the Better Access to Mental Health Care initiative. This initiative allows eligible individuals to receive psychological support from registered mental health professionals, including psychologists, social workers, and occupational therapists, under a Mental Health Treatment Plan (MHTP) developed by a General Practitioner (GP).

A mental health treatment plan is available to people who are diagnosed with a mental health condition. This helps cover the costs of up to 10 individual mental health treatment sessions each year.

Key Medicare-Funded Psychological Services in Australia

Better Access to Mental Health Care Initiative

The Better Access initiative is the primary way individuals can access subsidised psychological services in Australia. This program covers a range of mental health services, including assessment, diagnosis, and treatment of various mental health conditions.

To access this service:

• Step 1: Visit a GP: The first step is to see a GP who can assess your mental health and, if necessary, create a Mental Health Treatment Plan (MHTP). This plan outlines your mental health needs and sets goals for your treatment.
• Step 2: Referral to a Psychologist or Mental Health Professional: Based on the MHTP, your GP can refer you to a psychologist, social worker, or occupational therapist eligible for Medicare-rebated services. The referral may be to a specific therapist or practice.

Medicare Coverage:

• Up to 10 Sessions per Calendar Year: Medicare will fund up to 10 individual therapy sessions per year under the Better Access program. The number of sessions initially approved is usually 6, and if needed, the patient can return to their GP for a review and request a referral for up to 4 additional sessions.
• Up to 10 Group Therapy Sessions per Calendar Year: In addition to individual sessions, Medicare also covers up to 10 group therapy sessions each year. Group therapy can be beneficial for conditions such as anxiety, depression, and trauma and often involves learning new skills in a supportive environment.
• Rebates: Medicare rebates cover a portion of the cost of psychological services, but the individual may need to pay a gap fee, depending on the psychologist’s rates. The rebate amount varies based on the level of the psychologist:
• Clinical Psychologist: Medicare rebates approximately $136.35 per session.
• General Psychologist/Allied Health Practitioner: Rebates approximately $92.90 per session.

Accessing Psychologists under Medicare

Psychologists who provide services under Medicare must be registered with Medicare Australia and meet specific eligibility criteria. They typically offer therapies such as:

• Cognitive Behavioral Therapy (CBT)
• Interpersonal Therapy (IPT)
• Trauma-Focused Therapies
• Mindfulness-Based Therapies

Patients can see a clinical psychologist, general psychologist, or other qualified mental health professionals based on their needs and GP referral.

Mental Health Treatment Plan (MHTP)

The Mental Health Treatment Plan is a structured plan that a GP creates to provide ongoing care for patients with mental health conditions. It includes:

• An assessment of the patient’s mental health and concerns.
• Diagnosis or identification of a mental health condition (such as anxiety, depression, PTSD, etc.).
• Treatment goals and the number of recommended therapy sessions.
• Referrals to appropriate mental health professionals.

The MHTP can be updated as needed. After the initial set of sessions (usually 6), the patient returns to the GP for a review, which may include recommendations for further therapy or adjustments to the treatment.

Bulk-Billing and Gap Fees

While Medicare provides rebates for psychological services, not all psychologists bulk bill. Bulk billing means the psychologist accepts the Medicare rebate as full payment, meaning the patient pays nothing out of pocket. However, many psychologists charge a fee higher than the Medicare rebate, requiring the patient to pay a gap fee to cover the difference.

The gap fee varies depending on the therapist’s rates, location, and the type of service provided.

Chronic Disease Management (CDM) Plans

In addition to the Better Access initiative, individuals with chronic mental health conditions may also access psychological services under a Chronic Disease Management (CDM) plan. This plan allows people with chronic or complex health conditions, including long-term mental health disorders, to receive Medicare rebates for allied health services, including psychology.

CDM plans can benefit individuals who require long-term management and receive other medical treatments as part of their condition.

Better Access for Eligible Populations

Certain groups within Australia have enhanced access to Medicare-funded psychological services, including:

• People in rural and remote areas are eligible for telehealth consultations, which allow them to access psychological services via videoconferencing or phone when face-to-face services are unavailable.
• Veterans and their families: Eligible for mental health services through the Department of Veterans Affairs (DVA). These services are similar to those available under Medicare, but DVA covers the full session cost without needing gap fees.
• Aboriginal and Torres Strait Islander Peoples: They can access specific mental health programs under Medicare and benefit from culturally appropriate services through community health programs.

Telehealth Services

Since 2020 Telehealth psychological services became widely available. In specific circumstances, patients can now access therapy via phone or video calls under Medicare. This is especially beneficial for individuals who:

• Live in rural or remote areas with limited access to face-to-face services.
• Are unable to attend in-person appointments due to health concerns or restrictions.
• I prefer the flexibility of receiving therapy from home.

Telehealth services offer the same Medicare rebates as in-person services, but not all psychologists offer this option, so it is important to check with the therapist beforehand.

Head to Health (Digital Mental Health Services)

Head to Health is an Australian Government initiative that provides free or low-cost digital mental health services. Medicare does not directly cover these services but are part of the broader mental health support system in Australia. The platform connects individuals to:

• Online programs: Self-guided therapy programs for anxiety, depression, and other mental health concerns.
• Mental health apps: Tools for managing mental health symptoms.
• Phone and chat services: For immediate support from trained counsellors.

Other Medicare-Funded Mental Health Programs

Medicare also funds mental health services through specialised programs, including:

• Perinatal Mental Health Services: New mothers can access Medicare-rebated mental health services to support them through pregnancy and the postnatal period.
• Alcohol and Other Drugs (AOD) Treatment Services: For individuals struggling with substance abuse issues, Medicare may fund psychological services that are part of a comprehensive treatment plan.

Private Health Insurance and Medicare

Patients with private health insurance may be able to claim psychological services through their extra coverage in addition to Medicare rebates. However, you cannot claim a Medicare and private health rebate for the same service. Patients must check with their health insurer about their entitlements and whether private coverage offers better value for specific mental health services.

Key Points to Remember

• Accessing Medicare-funded psychological services: Patients need a Mental Health Treatment Plan from their GP to access rebates for psychological services.
• Number of sessions: Medicare funds up to 10 individual and 10 group sessions per year, with an option for more in special circumstances.
• Gap fees: Not all psychologists bulk bill and patients may need to pay a gap fee depending on the therapist’s rates.
• Telehealth: Psychological services via phone or video are available for individuals in rural areas or those unable to attend in person.
• Special populations: Veterans, people in remote areas, and Aboriginal and Torres Strait Islander Peoples may have enhanced access to psychological services.