Psychology, Medicare and Private Health Rebates

Everything you need to know to reduce your cost per session with access to Medicare rebates.

For many people managing the financial cost of therapy is an important consideration. Medicare rebates are available for psychological therapy for all people with a mental health care plan and diagnosed mental health conditions. These rebates provide financial assistance to eligible individuals, allowing them to receive quality treatment from qualified psychologists at a reduced cost. Medicare provides rebates for up to 10 sessions a calendar year (January to December) whereas most people need between 12 and 20 sessions. Spacing your non-rebated sessions and using your private health are effective ways to spread the cost.  Individuals that start therapy later in the year are likely to benefit from the safety net and also have the added benefit for a new referral of 10 sessions in January to ensure that sessions are spaced well.

In this article, we will explore the numerous benefits of Medicare rebates for psychologists and provide you with invaluable tips on how to make the most of your mental health care. Whether you’re seeking therapy for yourself or a loved one, understanding the ins and outs of Medicare rebates will empower you to prioritise your mental well-being without breaking the bank.

Since each person’s mental health journey is unique, it’s your responsibility to maintain and update your Mental Health Plan to access rebates. To simplify this process, we’ve outlined the steps to access rebated sessions.

Your referral won’t grant immediate access to all 10 eligible sessions. Instead, you’ll have periodic referral check-ins with your GP to replenish your plan and assess your progress. This pathway is as follows:

Private Health Fund Claims

Your invoice will include an item code for private health rebates if there is not a Mental Health Plan attached for you to make a claim with your private health fund. If a Mental Health Plan is attached to the service generally, you cannot claim both a Medicare rebate and a Private Health Fund rebate.

Medicare-funded services

Medicare rebates are available for psychological therapy by registered psychologists under the Australian Government’s Better Access to Mental Health Care initiative. This scheme provides considerable assistance to people living with mental health problems, allowing them greater access to psychologists and providing more affordable mental healthcare. You can access up to 10 Medicare rebated sessions per calendar year. Most people require between 12 and 20 sessions.

How many psychology sessions does medicare cover?

Under this scheme individuals diagnosed with a mental health disorder and have a Mental Health Care Plan drafted by their GP can access up to 10 individual and 10 group treatment sessions per year. The MHP allows up to 10 Medicare-rebated sessions per calendar year. Medicare will subsidise $93.35 (Generally Registered Psychologists) or $136.65 for Clinical Psychologists.

Eligibility

You need valid referral letter from your GP (addressed ‘To Psychologist’ or ‘To Psychologist Jane Doe’) dated on or before the session you wish to claim. You will also need to provide us with your re-referral letter from your GP after 6, 4 and 10 sessions and before your next session.

Medicare Rebate processing

Our system requires that you make full payment for the service before we process your Medicare rebate. We usually process rebates for you on the day of your sessions but please allow a few days for processing to be completed, in particular the first session. If you have a child, we need the parent who is paying for the session’s Medicare details to process the rebates so please provide this on the registration form. You also need to advise us if you need to change the claimant when the Medicare rebate is processed. If you pay your session fee after the day of the appointment please email or phone the office to request for your rebate to be processed.

More information about medicare rebates can be found on our referral page. 

Progress updates to your GP

When we accept a mental health care plan from your GP we are required by Medicare to provide the GP with updates regarding your progress in therapy (after 6, 4, and 10 sessions). If you discontinue therapy before the first 10 or re-referral extended sessions we will write and tell your GP.

Ongoing eligibility

While we take care to inform you of the availability of this rebate and offer the service to process rebates, ultimately it is your responsibility to check and keep track of the number of sessions you have and provide us with a re-referral letter after the initial 6 sessions. We cannot be held responsible for any issues with rebates provided by Medicare.

Late notice fees Medicare does not provide a rebate for fees for late notice cancellations but they do provide rebate for video/phone sessions so we recommend you attend.

Medicare Safety Net information

If you see a doctor often, or have tests regularly, your medical costs could be high. Visiting a doctor or having tests may cost you less for the calendar year once you reach a Medicare Safety Net threshold. This is because Medicare will rebate up to 80% of out of pocket expenses.

Once you reach the relevant threshold for out of pocket expenses ($2414  for no concessional or for $770.30 concessional), the Medicare Safety Net may provide a higher Medicare benefit for all eligible services for the rest of the calendar year. This may mean that visits to your psychologist, doctor or having tests could cost you less. For example, once you reach the relevant threshold, you still pay the same amount upfront to your psychologist, however Medicare may subsidise a higher amount for each session, making your out of pocket expenses much less.

Please read the Medicare website information carefully and call Medicare to confirm eligibility. We provide this information as a guide only and while we make all effort to ensure that it is accurate we cannot be held accountable for Medicare’s decisions.

Medicare Rebates and Medicare Safety Net

The Medicare Safety Net covers a range of out of hospital doctor visits and tests covered by the Medicare Benefits Schedule. These include:

• Healthcare professional consultations, including psychology and psychiatry
• Blood tests
• CT scans
• Pap smears
• Radiotherapy
• Tissue biopsies
• Ultrasounds
• X-rays

If a service is not in the Medicare Benefits Schedule it does not count towards the Medicare Safety Net. If you have surgery, see a doctor or have tests while you are in hospital, these services don’t count towards the Medicare Safety Net.

Once you reach the relevant threshold, the Medicare Safety Net may provide a higher Medicare benefit for all eligible services for the rest of the calendar year – it will cover 80% of out of pocket expenses.

Medicare Safety Net family – 

Couples and families need to register as a Medicare Safety Net family, even if you are all on the same Medicare card, in order for Medicare to keep a total of the medical expenses you have as a family. For Medicare Safety Net purposes, a family consists of:

• A couple who are legally married and not separated, or a couple in a de facto relationship, with or without dependent children
• A single person with dependent children
• A dependant is someone who the family contact or spouse supports financially and is either a 1) child dependant aged under 16 years, or 2) a student dependant aged between 16 and 25 who is in full time education.

Using your sessions throughout the year This information is important for your session planning for the year. If you are attending therapy with your or at the same time as other family members the initial out of pocket costs may be high however, you may find that you save more on medical expenses all round for the rest of the year by making use of the Medicare Safety Net threshold. Your Medicare Safety Net Threshold expires on the 31^st of December.  Don’t forget to register as a family today.

Are Medicare rebates available for couple or family sessions?

If one of the individuals in the couple or family is suffering from a condition that meets the criteria of a mental health condition and is severe enough etc then that individual can seek a care plan from their doctor. If in the psychologists’ opinion the best treatment for the individual involves undertaking therapy that includes their partner or other family members, then that is what we will do. This assessment is up to you and your psychologist.

Can I get Medicare rebates and private health fund rebates for the same session?

You can get Medicare rebates for sessions OR private health fund rebates for sessions throughout the calendar year. You cannot obtain both for the one service. You cannot use your private health insurance ancillary cover to top up the Medicare rebates. You need to decide if you will use Medicare or your private health insurance ancillary cover to pay for any psychological services you receive.

Telehealth services Medicare now provides rebates for Telehealth services for telephone and video sessions.

Private Health Fund Rebates We provide an invoice to you on the day of your consultation to take to your private health fund provider. Our invoice will have a HICAP code in the invoice notes for you. Private Health fund limits expire on the 31^st December each year.