What is a Mental Health Care Plan?

A mental health care plan is a plan that your GP writes about treating and managing a mental health condition.

It enables you to access certain allied health professionals, such as psychologists, social workers or occupational therapists who can provide you with psychological support.

Mental health care plans are a part of the Better Access initiative, which aims to improve access to mental health care services through Medicare.

Am I eligible for a mental health care plan?

You are eligible for a mental health care plan if you have a mental illness or mental disorder that has been diagnosed by a doctor.

If you are experiencing mental health issues but you have not been diagnosed with a mental health disorder, you will need to see your GP for a mental health assessment to determine whether you are eligible for a mental health care plan.

What is a Medicare rebate and how much do I get back?

A Medicare rebate is when Medicare refunds you part of the cost of your appointment. If you have received a mental health care plan referral from your GP, this enables you to claim a Medicare rebate of $84.80 for a general psychologist or $124.50 for a clinical psychologist per session.

If you are not eligible for a mental health care plan, you may be eligible for a enhanced primary care (EPC) plan. With an EPC plan, you will receive a rebate of $52.95. These amounts are set by Medicare.

How do I claim my Medicare rebate?

Most of the time, your rebate can be processed straight after you’ve completed the session with your psychologist. You will be required to pay the total cost of the appointment first and then your refund can be processed.

You will need to have your Medicare card and a debit card (refunds cannot be processed with credit cards) with you for the rebate to be completed so please make sure to bring these with you when you attend your appointment to be able to receive your refund on the spot.

Alternatively, you can claim your Medicare rebate online through the myGov website.

How much am I out of pocket?

The ‘gap fee’ or the ‘out of pocket’ cost will depend on the psychologist’s fee. With a GP referral, you will still need to pay the difference between the psychologist’s fee for the session and the Medicare rebate. This amount will vary.

It is best to ask what the ‘gap fee’ is when you book your appointment.

Can I use my private health insurance as well as claiming a Medicare rebate?

You cannot use your private health insurance to pay for the ‘gap fee’. You can use your private health insurance to claim a partial rebate (depending on your level of cover) if you do not claim a Medicare rebate.

However, the two cannot be used together to pay for one psychological session.

Can I see any psychologist with a referral from my GP?

If you have a mental health care plan or an enhanced primary care (EPC) plan and would like to claim your entitled Medicare rebate, you must see a psychologist who is registered with Medicare and has a Medicare Provider Number.

Your GP can refer you to a specific psychologist or other mental health service, or, you can do your own research and choose a particular mental health professional you might like to see.