Navigating Funding and Understanding Medicare for Mental Health Support in Australia

Short Summary (TL;DR)

Navigating mental health support in Australia can be overwhelming, but Medicare provides helpful rebates for psychology sessions through different funding options. The most common is the Mental Health Care Plan (MHCP), which allows you to access up to 10 psychology sessions per year with a referral from your GP. There are also options for people with chronic conditions (CDM) or neurodevelopmental disorders (under 25 yrs) for additional support. Before your GP appointment, it’s helpful to know what questions to ask and ensure your referral is addressed to the right psychologist. Keep reading for more details and a helpful guide to take to your GP appointment

Understanding Medicare for Mental Health

Accessing mental health support through Medicare can feel confusing, but it’s actually pretty straightforward once you know the basics. Here’s a simple guide to help you understand your options and get the most out of your sessions. And if it still feels overwhelming, we can go through it together in session!

Also, some people like to book an initial appointment first to ask questions about Medicare and referrals. If you don’t have a Mental Health Care Plan (MHCP) yet, you can still book in—just keep in mind that without one, the session won’t be eligible for a rebate.

How Does Medicare Help with Mental Health Support?

Medicare offers rebates that cover part of the cost of psychology sessions. There are different funding options depending on your needs.

The most common is a Mental Health Care Plan (MHCP), which you can get from your GP. With an MHCP, you’re eligible for up to 10 Medicare-rebated sessions per year with a psychologist.

How to Get a Mental Health Care Plan (MHCP)

1. Book a GP appointment. Let your doctor’s clinic know you’d like to discuss a Mental Health Care Plan so they can allow enough time.

2. Discuss your concerns. Your GP will assess whether an MHCP is suitable based on your mental health needs.

3. Receive a referral. Your GP will write a care plan and provide a referral letter. Even if a psychologist is named on the referral, you can see any psychologist you would like.

4. Book a psychology appointment. Make sure the psychologist offers Medicare rebates.

5. Review after your first six sessions. Medicare covers six sessions initially, then you’ll need a GP review before accessing four more sessions for the total allowed of 10 sessions per year. I’ll remind you when the time comes!

Key Things to Know About Medicare Rebates

• You can claim rebates for sessions dated on or after your referral date. For example, if your referral letter is dated February 3rd, you can claim rebates for any psychology appointments on or after February 3rd.

• Your referral doesn’t expire, but the 10-session cap resets every January 1st. If you don’t use all 10 sessions in a year, they don’t roll over, but the amount of sessions allocated on your referral does.

• GPs can only provide referrals in blocks of 6 and 4. Unfortunately you can't get all 10 sessions allocated at once. It's designed this way to have continued support from your GP but I get that it's frustrating and costly to have to go back to your GP!

• I send a brief letter to your GP as part of Medicare compliance for every referral that they give.

Medicare Complex Neurodevelopmental Disorders and Disability (Under 25 Years Old)

This funding option is specifically for individuals under 25 who have complex conditions needing support across multiple areas. It requires a referral from a paediatrician or psychiatrist and covers conditions such as Autism, ADHD, learning disabilities, intellectual disabilities, and other significant conditions like sight impairment, hearing loss, FASD, cerebral palsy, Down syndrome, and Rett syndrome.

• 20 sessions per lifetime (10 initially, then another 10 after a review with the referrer).

• Available to help manage the complexity of these conditions, ensuring you receive comprehensive support.

Medicare Chronic Disease Management (CDM)

This option is for individuals with chronic or terminal medical conditions lasting six months or more. If you are managing a long-term health condition that affects your overall well-being, this might be the right option for you.

• Covers up to 5 Medicare-funded sessions per year.

• Can be used for multiple healthcare professionals, not just psychologists. You can also claim for physiotherapists, dietitians, osteopaths, etc.

For the latest updates, check the Australian Government’s Medicare website.

Download the below PDF as a quick overview to take with you to your GP appointment.

Medicare overview GP.pdf

Download PDF • 482KB

Other Ways to Get Funding for Psychology

Private Health Insurance Rebates

Some private health insurance policies cover psychology under extras. Things to check with your provider:

• Does your policy cover psychology? Some offer a set number of sessions or a percentage rebate.

• How much is the rebate per session? It varies depending on your provider and level of cover.

• Can you claim both Medicare and private health? Usually, you can’t claim both for the same session. However, private insurance may cover additional sessions after you’ve used your 10 Medicare-rebated ones. Always check with your provider.

NDIS (National Disability Insurance Scheme)

If you have a diagnosed disability (including Autism or ADHD), you may qualify for NDIS funding for psychological support.

This is a whole process in itself and outside the space of this article but feel free to ask me about it in session or have a look on the NDIS website for more information.

I know that navigating the funding options through Medicare can be confusing, but once you understand the steps, it becomes much easier to access the support you need. If you ever feel uncertain about the process or need assistance, don’t hesitate to ask—I’m happy to help clarify things for you. Your journey to better mental health is personal, and I’m here to support you in whatever way I can.