Medicare Care Plans
About Medicare Care Plans
Medicare care plans, most commonly a Chronic Disease Management plan or a GP Mental Health Treatment Plan, let a GP refer a patient for a set number of Medicare-rebated allied health sessions each calendar year. These can be physiotherapy, psychology, podiatry or dietetics, relevant to the condition.
The plan is set up with a GP, who decides whether the person meets the criteria and prepares the plan and referral. The patient then books an eligible allied health provider and claims the Medicare rebate. It is a Medicare pathway, separate from the NDIS, aged care or DVA. A GP is the starting point for setting one up or finding out whether someone qualifies.
At a glance
- A GP sets up the plan and the referral.
- A set number of rebated allied health sessions each year.
- Examples: physiotherapy, psychology, podiatry, dietetics.
- Separate from the NDIS, aged care and DVA.
This is general information, not financial or funding advice. Program names, amounts and eligibility rules change over time. Always confirm current detail with the relevant official body before relying on it.
How to prepare before arranging support
- Book a GP appointment and ask whether you meet the criteria.
- Ask the GP to prepare the plan and the referral.
- Book an eligible allied health provider, such as for physiotherapy, psychology, podiatry or dietetics.
- Claim the Medicare rebate for the sessions.
Information and records to have ready
- Policy, membership or claim details
- Referral, approval or case-manager correspondence
- Written quote and explanation of likely gaps
- Invoices, receipts and benefit statements
Questions to ask a provider
- Do you bill this scheme directly, or must the person pay and claim?
- Is a referral, approval number or case-manager authority required?
- What is the total fee and likely out-of-pocket amount?
- Are there annual limits, waiting periods, approved-provider rules or session caps?
- What happens if the claim is delayed, reduced or declined?
Common mistakes to avoid
- Assuming a service is covered because it was covered before
- Confusing a rebate with full payment
- Starting before required written approval
- Failing to check annual limits, waiting periods or provider eligibility
Frequently asked questions
Who sets up a Medicare care plan?
A GP, who decides whether you meet the criteria and prepares the plan and referral. You then book an eligible allied health provider and claim the Medicare rebate.
Who can confirm what Medicare Care Plans means for me?
Ask the responsible insurer, scheme or program. A provider can explain its services and billing, but it cannot make a binding funding decision for the responsible body.
Does a provider listing prove it accepts medicare care plans?
No. A directory or public-register listing describes a provider and the supports it lists. Confirm the funding arrangement, approval and current availability with the provider before booking.
What if the rules or my circumstances change?
Check the current guidance with the responsible insurer, scheme or program, tell your providers promptly and update written agreements or approvals before relying on the changed arrangement.
Official sources
Other Other Funding topics
Browse providers or explore other funding topics.
Helpful reading
- NDIS jargon explained: the terms you will hear and what they mean: Plans, supports, coordinators, managers, registered providers: a plain-language glossary of the words that come up most often.
- NDIS or My Aged Care: which system supports you?: Two government systems support people with disability and older people. Here is how to think about which one applies and what to do if you are not sure.
- Keeping records of your NDIS supports: a simple system: Good records make plan reviews, claim queries and changes of provider far easier. Here is a light-touch way to keep them.