Medicare is the national health insurance system in Australia. It ensures that healthcare is affordable for all Australian residents. Medicare covers a wide range of services, including GP visits, hospital treatments, and certain allied health services like physiotherapy. However, to access physiotherapy services through Medicare, certain conditions must be met. You’ll need a referral from a GP, and it must be for specific health issues, such as chronic pain or post-surgical rehabilitation.
Medicare works in partnership with private health insurers to provide comprehensive coverage for Australians. However, to access Medicare rebates for physiotherapy services, certain criteria must be met, including a valid EPC plan or CDM plan from your GP.
Medicare Plans and Physiotherapy: How Does it Work?
Medicare offers rebates for physiotherapy under two main plans:
- Enhanced Primary Care (EPC) Plan:
The EPC plan provides access to physiotherapy for patients with chronic conditions. This plan covers up to 5 physiotherapy sessions per year for eligible patients. Chronic conditions encompass issues such as back pain, arthritis, or sports injuries that necessitate ongoing management. Under this plan, your GP will refer you to a Medicare-approved physiotherapist. - Chronic Disease Management (CDM) Plan:
The CDM plan is similar to the EPC plan but specifically designed for managing chronic diseases. It also allows for up to 5 physiotherapy sessions per year. The key difference is that the CDM plan is geared more towards patients with long-term health issues that require ongoing care. Your GP will need to assess and refer you for this plan.
Both plans require a referral from your GP. Once your GP assesses your condition and confirms that physiotherapy is necessary, they will provide a referral under the EPC or CDM plan, allowing you to access medicare rebates for physiotherapy.
How Does Invigor Health Assist with Insurance Claims for Physiotherapy?
At Invigor Health, we make it easy for you to access Medicare-funded physiotherapy services. Here’s how we support you:
- Instant Medicare Claims: If you have an EPC plan, we can process Medicare rebates immediately through HICAPS. You won’t need to pay up front, making it convenient for you.
- Private Health Insurance: If you have private health insurance, we also accept all major insurers. You can use it to cover additional physiotherapy sessions beyond the Medicare limit.
- Telehealth Physiotherapy: For those unable to visit in person, we offer Telehealth physiotherapy consultations. These are also eligible for Medicare rebates, making it easier for you to get the care you need, no matter where you are.
At Invigor Health Bondi Junction & Maroubra, we ensure a seamless experience for Medicare claims, whether you need in-person physio or Telehealth consultations. By utilizing HICAPS, we simplify the claims process, allowing you to focus on your recovery instead of paperwork.
Eligibility for Physiotherapy Services Under Medicare
Not everyone automatically qualifies for Medicare-funded physiotherapy. Here’s how you can ensure you’re eligible:
Eligibility Criteria:
- Chronic Conditions: You must have a chronic medical condition (e.g., osteoarthritis, back pain, or tendonitis). If your condition requires long-term management or rehabilitation, you may be eligible.
- Referral from Your GP: To access Medicare rebates, your GP must refer you and outline the need for physiotherapy in your EPC or CDM plan.
- Medicare-Approved Physiotherapists: The physiotherapist you choose must be Medicare-approved to claim your rebates. At Invigor Health, our physiotherapists are fully accredited and registered with Medicare, ensuring you receive the appropriate rebates for your treatments.
Once you have your EPC plan or CDM plan in place, you can access up to 5 physiotherapy sessions per year. Additional sessions can be covered through private health insurance.
Does Private Health Insurance Cover Physiotherapy?
While Medicare provides coverage for a limited number of physiotherapy sessions, private health insurance can offer additional benefits. Here’s how it compares:
Private Health Insurance:
- Additional Sessions: If you need more than 5 sessions in a year, your private health insurance can help cover the extra costs.
- Supplementing Medicare: Use Medicare for the first 5 sessions under your EPC plan, then continue treatment with your private health insurance coverage for more sessions.
At Invigor Health, we accept all major private health insurance providers and help you process claims quickly and easily, reducing your out-of-pocket costs. You can use private health insurance to cover ongoing physiotherapy sessions after your Medicare-funded sessions are used up.
Frequently Asked Questions
Is Physio Covered by Medicare?
Yes, physio services are covered by Medicare for eligible patients under certain conditions. Physiotherapy isn’t entirely free under Medicare. However, Medicare rebates can significantly reduce the cost, especially if you’re eligible for an EPC plan.
How Many Physical Therapy Sessions Does Medicare Cover?
Medicare covers up to 5 physiotherapy sessions per year under the EPC plan for patients with chronic conditions. You can access additional sessions through private health insurance.
Do I Need a Referral for Physiotherapy Under Medicare?
Yes, a GP referral is required for Medicare-funded physiotherapy under the EPC or CDM plan. Without a referral, you won’t be able to access the Medicare rebates.
Can I Access Physiotherapy Online via Medicare?
Yes, Telehealth physiotherapy is available and eligible for Medicare rebates in some cases, particularly for patients with chronic conditions who are unable to attend in person.
How Can Physiotherapy Help with Chronic Pain and Rehabilitation?
Physiotherapy is a proven method for chronic pain management and post-surgical rehabilitation. At Invigor Health, we use evidence-based treatments to help you recover quickly and maintain long-term mobility. Some benefits include:
- Pain Relief: Through hands-on therapy and exercise-based treatment.
- Improved Mobility: Post-surgical rehabilitation helps you regain movement after surgeries like knee or hip replacements.
- Injury Prevention: Physiotherapy addresses the root causes of pain, reducing the risk of future injuries.
Whether you’re dealing with chronic pain, recovering from surgery, or preventing injury, physiotherapy at Invigor Health will get you back on track to a pain-free life. Our physiotherapists provide personalized, hands-on treatments to ensure long-lasting results.
Get Started with Invigor Health’s Physiotherapy Services Today
If you’re eligible for Medicare-funded physiotherapy, now is the time to start your recovery journey. Whether you need help with chronic pain, sports injuries, or post-surgical rehabilitation, Invigor Health is here to help.
We offer Medicare rebates through EPC plans and accept private health insurance for additional coverage. Our Telehealth physiotherapy services ensure you can access expert care no matter where you are
Contact Invigor Health today to book your appointment and see how we can help you access the physiotherapy services under Medicare or private health insurance.
