Health care costs can add up really quickly. In Australia, we can often receive Medicare rebates to reduce the burden of costs. With musculoskeletal pain being a common issue, lots of people are often left wondering if certain services such as physio are covered by Medicare.
In this post, we’ll put in simple terms of how and when physio is covered by Medicare to help you get on the path of recovery.
Is physiotherapy covered by Medicare?
Short answer – Yes.
Physiotherapy appointments can be covered by Medicare if you meet the eligibility criteria.
Follow the steps below to find out if you are eligible and what you need to do to receive the Medicare benefits.
1. Make sure you are enrolled in Medicare
You must have a Medicare card to accept Medicare benefits. If you do not have a Medicare card, you can apply via this link.
Note: You are only eligible for Medicare if you live in Australia and you’re any of these:
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an Australian citizen
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a New Zealand citizen
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an Australian permanent resident
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applying for permanent residency
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a temporary resident covered by a ministerial order.
You can also enroll if you’re a citizen or permanent resident of any of these:
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Norfolk Island
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Cocos (Keeling) Islands
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Christmas Island
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Lord Howe Island.
2. Meet the eligibility criteria
You can be eligible to receive physiotherapy treatment under the Medicare Benefits Schedule if you are experiencing:
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A chronic condition, and
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Have complex care needs and are being managed by a medical practitioner under a shared care plan or under a GP Management Plan and Team Care Arrangement.
We’ll briefly cover what both of these mean later in the article.
3. Receive a referral from a medical practitioner (e.g. GP)
To receive a physiotherapy review that is covered by Medicare, you will need a referral from any general medical practitioner and you must meet the eligibility criteria outlined above.
Your doctor will help you determine if your musculoskeletal condition meets the criteria.
4. Attend a clinic which accepts Medicare
Not all physiotherapy clinics will accept Medicare referrals. It is recommended that you call and ask if they accept Medicare referrals prior to making a booking to avoid paying a full fee.
5. Bring your Medicare Card and GP referral documents to the appointment
This will help the receptionist process your referral and payment and avoid the need for you to pay upfront and the hassle of processing a Medicare claim to receive your benefits.
FREQUENTLY ASKED QUESTIONS
You can receive up to 5 physiotherapy sessions in a calendar year. The number of sessions you receive is determined by your GP who assesses how many sessions will be appropriate to meet your treatment needs.
You may be required to pay a gap. This is dependent on the clinic that you are attending. As of 2022, under the Medicare Benefits Schedule, your Medicare rebate will cover you for $56.00. If the clinic charges above that, you will need to pay the difference.
We recommend calling clinics prior to attending your appointment to find out if that particular physio clinic is accepting Medicare referrals and ask up front what the gap is to avoid any expensive surprises when you walk out of the treatment room!
Unfortunately, your physio sessions will not be transferred to the following calendar year. When your physio is covered by Medicare, make sure you attend all your appointments as physiotherapists can often provide you with useful exercises to improve your overall strength and wellbeing and prevent future re-injury.
You can receive up to 5 physiotherapy sessions in a calendar year. The number of sessions you receive is determined by your GP who assesses how many sessions will be appropriate to meet your treatment needs.
A chronic condition is something that has been bothering you long term and involves lasting conditions. A chronic medical condition is considered to be one that has been or is likely to be present for at least six months. Some examples include arthritis or osteoporosis, which can cause people ongoing and frustrating joint pain.
A patient is considered to have complex care needs if they require ongoing care from a multidisciplinary team consisting of their GP or medical practitioner and at least two other health or care providers.
