In a world with rising interest costs and soaring fuel prices, Medicare plays a vital role in helping people receive the medical attention they need without breaking the bank. However, knowing if Medicare covers more specialised health services, such as physiotherapy, can be tricky for many Australians.
In this blog, we’ll confirm physiotherapy services that Medicare covers and what makes a person eligible to receive these benefits.
What is physiotherapy?
Physiotherapy is a crucial healthcare service and form of rehabilitation therapy that helps individuals improve mobility, recover from injuries, manage chronic conditions, and improve their overall physical well-being.
Physiotherapists, often called physios or physical therapists, are highly trained allied health professionals who assess, diagnose, and treat musculoskeletal, neurological, and cardiopulmonary conditions. They use manual techniques, therapeutic exercises, modalities (heat, cold, ultrasound), and patient education to help individuals regain or optimise their physical function.
But what about the financial aspect? What exactly does Medicare cover when it comes to physiotherapy?
Does Medicare cover physiotherapy?
Yes, Medicare covers physiotherapy. However there is a strict eligibility criteria you must meet to receive these benefits.
1. Confirm your Medicare enrolment
To receive Medicare benefits, you must have a valid Medicare card. To apply, you must live in Australia and be at least one of these:
- an Australian citizen
- a New Zealand citizen
- an Australian permanent resident
- applying for permanent residency
- a temporary resident covered by a ministerial order
Additionally, individuals who are citizens or permanent residents of the following territories are also eligible to enrol:
- Norfolk Island
- Cocos (Keeling) Islands
- Christmas Island
- Lord Howe Island
2. Meet the Medicare physiotherapy criteria
You may qualify for Medicare physiotherapy treatment coverage through the Medicare Benefits Schedule if you meet the following criteria:
- You have a chronic medical condition (long-term physical condition e.g. arthritis or osteoporosis, which can cause people ongoing and frustrating joint pain).
- You have complex care* requirements, and a medical professional is coordinating your care as part of a shared care plan or under a GP Management Plan and Team Care Arrangement.
*“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 2 other health or care providers”.
3. Receive a referral from your GP
To qualify for Medicare physiotherapy benefits, you must be referred to an eligible allied
health professional by a General Practitioner (GP) or medical practitioner.
Patients can receive a maximum of five physiotherapy sessions in a calendar year. The specific number of sessions you receive is determined by your GP, who will assess your condition and treatment requirements to determine the appropriate number of sessions needed to address your healthcare needs.
You must present the referral form to an eligible allied health professional during your initial consultation unless the GP or medical practitioner has previously forwarded it directly to the allied health professional.
Eligible allied health professionals include:
- Aboriginal and Torres Strait Islander health practitioners
- Aboriginal health workers
- Diabetes educators
- Exercise physiologists
- Mental health workers
- Occupational therapists
- Speech pathologists
4. Attend an eligible Medicare physiotherapy clinic
It’s important to note that not all physiotherapy clinics will accept Medicare referrals. It’s best to contact the clinic beforehand and ask about their acceptance of Medicare referrals before scheduling an appointment. This proactive step can help you avoid paying the full fee for your physiotherapy services.
Remember to take your Medicare card and referral to your appointment so you can receive your benefits!
Is there a gap fee?
The Medicare rebate may not always cover the entire cost of a physiotherapy consultation. You may need to pay an out-of-pocket fee referred to as ‘the gap’. This fee compensates for the time and expertise of the allied health professional, as the amount covered by the Care Plan is typically less than the standard charge for these sessions.
The gap fee can vary depending on the choice of practitioner, as senior physiotherapists often have higher prices. However, this fee may be lowered or waived if you have a Pension card.
Make an appointment with our physiotherapist today!
Experience excellent physiotherapy care paired with five-star customer service at MPhysio. Our innovative Optimal Health4Life Plan offers a structured method to identify the real cause of your pain and condition. Regain your health and well-being today.