Mental health care plans – what are they? How many sessions do they cover?

What is a mental health care plan?

As part of the Federal Government initiative Better Access, a mental health care plan is provided by a General Practitioner (GP) to a person diagnosed with a mental health condition. It outlines what you and your doctor are aiming to achieve in treating your condition, as well as the steps to get there. It may suggest assistance from psychologists, psychiatrists, social workers and occupational therapists, including up to ten individual or group sessions that are eligible for a Medicare rebate. Currently, there is a limit of one mental health care plan per patient per calendar year.

There is also a Medicare Benefits Scheme (MBS) Eating Disorders Treatment Pathway, which specifically supports people suffering from an eating disorder to access mental health treatment and dietetic services.

Who is eligible to receive a mental health care plan?

You’re eligible to receive a mental health care plan if you’re a Medicare card holder and have been diagnosed with a mental health condition by your GP.

How can I get a mental health care plan?

You will need to visit your GP of choice, who will discuss your symptoms and formally assess whether you have a mental health condition. This assessment will usually involve a questionnaire to fill out, and potentially create a mental health care plan for you. It can take longer than a regular consultation, so Queensland Health suggests booking a longer appointment.

Your GP will ask you about the symptoms you’re experiencing and about how you have been feeling, which can help them make an appropriate diagnosis before designing a personalised mental health care plan. Your doctor may outline their suggested treatments, including a referral to an allied mental health professional, who may be either recommended by them or someone of your choice.

What does a mental health care plan cover?

If you have a mental health care plan, you’re entitled to a Medicare rebate on up to 10 individual or group sessions with certain mental health specialists.
Specialists do set their own fees however, which means there could be a gap between the cost of the sessions and what Medicare covers. If you require prescription medication, it may be subsidised through the Pharmaceutical Benefits Scheme (PBS) rather than your mental health care plan.

How long does a mental health care plan last?

The mental health care plan will cover up to ten sessions in a calendar year. If you need more than the ten allocated sessions in a calendar year, you may be able to claim for the extra sessions using private health insurance, if you have cover and a policy that provides this service. Your GP can prepare another mental health care plan for you in the next calendar year if they believe it would be helpful.

Will I have any out-of-pocket expenses with a mental health care plan?

While a mental health care plan allows you to claim Medicare rebates for up to ten sessions, specialists set their own fees, so it’s important to check the cost of these services and the Medicare benefit available before making an appointment. This will give you a better idea of whether a gap payment will be required and how much it will be.

It’s also important to note that if your GP doesn’t bulk bill, you may be required to pay all or a portion of the costs associated with seeing them as well.

Will having a mental health care plan impact my insurance premiums?

While having a mental health care plan won’t necessarily lead to an increase in your insurance premiums, it’s still a good idea to check with your insurance providers, including health, life, income protection and travel insurance, regarding any potential impacts. According to Maurice Blackburn Lawyers, insurers may impose broad exclusions on your insurance policies for any mental health related condition. Insurers also determine premiums based on certain risk factors and if you are perceived to be more likely to make a mental health related claim they may price their policies with this in mind.

That being said, it’s important to disclose your mental health condition with your insurer when required. If you’re dishonest with your insurer, your claims may be denied and your policy could be voided.

If you or someone you know needs support, call Lifeline on 13 11 14 or BeyondBlue on 1300 22 4636. If it is an emergency, call 000.