NDIS and funding - adults

Medicare and other options

Mental Health Care - Medicare

When experiencing emotional and mental health concerns that do not require emergency help, seeing your doctor is the best way to assess what level of supports and services you may need.

When you see your doctor, they’ll assess what help you need. This could include:

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Making a mental health assessment
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Creating a mental health treatment plan
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Referring you to a psychiatrist, psychologist or other mental health professional
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Giving you a prescription for medicines

Your doctor might ask you some personal questions to understand your situation. Sometimes it can be hard to talk to others about your mental health. You can read tips for talking to your doctor about mental health on the Healthdirect website.

If your doctor bulk bills, Medicare covers the cost of the appointment. If your doctor doesn’t bulk bill, you’ll need to pay either:

  • the full cost
  • the difference between what they charge and what Medicare covers

If you pay the full cost, you can make a claim for the amount Medicare covers. Your doctor can also make a direct claim on your behalf.

Medicare rebates for diagnosis of autism (Complex neurodevelopmental disorder and eligible disability)

Medicare MBS items are available for diagnosing and treating patients with an eligible disability. Patients with both an eligible disability, or complex neurodevelopmental disorder (such as autism spectrum disorder) can access MBS services associated with these programs. When creating a treatment and management plan you should consider both conditions.

The patient must be under 25 years of age to have:

  • allied health MBS items for assistance in diagnosing the patient or contributing to a treatment plan
  • a treatment and management plan prepared by a specialist, consultant physician or general practitioner.

The patient must be under 25 years of age to have allied health MBS items for treatment services.

See more at Services Australia

Mental Health Treatment Plan

A mental health treatment plan lets you claim up to 10 sessions with a mental health professional each calendar year.

To start with, your doctor or psychiatrist will refer you for up to 6 sessions at a time. If you need more, they can refer you for further sessions. Health professionals set their own fees, so Medicare may only cover some of the cost. Ask how much you’ll pay and what you’ll get back from Medicare when you make your appointment. If they bulk bill, you won’t have to pay anything. If you have private health insurance, you may be able to get some money back. You can check with your insurer.

Rural and Remote Services

If you live in a remote area, it might be hard to see a mental health professional. You may be able to have a telehealth video consultation instead. You can claim for video consultation sessions with a mental health professional.

Ask your GP or mental health professional if they offer this service.

More information on rural and remote Medicare services:

More information on telehealth:

Private Health Cover

Private health insurance can assist with some of the costs related to health services you access. Each private health fund is different in what they charge and is also dependent on what level of services you want. For example, there can be bronze, silver and gold levels of insurance and these can be just for extras and/or hospital cover. Each level will cover a certain amount of the fee and/or will have an overall limit as to how much funding you can use over one year.

It is worthwhile considering how often you will use services that directly support your needs, the costs and compare to how much you will be paying in private health insurance. You may find if you use services infrequently, it may be cheaper in the long term to pay for the service each time you use it.

Disability Support Pension (DSP)

The disability support pension is financial support for when you are unable to work due to a permanent physical, intellectual or psychiatric condition. You have to access this through Centrelink.

There are two rules that you will need to meet:

  • Non-medical rules and
  • Medical rules

Non-medical rules are:

  • Be aged between 16 and the age pension age
  • Meet the Australian residency rules and
  • Meet the income and assets test

Medical rules are:

If you meet all of these rules, you may be able to get DSP.

For more information on accessing the disability support pension:

Helpful resources

Autism: What Next?

The first free digital toolkit - a central hub to help individuals and families navigate the first year following an autism diagnosis.

Visit here