Mental health plans: the basics

We all struggle with emotional challenges from time to time and when things start to feel overwhelming, a little bit of help can go a long way in getting us back to feeling ourselves again. Fortunately, emotional and psychological support is readily available to those experiencing mental illness, including depression and anxiety, thanks to the mental health plan provided by the Australian Government through Medicare.

The Medicare mental health plan (which is drawn up between you as a patient and your GP, psychiatrist or paediatrician) entitles you, the patient, to Medicare rebates for up to 10 individual psychological appointments and 10 group allied mental health services per calendar year (until the end of 2022, people experiencing severe or ongoing mental health issues due to COVID-19 may be eligible for an additional 10 sessions).

Officially called the Mental Health Treatment Plan, a Medicare mental health plan is designed to support and provide ongoing care for someone experiencing mental health issues. “It’s meant to state your diagnosis (and maybe symptoms) and your plans and goals for therapy,” explains Dr Hamish Black, nib Group Medical Advisor.

As everyone has individual healthcare needs, each person’s mental health plan may look a little different, and may involve support from varied sources, including GPs, psychologists and psychiatrists, psychiatric nurses, social workers, occupational therapists and other carers.

However, it’s important to note that you can’t get all the sessions in one go. After an initial six appointments, you’ll revisit the plan with your GP to determine whether you need additional sessions.

When it comes to mental health care plan eligibility, the service is available to people who have been diagnosed with a mental health disorder by a doctor. Beyond that, “anyone who is Medicare eligible and who has not already used the maximum number of therapy sessions that calendar year (usually 10 sessions per calendar year but currently 20 sessions until the year end due to the pandemic) [is eligible],” says Hamish.

When your mental health is taking a hit, reaching out for help can feel difficult, but thankfully, getting a Mental Health Treatment Plan is a streamlined and fairly simple process. The first step is to book a visit with your GP, letting them know you’d like to discuss a mental health plan when you make the appointment.

During your appointment, your doctor will assess whether you have a mental health disorder (including conditions such as anxiety and depression) and help you determine the best treatment options. They may recommend other services and professionals (such as a psychologist) and could help you set treatment goals.

Do I need a referral to get a mental health plan?

You don’t need a referral to speak to your regular GP about a mental health plan, however, your GP may give you a referral to an expert as a part of your Mental Health Treatment Plan.

What is the cost of a mental health plan?

The 10 psychology sessions Medicare offers are free, however, there may potentially be costs involved. “Drawing up the plan may be free if your doctor bulk bills,” says Hamish. “Otherwise, the price is the gap between what Medicare will pay and what your doctor is charging. Similarly, there is usually a gap between what your psychologist will charge and what Medicare will reimburse.”

Medicare may rebate some of the costs for specialist appointments, and if you have an appropriate level of private health insurance, you may be able to claim benefits towards the cost of consultations with a psychologist outside of the 10 annual visits that your Mental Health Treatment Plan covers. Unfortunately, private health insurance cannot cover any gap where the consultation is eligible for a Medicare rebate. The best idea is to check with your health insurance provider to find out if you are eligible for rebates.

Are you an nib member? At nib, we understand the importance of mental health and wellbeing. We provide a range of Extras cover options with psychology inclusions. Find a cover that's right for you.

Related: 6 ways to get help for mental health – without having to pay a thing

Getting help

If you or someone you know needs help, please call:

• Lifeline 13 11 14

• Beyond Blue 1300 22 4636

• Kids Helpline 1800 55 1800

Please note: The tips throughout this article serve as broad information and should not replace any advice you have been given by your medical practitioner.