Editing Medicare (Australia) (section)

=== Private hospital and allied health services ===
All patients that are eligible for Medicare are also eligible for state and territory public hospital services, which are typically free for most patients and funded under an agreement between the federal government and state and territory governments called the [[National Health Reform Agreement]].

Patients in public hospitals that elect to be treated as private patients and patients in private hospitals will have some costs charged by doctors covered at the admitted patient rate (currently 75% of the schedule fee). Hospital costs not listed on the MBS, or where the cost is greater than the Medicare benefit, can be paid by private health insurance or by the patient.<ref>{{Cite web |date=22 January 2024 |title=Medicare costs |url=https://www.health.gov.au/topics/medicare/about/costs#hospital-costs |access-date=8 June 2024 |website=[[Department of Health and Aged Care]] |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071157/https://www.health.gov.au/topics/medicare/about/costs#hospital-costs |url-status=live }}</ref> For MBS listed services provided to hospital inpatients, where the patient also holds private health insurance for that service, the private health insurer must contribute at least the remaining 25% of the schedule free. If a doctor chooses to charge more than the schedule fee, the private health insurer may contribute towards the gap depending on the insurance policy.<ref>{{Cite web |date=5 March 2024 |title=Out of pocket costs |url=https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs?language=und#costs-for-inhospital-services |access-date=8 June 2024 |website=[[Department of Health and Aged Care]] |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071158/https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs?language=und#costs-for-inhospital-services |url-status=live }}</ref>

Some allied health rebates are limited to patients with a chronic disease where the GP has initiated a General Practitioner Management Plan, Team Care Arrangements, a Mental Health Case Conference, or is related to a specific disease or diagnosis. Referrals made for conditions covered by one of these may attract Medicare benefits where the service would otherwise not be eligible.<ref>{{Cite web |date=3 January 2024 |title=Chronic disease GP Management Plans and Team Care Arrangements |url=https://www.servicesaustralia.gov.au/chronic-disease-gp-management-plans-and-team-care-arrangements |access-date=8 June 2024 |website=[[Services Australia]] |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071158/https://www.servicesaustralia.gov.au/chronic-disease-gp-management-plans-and-team-care-arrangements |url-status=live }}</ref> These include services such as physiotherapy, [[podiatry]] and audiology. Optometry services can be provided without referral, while dentistry is not covered at all.<ref>{{Cite web |title=Education guide – Chronic disease individual allied health services Medicare items 10950-10970 – Australian Government Department of Human Services |url=https://www.humanservices.gov.au/organisations/health-professionals/topics/education-guide-chronic-disease-individual-allied-health-services-medicare-items-10950-10970/33196 |access-date=2019-11-27 |website=humanservices.gov.au}}{{Dead link|date=November 2023|bot=InternetArchiveBot|fix-attempted=yes}}</ref> Where the service is not covered by Medicare, private health insurance policies may provide an "extras" or ancillary benefit (typically up to an annual cap) towards these costs.<ref>{{Cite web |title=Private health insurance |url=https://ahpa.com.au/advocacy-priorities/private-health-insurance/ |access-date=8 June 2024 |website=Allied Health Professions Australia |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071158/https://ahpa.com.au/advocacy-priorities/private-health-insurance/ |url-status=live }}</ref>

For patients receiving [[Mental health in Australia|mental health]] care, Medicare provides up to 10 fully covered individual and group counselling sessions per year as part of the [[Better Access Scheme]]. To access these, a general practitioner, in collaboration with the patient, needs to issue a "mental health care plan" outlining the diagnosed mental health condition, treatment and support options, and goals of care.<ref>{{Cite web |date=August 2019 |title=Mental health care plan |url=https://www.healthdirect.gov.au/mental-health-care-plan |access-date=4 December 2019 |website=Healthdirect Australia |archive-date=30 December 2019 |archive-url=https://web.archive.org/web/20191230213003/https://www.healthdirect.gov.au/mental-health-care-plan |url-status=live }}</ref> The [[Better Access Scheme]] also covers the cost of other mental health supports, including care from related professions such as occupational therapists, social workers, general practitioners and psychiatrists.<ref>{{Citation |last=Australian Government Department of Health |first=Health Services Division |title=Better access to mental health care: fact sheet for patients |url=https://www1.health.gov.au/internet/main/publishing.nsf/Content/mental-ba-fact-pat |access-date=2019-12-04 |publisher=Australian Government Department of Health |language=en |archive-date=4 December 2019 |archive-url=https://web.archive.org/web/20191204060124/https://www1.health.gov.au/internet/main/publishing.nsf/Content/mental-ba-fact-pat |url-status=live }}</ref>