Under Medicare’s Chronic Disease Management Plan (CDM), you could be claiming 85% of the Medicare-recommended fee for GP recommended services as a rebate. The Medicare rebate for CDM allied health services is currently set at $52.95.
The Medicare system can be confusing at times but having an understanding of how and where you can claim can be a real saver.
Read more about the changes to Medicare from July 1
Medicare provides benefits for clinically appropriate, privately rendered medical services listed in the Medicare Benefits Schedule (MBS).
MBS services provided in-hospital are eligible for benefits equal to 75% of the Medicare fee; out-of-hospital services are eligible for benefits equal to 85% of the fee.
Under the Chronic Disease Management system, you can not only claim GP services, but you could be eligible for CDM allied health services, which include exercise physiology; dietetics; occupational therapy, podiatry and psychology.
There is no official list classifying what diseases CDM covers, though the Department of human services explains examples are:
asthma
cancer
cardiovascular disease
diabetes mellitus
musculoskeletal conditions, and
stroke
If you have had a chronic medical condition for at least six months or it’s terminal, you and your GP can agree to a Chronic Disease Management Plan.
Treatments can include the following allied health services:
1. Exercise physiology
2. Podiatry
3. Psychological treatment
4. Dietetics
5. IVF
6.Weight-loss surgery
7.Occupational therapy
A spokeswoman for the Federal Department of Health told Now To Love a little bit more about how it all works.
“The decision as to whether or not to refer a CDM patient should be referred for allied health services is a matter for the patient’s GP, based on his or her clinical assessment of the patient’s health care needs,” they explained.
It is important to note, that although the Government sets the value for Medicare services, it has no authority to control the amount that allied health providers actually charge for their services.
“Patients may, therefore, have to pay out-of-pocket costs for their CDM allied health services. “
Medicare safety nets
“The Government currently assists patients with their out-of-pocket costs through a number of Medicare safety nets,” the spokeswoman told Now to Love.
“The most significant is the extended Medicare safety net (EMSN). “
“Once the relevant annual threshold of out-of-pocket costs has been met, Medicare will pay for 80% of any future out-of-pocket costs for out-of-hospital Medicare services for the remainder of the calendar year. However, there is an upper limit on the amount of benefit that can be paid under the EMSN for a small number of Medicare services.”
“The EMSN is not claimed per se but calculated by the Department of Human Services (DHS) which keeps a tally of individuals’ out-of-pocket expenses, and determines who is eligible for additional benefits under the safety net. The 2017 EMSN thresholds are: $656.30 for concession cardholders (pensioners, health care persons and seniors) and entitled Family Tax Benefit (FTB) Part A families, and $2,056.30 for non-concessional singles and all other families.”
Medicare covering IVF
“Medicare benefits are available for a range of assisted reproductive technologies (ART) listed on the MBS, including in vitro fertilisation (IVF),” spokeswoman for the Federal Department of Health.
“Most Medicare funded ART services would attract safety net benefits, however, EMSN benefits caps apply. An EMSN benefit cap is the maximum amount of EMSN benefits payable for an MBS item regardless of the fee charged by the doctor.”
Find out more
You can find out more about the services mentioned by clicking below
A complete list of MBS items and fees
More information about Medicare safety nets
More information about the CDM items
