What is an EPC Plan (Medicare)?
An Enhanced Primary Care Plan, or EPC for short, is a treatment plan that your doctor can create for you, helping you access various treatment options through Medicare. It is now known as a Chronic Disease Management (CDM) plan[1].
There are numerous services available under an EPC or CDM, including:
How to qualify for an EPC Plan?
The first step would be to see your local GP who will assess you, and provide you with a referral if you meet the criteria.
To qualify for an EPC or CDM plan, your doctor must deem that you’re suffering from a chronic health condition that would benefit from both their input as a GP, as well as another allied health service (e.g. physiotherapy). Read about the difference between acute vs chronic pain.
According to the Department of Health and Aged Care of Australia, "To be eligible for any of the CDM items, a patient must have a chronic or terminal medical condition. This is one that has been or is likely to be present for six months or longer and includes but is not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, musculoskeletal conditions and stroke."[1]
Common conditions that are covered by Medicare (EPC Plan)
How do I claim the Medicare rebate?
Each physiotherapy clinic has a slightly different process, but you should be able to claim the rebate on the spot at your preferred clinic. Ensure that you bring your EPC or CDM referral with you, as well as your Medicare card and preferred payment method.
Medicare Rebates for Physiotherapy
The Medicare rebate given is a fixed amount of $56.00 per session for physiotherapy. (This rebate is current as of July 1st 2022.)
This is well below the standard rate for a treatment session for most physio practices across Australia, with the majority charging between $95-110 per session. This would leave you with a gap payment for each session of physiotherapy.
| Appointment Fee | Medicare Rebate | Gap payment |
|---|
| $95 | $56.00 | $39.00 |
| $100 | $56.00 | $44.00 |
| $105 | $56.00 | $49.00 |
| $110 | $56.00 | $54.00 |
Do all physiotherapists accept EPC Plans?
Yes, all physiotherapists do accept EPC Plans. The physiotherapist you see will have to accept the team care arrangement and contact your doctor to let them know. Once your GP has created the CDM you will be able to take that to your local physiotherapist immediately.
Can I use my health fund and an EPC Plan at the same time?
Unfortunately, you cannot use your EPC plan and health fund at the same time. Medicare will not allow a private health insurance claim to be used simultaneously as an EPC Plan. You have to use either one or the other.
The good news is if you get an EPC Plan, you can save your extras cover for later in the year!
