What is An Enhanced Primary Care Plan (EPC)

Enhanced Primary Care plan helps you access support services

Enhanced Primary Care plan helps you access support services

As a general rule Medicare refunds do not cover services like physiotherapy. However there is an exception that you might find useful when you get to the end of what your private plan cover or your child needs more than a weekly hospital session.

The Medicare allied health and dental care initiative allows chronically ill children and teenagers who are being managed by their GP under an Enhanced Primary Care (EPC) plan access to Medicare rebates for allied health services.

This means that you can get financial assistance from Medicare once your doctor sets up an Enhanced Care Plan for your child.  Your GP must believe the additional services are clinically necessary.

The list of allied health services you can claim includes psysiotherapists, psychologists and dental services. To view or print a A4 brochure that sets who is eligible and what services can be accessed visit Medicare Rebates for Allied Health Services. This brochure is produced by the Department of Health and Aging.

Once your care plan has been completed and lodged by your GPand approved by Medicare you then have an ECP In place.

As your child requires services you request a referral from your GP for that service and then claim the costs back from Medicare. Your GP will need to approve that the service is necessary for your child’s health.

To give you an example of what might be covered by the plan Medicare will refund approximately 85% of the cost of :

Psychologists 12 visits per year
Psysiotherapy 5 visits per year
Podiarty 5 visits per year

Some providers will bulk bill for their services and accept the government refund as the full fee.  It is worth speaking to individual providers.  Many understand that caring for a child with a chronic condition places extra pressure on family budgets.

If your child has a chronic condition and you need financial assistance with physiotherapy or psychology this might be an option worth exploring next time you visit your GP.

Photo courtesy of g-mikee at Flickr Creative Commons.