Understanding the costs of mental health treatment
Between Medicare, private health insurance and different types of mental health professionals, it can be hard to know how much mental health treatment will cost. The truth is there’s no one-size-fits-all answer, but understanding a few key factors can help you make more informed choices when it comes to accessing mental health support.
In Australia, the cost of mental health treatment depends on several factors, including:
- the type of support or treatment you’re receiving
- who’s providing it, and where
- whether you have a mental health treatment plan
- whether you’re eligible for subsidised services
- whether you have private health insurance with extras cover that includes mental health.
In this article, we’ll explain your treatment options and what they might cost, ways to reduce your out-of-pocket expenses, as well as where to access low or no cost options.
What is a mental health treatment plan?
While the cost of mental health treatment can vary, the first step to getting help is often the same: booking an appointment with your general practitioner (GP).
If your GP has diagnosed you with a mental health condition and thinks you would benefit from mental health support, they may create a mental health treatment plan with you. This plan outlines:
- your mental health goals
- your treatment options and the type of support you need
- referrals to mental health professionals like psychologists, psychiatrists, eligible social workers and eligible occupational therapists through Medicare.
Writing the plan usually takes longer than a standard consult, so it’s a good idea to ask for a longer appointment when booking. Keep in mind that longer GP appointments may cost more.
With a mental health treatment plan, you’ll be eligible for up to 10 Medicare-subsidised sessions with a mental health professional (per calendar year). You’ll initially receive access to six sessions; after that, your GP will need to review your plan before referring you for the remaining four sessions.
Can you see a mental health professional without a mental health treatment plan?
Yes. If you’d prefer not to get a referral, or you’ve already used your Medicare-subsidised sessions, you can still see a psychologist, counsellor or social worker privately.
If you have extras cover that includes mental health services, you may be able to claim part of the cost back through your private health insurance. Medibank members with eligible+ extras can claim benefits for sessions with:
- registered psychologists
- accredited mental health social workers
- Medibank-recognised counsellors.
It’s important to note that you can’t claim both Medicare and private health insurance for the same appointment.
You can also see a psychiatrist, which is partly covered by Medicare. The amount you get back from Medicare won't be affected by whether or not you have a mental health treatment plan.
How much does mental health treatment cost?
If you’re claiming through Medicare
If you’re claiming through Medicare, the amount you get back depends on the type of health professional and the service they provide. For example, if you have a mental health treatment plan and see a clinical psychologist for a 50-minute session (item 80010), and Medicare were to cover about $130^ you’d pay the difference (or gap) between $130 and the fee charged.
Keep in mind that fees vary. For example, a private psychologist may charge more than someone working in a community setting, and your gap fee could increase as a result. Always ask about fees when booking your first session.
If you’re claiming through extras cover
Medibank Extras cover, with mental health services included, can pay benefits towards consultations with a psychologist, Medibank-recognised counsellor or mental health social worker.§ How much you get back will depend on your level of Extras cover and annual limits. Medibank members can log in to My Medibank to check their level of cover and their annual limits.
There's no waiting period to claim for mental health services under eligible Medibank extras cover.
If you’re claiming through hospital cover
Sometimes, in-hospital mental health treatment, such as psychiatric services, may be appropriate. Medibank can help pay towards hospital psychiatric services in a private hospital for Medibank members on selected Silver or Gold hospital cover that includes hospital psychiatric services, and for members who have served their 2-month waiting period. Your cover can pay towards hospital accommodation and any medical costs raised by doctors where a Medicare benefit is payable.
There may be out-of-pocket costs, which depends on the hospital you’re admitted to and what your treating specialists charge. Speak to your treating specialist about what your out-of-pocket costs may be.
We pay limited benefits for Medibank members on Basic, Bronze or selected Silver hospital cover with restricted hospital psychiatric services who have served their 2-month waiting period. This means that if you choose to be treated in a private hospital, the benefits we pay will not cover all hospital costs and you could have to pay significant out-of-pocket expenses. Speak to your treating specialist about what your out-of-pocket costs may be.
How to use the Mental Health Waiver
Eligible members† with hospital cover who have served a waiting period for restricted hospital psychiatric services on Basic, Bronze or Silver Hospital cover can choose to upgrade their hospital cover to a product which includes higher benefits for hospital psychiatric services, and elect to have the 2-month waiting period waived for psychiatric services. This waiver can only be used once in a person's lifetime.
You can also grant authority to another person to make changes to your policy on your behalf.
If you need to discuss using the Mental Health Waiver, contact us on 132 331 or via our 24/7 live chat.
24/7 Medibank Mental Health Support
Medibank health insurance members can chat to a mental health professional about how they feel and ask questions about a range of mental health concerns for themselves or a loved one and get guidance on what they can do next. Chat online or call 1800 644 325 anytime of the day or night, 7 days a week at no extra cost.~
Understanding your mental health medication benefits
In some situations, your doctor may prescribe medication as part of your mental health treatment. Many of these medications are covered under the Pharmaceutical Benefits Scheme (PBS), meaning you don't have to pay full price for them. If your medication is not listed on the PBS, Medibank members with extras cover that includes non-PBS pharmaceuticals may have a benefit payable towards the medication# – check your cover via My Medibank or contact us to find out.
Medibank members with mental health services included in their extras cover may also be eligible for pharmacogenetic (PGx) testing. This testing can help determine the most appropriate medication and dosage for your condition. Please consult your treating physician to see if PGx testing is suitable for you.
Low and no cost options
Phone and online support
In an emergency or if someone’s life is in danger, always call 000.
The following organisations offer free and confidential phone or online counselling:
- 13 YARN is a 24/7 phone counselling support service for Aboriginal and Torres Strait Islander people in need of mental health support. Call 13 92 76.
- Beyond Blue offers 24/7 phone and online counselling for non-emergency mental health support. Call 1300 224 636.
- Headspace offers phone and online counselling for people aged 12–25, plus support for families. Call 1800 650 890 (9am–1am AEST/AEDT).
- Kids Helpline offers free, phone and online counselling for children and young people aged 5–25, available 24/7. Call 1800 551 800.
- Lifeline offers 24/7 crisis support via phone, online and text. Call 13 11 14.
- National Alcohol and Other Drug Hotline provides 24/7 phone support for people struggling with addiction.
- Reach Out offers 1:1 online mental health support for people aged 16–25.
- SANE Australia offers phone support to help you navigate the mental health system. Call 1800 187 263 (Mon–Fri, 10am–8pm AEDT/AEST).
Work or school based support
If you’re employed, ask your employer if they have an Employee Assistance Program (EAP). These often include free, confidential counselling sessions.
Students may have access to free counselling through their school, TAFE or university. Speak to your student wellbeing coordinator to find out.
Community mental health services
Your GP might also be able to refer you to public mental health clinics or programs run through community health centres. You can also contact your local council for services near you.
Online tools and apps
There are also many free online mental health tools and apps that provide support at any time. Many are evidence-based and offer self-guided support. Reach Out keeps a list on its website. Medibank members with hospital cover* can also access the Better Minds app, which includes wellbeing checks, skills-based learning and one-on-one coaching with a mental health professional.
How can we help?
I want to know how my cover supports mental health
I need help and want to talk
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Things you need to know
+ Check your cover summary to see if these services are included on your extras cover and if annual limits apply. Counsellors must be registered with Australian Counselling Association, Psychotherapy and Counselling Federation of Australia, Australian Traditional Medicine Society.
^ Medicare rebates vary depending on the service, provider, and current Medicare Benefits Schedule. The example provided is illustrative only. For the latest rebate information, refer to the Medicare Benefits Schedule or speak with your provider.
§ Annual limits apply. Counsellors must be registered with Australian Counselling Association, Psychotherapy and Counselling Federation of Australia, Australian Traditional Medicine Society.
† To be eligible for the waiver, you need to have held Basic, Bronze or Silver hospital cover without a break for more than 2 months. You can only use the Mental Health Waiver once in your lifetime. The waiver only applies to the 2-month waiting period for the higher included benefits for in-hospital psychiatric services and all other applicable waiting periods will continue to apply.
# Benefits are payable up to a set amount for each prescription pharmaceutical. Before paying any benefits, Medibank will deduct an amount equivalent to the current non concessional PBS co-payment amount. This means that you will be out of pocket for the co-payment amount plus any cost above the set benefit we’ll pay for the pharmaceutical. Where your prescription pharmaceutical costs less than the co-payment amount, we won’t pay any benefits.
~ Some referred services may involve out of pocket costs and waiting periods may apply. The Medibank Mental Health Support service is being delivered by Amplar Health. Amplar Health is a business of Medibank Health Solutions Pty Limited (ABN 99 078 934 791), a member of the Medibank group of companies.
* Not available for members with extras only cover, ambulance only cover, Overseas Student Health Cover or Overseas Workers or Visitors Health Cover.
While we hope you find this information helpful, please note that it is general in nature. It is not health advice, and is not tailored to meet your individual health needs. You should always consult a trusted health professional before making decisions about your health care. While we have prepared the information carefully, we can’t guarantee that it is accurate, complete or up-to-date. And while we may mention goods or services provided by others, we aren’t specifically endorsing them and can’t accept responsibility for them. For these reasons we are unable to accept responsibility for any loss that may be sustained from acting on this information (subject to applicable consumer guarantees).