How Long Does a Mental Health Care Plan Last?

A Mental Health Care Plan itself does not automatically expire. It can be reviewed and updated when needed. In Australia, the official term is usually Mental Health Treatment Plan. 

Once your GP prepares a plan, it can continue to support your mental health care while your GP is managing your condition, and eligible services are still clinically recommended. You do not usually need a brand-new plan every year just because the calendar has changed. 

However, there is one important difference: your plan, your referral, and your Medicare-rebated sessions are not all the same thing.

Your plan may continue, but your referral may only cover a set number of sessions. Medicare also has annual limits on the number of eligible mental health treatment sessions for which a beneficiary can receive a rebate.

Does a Mental Health Care Plan Expire After 12 Months? 

No, a Mental Health Treatment Plan does not expire simply after 12 months. MBS Online states that a Mental Health Treatment Plan does not expire, and exceptional circumstances may include a significant change in the patient’s mental health or the treating practitioner being unable to obtain a copy of the previous plan 

This is where many patients get confused.

You may hear people say a Mental Health Care Plan “lasts 12 months” because Medicare session limits are counted by calendar year. But the plan itself is different from the annual Medicare claiming limit.

In simple terms:

How Many Sessions Do You Get on a Mental Health Care Plan? 

 A Mental Health Care Plan may allow eligible patients to access Medicare-rebated sessions with eligible mental health professionals.

Department of Health, Disability and Ageing confirms the 10 individual and 10 group therapy service limit per calendar year under Better Access. This does not always mean you receive all 10 sessions at once.

Usually, your GP may refer you for an initial course of treatment of up to 6 sessions. After those sessions, your mental health professional may provide feedback to your GP, who may review your plan before deciding whether more sessions are suitable.

What Is a Mental Health Care Plan Review?

A mental health care plan review is an appointment where your GP checks how your treatment is going. During the review, your GP may look at your progress, symptoms, goals, current treatment, support needs, and whether your existing plan should be updated. 

The review may also help your GP decide whether further Medicare-rebated sessions are clinically appropriate. A review is not just a formality. It is an important part of making sure the plan still matches your current needs.

Your GP may consider questions such as:

• Are your symptoms improving, worsening, or staying the same?
• Have the original goals of the plan changed?
• Are the current treatment options helping?
• Do you need further sessions?
• Should another type of support be considered?
• Is there any need to update the plan?

When Do You Need a Mental Health Care Plan Review?

You may need a review after you have used the number of sessions listed on your referral, and need more treatment sessions.

For example, if your GP first refers you for 6 psychology sessions, you may need to return to your GP after those sessions before you can be referred for more Medicare-rebated sessions under the same calendar year limit.

A review may also be appropriate if your mental health changes, your treatment goals change, your psychologist or mental health professional recommends further treatment, or your GP wants to check whether the current plan is still suitable.

How Often Can a Mental Health Care Plan Be Reviewed? 

Mental Health Treatment Plan review should generally occur no more than once every 3 months or within 4 weeks of preparing the plan, unless exceptional circumstances apply. It is generally recommended that most patients need no more than 2 reviews in a calendar year.

This does not mean you can only see your GP twice for mental health support. It refers specifically to formal reviews of the Mental Health Treatment Plan. MBS Online explains that time-tiered professional/general attendance items can also be used to deliver mental health care and support to patients, not only formal plan reviews. 

If you need ongoing help, your GP may still provide mental health care and support through appropriate consultations, depending on your situation.

Do You Need a New Mental Health Care Plan Every Year?

Usually, no, you do not normally need a new Mental Health Treatment Plan every year just to keep accessing eligible services. The plan can continue, and a new plan should not usually be created unless clinically required or exceptional circumstances apply. 

What you may need is a new referral, not necessarily a new plan.

If you have completed all the sessions listed on your referral, you may need to return to your GP for review and a new referral if further treatment is appropriate. 

What Happens If You Have Unused Sessions at the End of the Year?

If you have unused sessions on your referral at the end of the calendar year, they may still be used in the next year. However, they will count towards the new year’s Medicare claiming limit.

For example, if you have unused referred sessions from December and attend those sessions in January, they may count toward your January to December Medicare limit for the new year.

This is why it is helpful to check with your GP, mental health professional, or Medicare if you are unsure how many sessions you have already used.

Does a Mental Health Care Plan Mean 10 Free Sessions?

Not always, a Mental Health Care Plan may help eligible patients access Medicare rebates for mental health treatment sessions. But it does not automatically mean every session is free. If your mental health professional bulk bills, there may be no out-of-pocket cost. If they charge more than the Medicare rebate, you may need to pay a gap fee.

Before booking, it is a good idea to ask:

• How much does the appointment cost?
• Is it bulk billed?
• How much will Medicare cover?
• Will there be an out-of-pocket gap?
• Do I need a referral before attending?

What Should You Do If You Are Not Sure Your Plan Is Still Valid?

If you are unsure whether your Mental Health Care Plan is still active, the best course of action is to book an appointment with your GP.

Your GP can check your previous plan, review your current mental health needs, confirm whether a new referral is needed, and explain how many Medicare-rebated sessions may still be available to you.

You may also want to ask your psychologist or mental health provider how many sessions were listed on your referral and whether they need an updated referral before your next appointment.

Need Help Reviewing Your Mental Health Care Plan?

If you are unsure whether your Mental Health Care Plan is still current, whether you need a review, or whether you can access more Medicare-rebated sessions, speaking with a GP is a good next step.

At Smith Street Medical, your GP can review your current situation, assess whether your existing plan still suits your needs, and explain whether a new referral, a review appointment, or another support option may be appropriate.

You do not need to work it out alone. Book a GP appointment to discuss your mental health care options and what support may be suitable for you.