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  • Updated:3 Aug 2006
 

06.Enhanced primary care

  • If you’ve got a chronic medical condition (e.g. diabetes) or have complex care needs (e.g. as a result of HIV-related illnesses) you can get additional Medicare benefits for some services provided to you by allied health professionals (such as physiotherapists, psychologists and speech pathologists) and dentists, so long as you're being managed by your GP under something known as an Enhanced Primary Care (EPC) plan.
  • Any out-of-pocket expenses for patients being managed under an EPC can contribute towards the Medicare Safety Net thresholds.

What's an EPC plan?

It's a fairly complicated arrangement where your GP needs to:

  • Prepare for you a GP management plan — a comprehensive plan for the management of your condition
  • Co-ordinate your team care arrangements, which are the treatment and services provided by at least three different providers. The team for someone with type 2 diabetes, for example, might include their GP, a dietitian and a podiatrist.

How to apply for EPC benefits

  • The need for allied health or dental services must be identified in your EPC plan, and Medicare rebates are available for a maximum of five allied health and three dental care services per patient in a calendar year.
  • Your GP needs to refer you for these services (using an EPC program referral form), and can only refer you if the service relates to the condition for which the EPC plan was formed.
  • It’s not mandatory for GPs to manage eligible patients under an EPC plan, so if you’re not being and think you should be, try discussing it with your GP. Not only will an EPC plan give you access to additional Medicare benefits, it will also help ensure good quality of care and regular assessments.
 

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