Medicare Rebates for Counselling
It’s surprising, but yes, seeing a psychologist with a Medicare rebate (mental health care plan) can actually be more expensive than seeing a highly qualified counsellor or psychotherapist.
However before going through the sums, I would first like to explain a little bit more about the Medicare system and its influence on choosing the best therapist for you.
Why can’t counsellors and psychotherapists give Medicare rebates?
There is a myth that counsellors and psychotherapists have been left out of Medicare due to lack of education or ability, which is simply not true. There was no moment where the government carefully compared the qualifications and skills of psychologists’ vs counsellors and deemed only psychologists’ worthy! For example, there are counsellors with doctorates, who have undertaken research, lectured at universities and have obtained decades of highly specialised experience and will still never be allowed to give Medicare rebates. Medicare has nothing to do with one profession being better than the other, it is about understanding how the rebates came to be in the first place.
The Medicare rebates given to psychologists are part of the Better Access Initiative (BAI) and was introduced in 2006. According to the Australian Psychological Society (APS), they have been lobbying for psychologists to be included in Medicare for 30 years before this point. APS itself was created in 1966. In comparison, PACFA, one of the first counselling and psychotherapy representing bodies, was created in 1998. At the time of BAI being introduced, our representative body was just 8 years old. Counsellors and psychotherapists weren’t included as we were simply not part of the decades long advocating that it takes to bring in initiative such as BAI.
We are a relatively new profession to Australia, and it takes time for the slow-moving medical system to understand how to best use all its allied health resources. Most importantly, Australia’s mental health needs are changing and as we speak, the government is undertaking research on how to better use counsellors and psychotherapist. Read more about that here.
Why Medicare is NOT always cheaper
Another misconception is that a mental health care plan means free therapy. Well, technically it’s true, but very rare! The current Medicare rebate for a registered psychologist is $93.35. At the same time, the APS recommends a fee of $300 per session, which means bulk billing psychologists are potentially losing over $200 per hour, every single bulk billed session. Keeping in mind that out of that $93.35, they need to pay for an office, professional development, practice software, pay tax, and additional administration that is required. Should you be lucky enough to find a psychologist who is willing to bulk bill, I would suggest the waitlist would expand from months to years.
So, psychologists charge a gap. Around metropolitan Melbourne, fees for a psychologist are around $250, which is an out-of-pocket fee of $156.65. Currently, PACFA suggest the recommended rate for counsellors is $150, and my current hourly rate is $137.
In this scenario, despite the Medicare rebate, you are still paying more.
There are of course, psychologists who are mindful of being more affordable, for example charging only $200 per session, which is about $106 out. This is cheaper, right? Maybe not.
A mental health care plan allows rebates for, at maximum, 10 sessions. This is perfect if there are smaller issues you need help with or if you have already done the hard work on your mental health, and you just need to touch base with your therapist to keep you on track. But what if things are worse than this? What if you know from your experience, that you need more than 10 sessions?
Short term counselling is generally considered around 20 sessions. See below the table showing the overall out of pocket cost of therapy as time goes by:
| Session # | Full Fee $137 | Full Fee $200 / After Rebate $106 | Full Fee $250 / After Rebate $156 |
| 1 | $137 | $106 | $156 |
| 10 | $1,370 | $1060 | $1560 |
15 |
$2,055 | $2060 10 rebated & 5 sessions at full fee | $2810 10 rebated & 5 sessions at full fee |
20 |
$2,740 | $3,060 10 rebated & 10 sessions at full fee | $4,060 10 rebated & 10 sessions at full fee |
How to choose the right therapist for you
The purpose of this information is not about criticising Medicare, pitting one profession against another, or even self-promotion. My greatest wish is that anyone who is experiencing difficulties with their mental health has all the information needed to choose the best professional for them.
Often, when struggling, a GP is our first point of contact. And from there, they issue a mental health care plan which funnels their patients to a select number of psychologists within their referral base. However therapy is deeply personal, and you should get a say in who you trust your mental health with. Research has proven one of the most important factors in the success of therapy is the relationship you have with your therapist. Not the type of therapy, not the amount of education, not the profession, not the cost.
And so the message I want to leave you with is to do your research. Find a few different therapists who resonate with you and specialise in what you are experiencing. Contact them and see if you feel they are a good fit for you.
If you have found this article because you are considering me as a therapist, I am happy to have a chat by phone, email or even text, to help you see if I might be the right person for you. Follow this link for my details.
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