Medicare
Chronic Disease Management Plan and Type 2 Diabetes Plan
What Is a Chronic Disease Management Plan?
A Chronic Disease Management (CDM) Plan (previously known as an Enhanced Primary Care (EPC) plan) allows those with chronic health conditions to access Medicare rebates for five (5) Allied Health services per year, including Exercise Physiology.
This program requires a referral from your GP and it is designed to help manage long-term conditions by providing structured support from healthcare professionals.
Who Is Eligible?
Anyone who has access to Medicare is entitled to a CDM plan.
However as the name suggests, you have top be diagnosed with a chronic condition (lasting three months or longer), such as:
-
Chronic pain
-
Long standing musculoskeletal injury (such as back pain)
-
Diabetes
-
Heart disease
-
Osteoarthritis
-
Obesity
Your GP will determine eligibility based on your medical history and treatment needs.
What Is the Type 2 Diabetes Medicare Plan?
Medicare provides rebates for Exercise Physiology, Diabetes Educator and Dietitian services specifically for individuals with Type 2 Diabetes.
This support is part of a GP Management Plan (GPMP) and aims to improve diabetes management through structured exercise and education programs.
This can be combined with the CDM plan above.
Who Is Eligible?
To be eligible for this plan, you must:
-
Have a diagnosis of Type 2 Diabetes.
-
Be under the care of a GP who has created a GP Management Plan (GPMP) and Team Care Arrangement (TCA).
Your GP will determine if Exercise Physiology is suitable for your diabetes management and include it as part of your treatment plan.
How to Apply for a CDM and diabetes Plan
Step 1: Schedule an appointment with your GP to discuss your chronic condition or type 2 diabetes and how Exercise Physiology can assist in managing your condition.
Step 2: Your GP will assess your eligibility and create a GP Management Plan (GPMP). If required, they will also establish a Team Care Arrangement (TCA) to coordinate care with the allied health professionals.
The paperwork is usually then done by the Practice Nurse, make sure they select Exerciose Physiologist.
Step 3: Once the plan is in place, you can begin Exercise Physiology sessions with Medicare covering a portion of the cost. There will be a gap fee
How Many Sessions Are Covered?
CDM Plan: Medicare provides up to five (5) Allied Health sessions per calendar year under the CDM Plan.
These sessions are shared across all eligible providers, such as Exercise Physiologists, physiotherapists, or dietitians.
Type 2 Diabetes plan:
-
1 individual assessment session per year (by Exercise Physiologist, Diabetes Educator or Dietitian)
-
Up to 8 group exercise sessions per calendar year (by Exercise Physiologist only)
What happens if I need more than five sessions, can my GP extend the plan?
Medicare limits plan coverage to the sessions listed per calendar year.
These provide a great way to get started by removing a cost barrier to Allied Health Services. Most of the time, individuals are able to manage independently by the time the eligible sessions are exhausted. However some people do need extra support and on going care.
If additional sessions are needed, you may discuss alternative funding options with your GP, such as private health insurance or out-of-pocket payments.
Get Started with Exercise Physiology Under Medicare If you have a chronic condition or Type 2 Diabetes.
Improve your pain, blood sugar control, increased energy, and better overall health.
Speak with your GP today to check your eligibility and get started with Medicare-funded Exercise Physiology sessions. If you have any questions, contact us—we’re here to help!