Physiotherapy can significantly improve well-being, especially for those with chronic or complex health needs, but it can be costly for pensioners. Thankfully, there are ways pensioners in Australia can access up to 5 free physiotherapy sessions each year through Medicare. In this blog post, we’ll explain how Medicare can help, who is eligible, the costs involved, what Medicare covers, and how to claim rebates. By understanding the process, you can make the most of the available physiotherapy sessions to manage your health better. Read on to learn how you or your loved ones can benefit from these free sessions.
Chronic and Complex Care Needs
If you have a chronic or complex condition, you may be eligible for up to 5 free physiotherapy sessions in Australia through Medicare under a Chronic Disease Management (CDM) plan. A chronic condition is typically a health issue that lasts for six months or longer, such as arthritis, osteoporosis, or long-term disabilities from injuries. These conditions often need continuous treatment and involve multiple healthcare professionals.
To qualify for physiotherapy under Medicare, your condition must not only be chronic but also complex. A complex condition requires care from a multidisciplinary team, which includes your GP and at least two other healthcare professionals. This could involve allied health professionals like physiotherapists, occupational therapists, or dietitians who collaborate to manage your health comprehensively.
Your GP plays a crucial role in setting up your care plan. Initially, your GP will create a GP Management Plan (GPMP), designed to help manage your chronic condition. Then, a Team Care Arrangement (TCA) is established, involving other healthcare professionals who support your treatment. For example, if you have osteoporosis, your care might involve physiotherapy to strengthen bones and occupational therapy to assist with daily activities. This team approach ensures that all aspects of your condition are managed, improving your overall quality of life.
It is essential to keep your Care Plan up to date, and regular reviews with your GP are critical. These reviews ensure that your Care Plan remains aligned with your health needs, qualifying you for continued Medicare rebates. Discuss any changes in your condition with both your GP and physiotherapist to adjust the CDM plan and keep it valid each calendar year. A patient is considered to have complex care needs if ongoing care from a multidisciplinary team is required, consisting of a GP or prescribed medical practitioner and at least two other health or care providers.

Eligibility Requirements for Free Physiotherapy Sessions
To be eligible for up to 5 free physiotherapy sessions funded by Medicare, pensioners need to meet specific criteria. First, you must hold a valid Medicare card. Second, you must have a referral from your GP, which is part of a CDM or Enhanced Primary Care (EPC) plan—these plans are designed for patients with long-term or serious conditions requiring continuous care from different healthcare providers.
A chronic condition is defined as a health issue lasting, or expected to last, six months or longer. Common examples include arthritis, osteoporosis, diabetes, and other chronic musculoskeletal issues. Once your GP assesses that you meet the criteria, they will create a CDM plan that includes referrals to allied health professionals, such as physiotherapists.
It’s also important to know that not all physiotherapy clinics accept Medicare referrals. To avoid unexpected costs, ensure your physiotherapist is registered to provide Medicare services. Coverage is available to Australian citizens, permanent residents, certain temporary residents, and visitors from countries with Reciprocal Healthcare Agreements. Addressing these requirements broadens the audience who can benefit from the program and helps ensure pensioners can access affordable physiotherapy.
Gap Payments and Costs
While Medicare helps cover physiotherapy services, there may still be some costs involved. Medicare rebates may not cover the entire cost of treatment, which can lead to gap payments. A gap payment is the difference between the Medicare rebate and the actual cost of the service, which patients may need to pay out of their own pocket.
The Medicare Benefits Schedule (MBS) decides how much of the cost Medicare will cover for physiotherapy services, but extra fees might apply depending on the clinic and type of treatment. Some physiotherapy clinics may bulk bill, which means there is no out-of-pocket cost for the patient, but others may require a gap fee or partial payment. It is important to discuss these costs with your physiotherapist beforehand so that you know what to expect.
For pensioners with limited money, many physiotherapy clinics offer lower rates or support options. Some clinics also accept private health insurance, which can further lower the cost of treatment. It is always a good idea to ask about any extra fees before starting treatment to avoid unexpected costs.
Medicare Coverage for Physiotherapy
Medicare covers physiotherapy services for patients with chronic and complex care needs under a Chronic Disease Management plan. To qualify, patients must have both a GP referral and a Team Care Arrangement in place. These arrangements highlight that your condition requires the involvement of a team, including multiple healthcare professionals.
The Medicare Benefits Schedule (MBS) determines which physiotherapy services are eligible for coverage. Typically, conditions like arthritis, lower back pain, and tendon tears qualify for coverage. However, it’s vital to clarify that coverage can vary depending on individual circumstances, such as the specific type of physiotherapy needed and the reasons for seeking treatment. Understanding these limitations can help you make the most of Medicare’s benefits.
Keep in mind that while Medicare can cover a significant portion of physiotherapy costs, some clinics may require a gap payment if the fee exceeds the rebate provided by Medicare. Discuss these potential costs upfront to prevent surprises.

Medicare Rebates Process
Claiming Medicare rebates for physiotherapy is straightforward if you follow the necessary steps. After getting a GP referral, patients can book an appointment with an eligible physiotherapist. During the appointment, the physiotherapist will provide treatment, and the patient can claim a rebate for the service through Medicare.
To claim a Medicare rebate, patients can visit a Medicare office or have the physiotherapist process the claim electronically using a HICAPS machine. This machine allows patients to swipe their Medicare card, and the rebate is processed automatically, making it easier. For those who prefer a manual process, patients can submit a claim form at a Medicare office to get reimbursed for any out-of-pocket expenses.
It is important to remember that there may be out-of-pocket costs if the physiotherapist charges more than the Medicare rebate. Private health insurance rebates may also be available for physiotherapy services, which can help cover extra costs that Medicare does not cover. Patients should ask about the rebate claim process when booking appointments to make sure they know how much they will need to pay upfront and how much they can claim back.
Session Limits and Allocation
Under the Medicare Chronic Disease Management (CDM) scheme, eligible patients can access up to 5 allied health services per calendar year, including physiotherapy sessions. These 5 sessions are shared across all allied health services, meaning they might need to be split between physiotherapy, dietitian services, and occupational therapy, depending on your needs.
It’s important to note that the 5 free physiotherapy sessions are allocated per calendar year and do not roll over. If you don’t use all of your allocated sessions by the end of the year, they are forfeited. Therefore, it’s crucial to plan your treatments accordingly to maximise the available Medicare benefits.
During your initial consultation, your physiotherapist will assess your condition and develop a treatment plan, including exercises you can do at home to continue improving your health outside of the clinical setting. Tracking your session usage is also essential; this ensures you do not exceed the yearly limit, which could result in unexpected out-of-pocket expenses.
If you require more than five physiotherapy sessions, additional visits must be paid for out of pocket or covered through private health insurance.
How to Get Started with Free Physiotherapy Sessions
If you are a pensioner with chronic or complex care needs, accessing free physiotherapy sessions through Medicare can significantly enhance your quality of life. Start by discussing your eligibility with your GP, who will establish a Chronic Disease Management plan. Once you have a GP referral and a Team Care Arrangement in place, you can book an appointment with an eligible physiotherapist and start receiving treatment.
Understanding the eligibility requirements, session limits, and Medicare rebate process can help you make the most of the available support. Up to 5 free physiotherapy sessions per year are a valuable resource for managing chronic conditions and improving your well-being. Talk to your GP today to get started and take control of your health.
Frequently Asked Questions
How to get 5 free physio?
To access up to five Medicare-subsidised physiotherapy sessions in Australia, follow these steps:
1. Consult Your GP: Discuss your chronic medical condition (lasting six months or more) with your General Practitioner.
2. Obtain a Care Plan: If eligible, your GP will create a Chronic Disease Management (CDM) plan, previously known as an Enhanced Primary Care (EPC) plan.
3. Referral: Your GP will refer you to a registered physiotherapist under this plan.
4. Access Sessions: With the referral, you can receive up to five physiotherapy sessions per calendar year, subsidised by Medicare.
Ensure your physiotherapist accepts Medicare referrals to avoid out-of-pocket expenses.
What is a 5 free visits care plan?
A “5 free visits care plan” refers to Medicare’s Chronic Disease Management (CDM) program in Australia.
This program allows patients with chronic or complex medical conditions to receive up to five Medicare-subsidised sessions with allied health professionals, such as physiotherapists, per calendar year.
To qualify, your GP must develop a CDM plan that includes referrals to the necessary allied health services.
How many free physio sessions are there on Medicare?
Medicare provides up to five subsidised physiotherapy sessions per eligible patient each calendar year under the Chronic Disease Management (CDM) program.
These sessions are intended for individuals with chronic or complex medical conditions requiring multidisciplinary care.
It’s important to note that the five sessions can be allocated across different allied health services, not exclusively physiotherapy.
How do you qualify for EPC on Medicare?
To qualify for an Enhanced Primary Care (EPC) plan, now known as a Chronic Disease Management (CDM) plan, under Medicare, you must:
- Have a Chronic Condition: A medical issue persisting for six months or longer, such as diabetes, arthritis, or chronic back pain.
- Require Multidisciplinary Care: Your condition necessitates ongoing treatment from multiple healthcare providers, coordinated by your GP.
Your GP will assess your eligibility and, if appropriate, develop a CDM plan to coordinate your care and provide access to Medicare-subsidised allied health services.