Medicare Rebates for All Eligible Medicare Recipients
Medicare Items for complex and chronic conditions
Individuals may be eligible for rebates under the Medicare items for complex and chronic conditions. Clients have complex care needs if they need ongoing care from a multidisciplinary team consisting of their GP and at least two other health care providers, one of which may be an audiologist.
Referral process
The GP will prepare a GP Management Plan and Team Care Arrangements and make the referral to the audiologist using a CDM referral form. The client cannot claim the rebate from Medicare until the audiologist receives the referral form.
Medicare Items for GP referral
Starting March 1, 2023, Medicare offers rebates for hearing tests when referred by a GP, in addition to ENT referrals or Enhanced Primary Care (EPC) plans. This is the first time Medicare will partially cover hearing assessments, making these services more accessible to those in need.
If you’re experiencing hearing loss, getting tested is crucial for identifying the cause and receiving the right treatment. With Medicare rebates now available, more people can access the care they need.
Referral process
Discuss your concern with the GP. If you GP determines that a hearing assessment is necessary, they will provide you with a written referral. When you attend your hearing assessment, make sure to bring the GP referral with you. This is essential for accessing HICAPS.
Private health (HICAPS)
Rebates for audiology services may be available through your private health fund (PHF). You will need to determine the rebates with your health fund provider prior to commencing the service.
You may not claim a Medicare rebate and a private health insurance rebate for the same service. You may not claim a private health insurance rebate for a session where you have also used NDIS funds. You must choose which rebate they are going to claim for a service.
Funded Programs
National Disability Insurance Scheme (NDIS)
The Hearing Services Program (HSP) and NDIS fund public hearing services in Australia.
The HSP funds hearing services for Australian citizens and permanent residents, including children and young people under 26, who satisfy its eligibility criteria.
The NDIS funds hearing supports for NDIS participants aged 26 and over who are not eligible for the HSP. The NDIS also funds additional reasonable and necessary hearing supports for participants if they are not available through the HSP. This includes people under 26.
You can access the NDIS and HSP at the same time but you can’t get the same supports from both programs at the same time.
If you are an NDIS participant accessing services and support from the HSP, there will be no immediate changes to your current arrangements.
If you are applying to access the NDIS, you will need to meet the disability or early intervention requirements outlined in the NDIS Act.
Eligibility for hearing loss to apply NDIS:
If you have an average hearing loss that is moderately-severe (65 decibels or more) in your better ear, you may meet the eligibility criteria for the NDIS. If your hearing loss is below this average, but you have other permanent impairments e.g. vision or cognitive impairments, or significant difficulty with understanding speech, you may be eligible for the NDIS.
To apply for the NDIS you will need to complete an Access Request form, which can be requested by:
- Calling the NDIA on 1800 800 110
- Using the NDIA teletypewriter (TTY) service on 1800 555 677
- Phoning the National Relay Service, 1800 555 727
- Telephone Interpreting Service, 131 450
- Completing an online contact form
- Emailing NAT@ndis.gov.au
- Visiting a local office
- Posting a letter to the National Disability Insurance Agency, GPO Box 700, Canberra ACT 2601.
Home Care Package Program
The Home Care Packages Program is designed to help older people with complex care needs live independently at home. It allows you to access a variety of personal care, allied health, and clinical services to help you maintain optimal physical, sensory, psychological, cognitive, social, and cultural functions.
Hearing aids, which are vital for communication, social well-being and welfare at home, may be funded under a Home Care Package.
Through a Home Care Package, a coordinated range of services is provided, which can include:
- Assistance with household tasks
- Personal equipment, such as walking frames and hearing aids
- Minor home modifications
- Personal care
- Clinical care, including nursing, allied health, and physiotherapy services
There are four levels of Home Care Packages, each catering to different care needs:
Level 1: Basic care needs
Level 2: Low care needs
Level 3: Intermediate care needs
Level 4: High care needs
Eligibility
Eligibility for a Home Care Package is determined by an assessment of your care needs. To qualify, you must be:
- An older person needing coordinated services to remain at home, or
- A younger person with a disability, dementia, or other care needs not covered by other specialist services
Your financial situation does not affect your eligibility. However, you cannot claim through a Home Care Package if you are already receiving government support, such as the Hearing Services Program.
To apply:
You can complete the application yourself or on behalf of a family member or friend. If you’d like to set up an ongoing support person, you can also do that here.
There are three parts. The first checks you are eligible, the second captures your details, and the third confirms who the assessment organisation should call to confirm your needs and
arrange the assessment. You will need your Medicare card and enough time to complete it.
Workcover (in each state) – Motor vehicle/transport accident insurance
The WorkSafe Agent, can pay the reasonable costs of approved hearing services and hearing devices provided by Hearing service providers approved by WorkSafe Victoria (WorkSafe) to assist workers in the rehabilitation of work-related injuries or illness under Victorian workers’ compensation legislation. Prior approval from the agent is required before a hearing device can be provided to a worker with an accepted hearing loss claim.
For details please refer to:
- ACT: various insurers. See ACT Department of Treasury
- NSW: State Insurance Regulatory Authority
- Northern Territory: Motor Accidents Compensation (with the TIA)
- Queensland: Motor Accident Insurance Commission (MAIC)- regulatory authority
- South Australia: Motor Accident Commissions (MAC)
- Tasmania: Motor Accidents Insurance Board (MAIB)
- Victoria: Transport Accident Commission (TAC)
- Western Australia: Insurance Commission of Western Australia (IC)
Book an Appointment
Ivory Hearing
Shop 5, 90-94 Melbourne Hill Rd
Goldfields Shopping Plaza
Warrandyte 3113 VIC
T 03 9844 5863 | F 03 9844 5864
admin@ivoryhearing.com.au
Business Hours
Monday–Friday: 9.00am-5.00pm
Bus Services
364, 578, 579, and 906
Home Visit
Please call to ask about Audiologist home visit. We are also looking after 5 different retirement villages & aged care homes around us. Please call to discuss about what our aged care services can do for you.