Medicare Telehealth Guide: When Can a New Patient Get an MBS Rebate for a Consultation?
Telehealth
If you've tried to book a telehealth consult with a new GP, you may have been told: "You're not eligible for a Medicare rebate because we haven't seen you in the last 12 months."
This is the famous "established clinical relationship" rule, and it's the biggest hurdle for patients trying to access convenient telehealth for the first time. The regulation is in place to encourage continuous, quality care with your usual doctor.
But here is the most important piece of information for new patients: The rule does not apply to all consultations.
This guide, written to provide absolute clarity, will explain the rule, detail the crucial exceptions that allow you to access an MBS rebate today, and position Medicly as the compliant and convenient path to care.
1. The Baseline Rule: Why the "12-Month Wait" Exists
The default position under the Australian Medicare Benefits Schedule (MBS) is that for most general attendance telehealth items, the patient must have an "established clinical relationship" with the practice.
What is an Established Clinical Relationship?
It means the patient must have seen the specific GP or another health practitioner at that same medical practice face-to-face within the 12 months prior to the telehealth consultation.
If you are a new patient to a practice, you are technically not eligible for an MBS rebate on a general telehealth consultation (e.g., a simple cold or a routine follow-up) until you've had that first in-person visit.
2. The Strategic Advantage: Three Ways New Patients Get an MBS Rebate TODAY
The regulatory framework contains vital and specific exemptions designed to ensure urgent and sensitive care is never delayed. Medicly utilizes these three main exceptions to serve new patients immediately and compliantly:
Exemption CategoryPatient Benefit HighlightExamples of Medicly ServicesSexual & Reproductive Health Immediate, discreet access for sensitive issues without the prerequisite of a prior face-to-face visit. ED Consults, Contraception Renewals, STI Testing Referrals, Thrush/BV treatment. Mental Health Planning Allows patients to start planning/treatment immediately, crucial for urgent mental wellness support. Preparation of a Mental Health Treatment Plan (MHTP) and referrals for psychological services. Urgent After-Hours Services Enables patients to receive urgent care when traditional clinics are closed (during unsociable hours). Acute illnesses or injuries requiring urgent assessment outside of standard business hours. The Medicly Guarantee: By structuring our services around these legislated MBS exemptions, Medicly can offer new patients a legitimate, rebated consultation from the very first contact, distinguishing our offering from traditional practices that may not apply these exemptions for new patients.
Book Your Rebate-Eligible Consultation Now
3. Understanding MBS Eligibility and Your Out-of-Pocket Cost
Medicare eligibility for a rebate is separate from the fee charged by the practice.
A. Bulk Billing (No Out-of-Pocket Cost)
Who is eligible? Bulk billing (where the MBS benefit is accepted as full payment) is generally available for patients who hold a valid Health Care Card, Pensioner Concession Card, or children under the age of 16.
Medicly's Position: If you meet these criteria, you may be bulk-billed for the consultation (depending on our current pricing policy), meaning zero out-of-pocket expenses for the consult itself.
B. Private Fee with MBS Rebate:
Who is eligible? All Medicare-eligible Australians who do not qualify for bulk-billing.
The Process: You pay Medicly the full private consultation fee upfront. Medicly processes your Medicare claim instantly, and Medicare deposits the rebate directly into your bank account, covering a portion of the fee (e.g., the rebate for a short consult is approximately $39.75). The difference is your "gap fee."
Crucial Note on Prescriptions: While the consultation may be rebated, you must always pay the dispensing pharmacy separately for the medication itself.
4. Special Scenarios: MyMedicare and Other Exemptions
The MBS landscape is detailed, and a few other scenarios apply to new patients:
MyMedicare Registration:
From November 2023, patients registered with a specific practice under the MyMedicare scheme may access certain Level C and D phone consultations (longer than 20 minutes) with that registered practice, even if they haven't had a recent face-to-face visit. This is an option for ongoing care but does not apply to new patients who are not yet registered.
Other Groups:
The established relationship rule also does not apply to certain groups, including:
- Children under 12 months
- People who are homeless
- People affected by a declared natural disaster
Conclusion: Accessing Compliant Care Today
Navigating Medicare rules for telehealth can be complex, but the path to immediate care is clear: if your health concern falls under sexual/reproductive health or mental health planning, you are eligible for an MBS-rebated consultation with a Medicly GP today, regardless of your patient history.
Medicly provides the clear, compliant, and convenient solution, ensuring you never have to delay essential care.
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Stop worrying about Medicare rules. Book your consultation now and let our team ensure your service is MBS-compliant from your very first contact.