Navigating the Australian Healthcare System
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Living with arthritis can be expensive. From medicines to specialist appointments, the costs add up.
This page explains the supports available to help you manage costs and get the care you need.
The Australian health system offers a range of supports for people living with arthritis and musculoskeletal conditions — but they can be hard to find if you don’t know where to look. Understanding your options can make a real difference to your out-of-pocket costs and your access to care.
This page covers the key things worth knowing, including how to reduce the cost of medicines, what your GP can arrange on your behalf, and how to access financial support if you need it. If you’re not sure where to start, talk to your GP or a social worker.
Seeing a GP
When a GP bulk bills, they charge Medicare directly and you pay nothing. Bulk billing availability varies by practice and location. If cost is a barrier to seeing a GP, you can find a bulk billing practice near you https://www.health.gov.au/bulk-billing or call healthdirect on 1800 022 222.
GP chronic condition management plan
If you have a long-term condition such as arthritis, your GP can put a GP chronic condition management plan (GPCCMP) in place for you. These used to be called a Chronic Disease Management (CDM) plan. This plan allows you to access Medicare rebates for up to five allied health visits per year – such as physiotherapy, occupational therapy, exercise physiology or dietetics. Ask your GP if a GPCCMP is right for you. They can also prepare a Team Care Arrangement (TCA) to coordinate care across multiple health professionals.
More information https://australian.physio/advocacy/changes-medicare-chronic-disease-management
Referrals
A referral is a written recommendation from your GP to see a specialist or allied health professional. Understanding how referrals work can help you access the right care more efficiently.
When do I need a referral?
You need a referral to see a specialist such as a rheumatologist or orthopaedic surgeon, and to claim a Medicare rebate for that appointment. You don’t always need a referral to see an allied health professional, but a referral from your GP may be required to access Medicare rebate.
How long does a referral last?
A referral to a specialist from a GP is valid for 12 months. A referral from one specialist to another is valid for three months. If you’re receiving ongoing care from a specialist, ask whether an indefinite referral is appropriate.
Can I choose my own specialist?
Yes. Your GP may recommend a specialist, but you can ask to be referred to a different one if you prefer. If you are not happy with your specialist’s advice, you also have the right to seek a second opinion. Ask your GP for a referral to another specialist for this purpose.
How much will it cost to see a specialist?
Many medical specialists have private clinics, and it can be quicker to get to see them, however they can set a fee for the service that is higher than the Medicare benefit. The Medical Costs Finder is a tool to find and understand costs for GP and medical specialist services across Australia.
Medical Costs Finder https://medicalcostsfinder.health.gov.au/
What to do if you’re waiting too long
If you are waiting a long time to see a specialist, talk to your GP about whether there are other options such as a telehealth appointment, a different clinic, or a public hospital service. Early treatment is important for many musculoskeletal conditions, so don’t wait if your symptoms are getting worse.
Public vs Private Services
Understanding the difference between public and private services can help you make the most of your options — and manage your costs.
Public services
Public rheumatology and allied health services are available through public hospitals and community health centres. These services are funded by the government, so your out-of-pocket costs are generally lower or nil. Wait times can be longer, and you may not be able to choose your specialist. Your GP can refer you to a public service.
Private services
Private specialists and allied health professionals offer more choice and often shorter wait times. However, costs are higher. Medicare will cover part of the cost, and private health insurance may cover some of the gap depending on your level of cover. Always check the likely costs before booking, including the gap fee. If cost is a concern, ask the practice whether a payment plan or reduced fee is available.
Mixed approach
Many people use both public and private services depending on their needs and circumstances. For example, you might see a private GP who bulk bills but access a public hospital rheumatology clinic for specialist care. Talk to your GP about what might work best for you.
Help with The Cost of Medicines
Medicines for arthritis and musculoskeletal conditions can be expensive, particularly specialist medicines such as biologics. There are several ways to reduce what you pay.
Pharmaceutical Benefits Scheme (PBS) and co-payments
The PBS is an Australian Government program that subsidises the cost of many medicines. If you have a Medicare Card this means you pay a set amount, called a co-payment, or ‘co-pay’ rather than the full price. People with a Concession Card pay even less. Some arthritis medicines are only available on the PBS if you meet certain criteria, such as having tried other treatments first. Your doctor can advise on what is covered for your condition.
About PBS co-payments https://www.health.gov.au/cheaper-medicines/pbs-co-payments
60-day prescribing
From 2023, eligible medicines in Australia can be prescribed as a 60-day supply rather than a 30-day supply. This means fewer trips to the pharmacy and lower out-of-pocket costs over time. Ask your GP or specialist whether your medicines are eligible for 60-day prescribing.
Eligibility for 60-day prescriptions https://www.health.gov.au/cheaper-medicines/60-day-prescriptions#about-60day-prescriptions
Safety Net
Once you reach the PBS Safety Net threshold in a calendar year, the cost of your PBS medicines is reduced further for the rest of that year. Keep your pharmacy receipts or ask your pharmacist to keep track of your spending. Family members can pool their costs toward the Safety Net threshold.
PBS Safety Net and cost savings https://www.health.gov.au/cheaper-medicines/safety-net-and-cost-savings
Financial Support
There is financial help available if arthritis or a musculoskeletal condition is affecting your ability to work or manage daily life. A social worker can help you understand what you may be eligible for and how to apply. Ask your GP or specialist for a referral.
Disability Support Pension
If your condition significantly affects your ability to work, you may be eligible for the Disability Support Pension through Services Australia. Eligibility depends on the impact of your condition on your daily functioning.
Disability Support Pension https://www.servicesaustralia.gov.au/disability-support-pension
Carer Payment and Carer Allowance
If someone provides care for you, they may be eligible for financial support through Services Australia. Different rules apply to each payment.
Carer Allowance https://www.servicesaustralia.gov.au/carer-allowance
Mobility Allowance
If your condition means you can’t use public transport, you may be able to get help with travel costs for work or study through the Mobility Allowance.
Mobility Allowance https://www.servicesaustralia.gov.au/mobility-allowance
Health Care Card
A Health Care Card gives you access to cheaper medicines under the PBS and other concessions. Services Australia can advise on eligibility.
Health Care Card https://www.servicesaustralia.gov.au/health-care-card
NDIS
Arthritis and musculoskeletal conditions may be covered under the National Disability Insurance Scheme (NDIS) for people aged 65 or under. Eligibility depends on how your condition affects your life. A member of your healthcare team can support your application.
NDIS website https://ndis.gov.au/
State and territory supports
State and territory governments may also offer their own payments and benefits. Check your state or territory government website for what’s available in your area. Or call the free Arthritis Infoline and connect to someone in your state who can provide advice tailored to your needs: 1800 011 041.
Not sure what support you’re entitled to? Ask your GP for a referral to a social worker.
They can help you work out what’s available and how to access it.
Getting the care you deserve
Questions to ask at your appointment
