GP Chronic Condition Management Plans: How Medicare Funds Ongoing Care (the plan formerly called EPC)

If you live with a long-term health condition, Medicare has a mechanism for funding more of your care than a standard GP visit: the GP Chronic Condition Management Plan. The plan goes by a few names in older material, including the Enhanced Primary Care Plan and, later, the GP Management Plan, but the current arrangement has been in place since 1 July 2025. This article explains what the plan is, who it is for, what it opens up and what you pay.

What the Plan Is (the Former EPC Plan)

A GP Chronic Condition Management Plan is prepared by your general practitioner for a patient with one or more chronic medical conditions. It records the condition, the assessments made, the goals agreed with the patient and the care the patient needs. Its main practical effect is to open access to Medicare-subsidised allied health services, which are otherwise largely a private expense.

If you have heard the scheme called the EPC Plan, that name is out of date. The Enhanced Primary Care items were replaced by chronic disease management items on 1 July 2005, and the EPC name has not applied in the MBS since. The current structure, the single GP Chronic Condition Management Plan, replaced the former two-document model of a GP Management Plan and Team Care Arrangements.

Why the Plan Matters for Ongoing Conditions

Long-term conditions are rarely managed by one clinician alone. Arthritis, diabetes, asthma and heart disease are typically managed with a mix of medical care, allied health input and self-management, and the plan is the mechanism that coordinates those parts and subsidises the allied health side.

Three practical benefits follow. The care is coordinated rather than piecemeal, because the plan sits with the GP as the central record. The cost of allied health is reduced, because the services attract a Medicare rebate. And the arrangements are reviewed, so the plan stays current as the condition changes.

How the Plan Works

The process follows a defined sequence.

1. Your GP assesses you and confirms that you have a chronic condition, meaning one that has lasted, or is likely to last, six months or more. The assessment covers your diagnosis, your current treatment and the risk factors at play.
2. The plan is prepared and recorded. It sets out the condition, the goals of care and the services required, and it is kept with your medical records.
3. Your GP refers you to the allied health providers named in the plan. A referral is required for the subsidised sessions, and the referral names the provider and the number of sessions.
4. The plan is reviewed periodically, generally at least once a year, so that referrals stay valid and the goals stay relevant. Reviews can happen sooner if your condition or needs change.

What the Plan Funds

Under the plan, Medicare subsidises up to five allied health services per eligible patient per calendar year. The sessions are individual consultations by default, and the allied health professions covered include physiotherapy, podiatry, dietetics, exercise physiology, occupational therapy and speech pathology.

The sessions are not a care package on their own. They are intended to work alongside the plan’s goals, and your GP decides which professions are appropriate. For many people, five sessions across a year are best used on the specific problems the plan targets rather than spread thinly across everything.

Who Is Eligible

Eligibility rests on two conditions. The patient must have a chronic medical condition, or multiple conditions, and the care must be managed by a GP under a plan. Medicare eligibility applies as usual.

There is no requirement that the condition be severe. What matters is that it is ongoing, that it needs structured management and that allied health input is likely to help. If you are not sure whether you qualify, that is a question for your GP rather than something to self-assess.

What You Pay

The Medicare rebate covers part of the cost of each allied health session, not all of it. Providers set their own fees, so the gap between the rebate and the fee varies between practices, and some providers bulk bill while others do not. Before you book, ask three questions: the fee, the rebate you will receive and the gap you will pay. Ask whether the practice bulk bills for these sessions.

Private health insurance may also contribute to allied health services, depending on your cover. It is worth a call to your fund to check before you assume either way.

Getting the Most from the Plan

Bring a current medication list and the names of any specialists you see. Bring the goals that matter to you, not just the clinical ones: getting back to walking the dog is a valid plan goal and easier to work with than a vague wish to feel better.

Then ask what comes next. Which professions are being referred, how many sessions remain in the calendar year, and when the plan should be reviewed. A plan that is written and then filed away does very little. Used properly, it is one of the more practical pieces of support Medicare offers people with ongoing conditions.

Sources: Services Australia, Allied health referrals for GP chronic condition management plans; MBS Online, Notes AN.0.47, AN.15.4 (1 November 2025) and AN.15.5; RACGP, General practice and the management of chronic conditions (2006).