If you and your family have a lot of medical expenses throughout the year, the Medicare Safety Net could help you to save on your annual health care costs. In this month’s blog, we take a look at how the Medicare Safety Net works and how you can register for it.
What is Medicare?
Before we get to the Medicare Safety Net, we need to understand a bit about Medicare itself.
Medicare was first introduced in 1984 as a universal health insurance scheme for Australia. It was designed to assist all Australians with the costs of the health care they need, regardless of where they live or their ability to pay.
When you access eligible health services, including visiting your GP or specialist or undertaking certain tests and scans, Medicare provides a rebate to you – the patient – to assist covering the total cost of the health service provided.
Bulk billing is when the doctor or health care provider accepts the Medicare rebate directly for the services provided to patients, resulting in no out-of-pocket expense to the patient.
However, when bulk billing is not applied, patients are required to pay an out-of-pocket or gap fee to cover the difference between the healthcare provider’s cost for service and the Medicare rebate. This is where the Medicare Safety Net can come in handy for those who have a lot of health care expenses throughout the calendar year.
This video from Services Australia provides a brief overview of the Medicare system>>
What is the Medicare Safety Net?
The Medicare Safety Net is a scheme put in place to help people pay for their out-of-pocket medical expenses.
Medicare automatically adds up your out-of-pocket costs for the calendar year, from 1st January to 31st December. When you reach prediksi togel a certain amount, Medicare will give you a higher amount back.
It’s important to note that your doctor visits or tests will still cost you the same up-front. The Medicare Safety Net simply means that you will receive a greater rebate back from Medicare for those visits and tests, once you’ve reached the relevant threshold.
For example:
You see your GP for a Standard Consultation and are charged the private fee of $85.00 and receive the Medicare rebate of $39.75. Your out-of-pocket cost for this appointment is $45.25
If you have reached the Medicare Safety Net threshold, however, you will still pay the private fee of $85.00 but you now receive a Medicare rebate of $39.75 + 80% of the out-of-pocket cost ($36.20). This means your total out-of-pocket cost for this appointment is only $9.05.
What Are the Safety Net Thresholds
The Medicare Safety Net has a number of thresholds in place and only verified payments (i.e. when you pay for your health professional service in full, before you make a claim with Medicare) count towards the threshold.
Some services are capped, so you cannot claim more than a certain amount. These include:
- Assisted reproductive technology
- Obstetric services
- Pregnancy ultrasounds
- Midwifery services
- Certain procedures
- Certain consultations
The threshold amounts are set each year from 1 January. The current safety net thresholds for 2023 are as follows.
Thresholds | Threshold Amount | Who It’s For | What Counts Towards the Threshold | What Benefit You’ll Get Back |
Original Medicare Safety Net (OMSN) | $531.70 | Everyone in Medicare | Your gap amount for the calendar year | 100% of the schedule fee for out of hospital services |
Extended Medicare Safety Net (EMSN) – General | $2,414.00 | Everyone in Medicare | Your out-of-pocket amount for the calendar year | 80% of out-of-pocket costs or the EMSN benefit caps for out of hospital services |
Extended Medicare Safety Net (EMSN) – Concessional and Family Tax Benefit Part A | $770.30 | Concession cardholders and families eligible for Family Tax Benefit Part A | Your out-of-pocket amount for the calendar year | 80% of out-of-pocket costs or the EMSN benefit caps for out of hospital services |
Who Is Eligible?
If you’re enrolled in Medicare, you’re eligible for Medicare Safety Nets.
You don’t need to register for the Medicare Safety Net if you’re an individual with no dependants. Medicare will automatically keep a tally of your out-of-pocket and gap amounts and will pay the higher Medicare benefits when you reach your threshold.
If you’re part of a family or couple, however, you can combine your costs by registering as a family.
A family is defined as:
- a married couple, not separated, with or without dependants;
- a couple in a de facto relationship, with or without dependants; or
- a single person with dependants.
A dependant is someone the family supports financially and is either a child under 16 years of age or a full-time student aged between 16 and 25 years.
For more information on this topic, visit:
- Australian Government Department of Health and Aged Care – https://www.health.gov.au/topics/medicare/about/safety-nets
- Australian Patients Association – https://www.patients.org.au/medicare-safety-nets/
- Health Direct – https://www.healthdirect.gov.au/medicare-safety-net
- Services Australia – https://www.servicesaustralia.gov.au/medicare-safety-nets