More about Medicare Safety Nets
- Anyone enrolled in Medicare is eligible for the Medicare Safety Net. This is an initiative by the Federal Government that helps to keep out-of-pocket medical costs down for people who have lots of medical fees within a given calendar year.
What are thresholds?
- Each year, the Federal Department of Health sets certain thresholds for the Medicare Safety Net. Once you have reached the threshold, which means you have spent a certain amount in gap and out-of-pocket costs, you will start to get more money back from the Federal Government in the form of Medicare benefits for medical services.
What are unverified and verified costs?
- Only verified costs count towards the threshold. Verified costs are the doctor’s fees that you have already paid before you make a claim with Medicare. Unverified costs are the opposite – being the doctor’s fees that you have not claimed before you make a Medicare benefit claim.
What are the different types of Medicare Safety Nets?
- Original Medicare Safety Net (OMSN)
- Everyone enrolled in Medicare is eligible for the OMSN. Once you have reached the certain threshold for the OMSN, the Medicare rebates for your out-of-hospital medical services increase from 85 per cent to 100 per cent.
- Only the ‘gap amount’, which is the difference between the Medicare rebate and the MBS schedule fee, contributes towards the threshold value.
- Extended Medicare Safety Net (EMSN)
- Unlike the OMSN, which only includes the ‘gap amount’, the EMSN includes all out-of-pocket costs as a contribution to reaching the threshold. This means the EMSN includes the Medicare rebate as well as the out-of-hospital doctor’s fees that you pay.
- Once you have reached the threshold, Medicare will pay 80 per cent of all out-of-pocket costs within the given calendar year. However, there are a small number of medical services on the MBS that are capped at a certain amount. For the cost of these services is greater than the EMSN benefit cap, the patient will receive the benefit cap rather than the 80 per cent of the out-of-pocket costs.
- There are two different types of EMSNs:
- General – everyone enrolled in Medicare is eligible
- Concessional and Family Tax Benefit Part A – concession cardholders and families part of the Family Tax Benefit Part A program are eligible
What are the different threshold values for Year 2022 for each type of Medicare Safety Nets ?
Medicare Safety Net | Threshold Amount | Benefit Amount |
---|---|---|
OMSN | $495.60 | 100% of schedule fee |
EMSN – General | $2249.80 | 80% of out-of-pocket costs or benefit cap |
EMSN – Concession/Family Tax Benefit Part A | $717.90 | 80% of out-of-pocket costs or benefit cap |
- This means if you have spent $495.60 or more within a given calendar year as the ‘gap amount’ for medical services listed on the MBS, you will start to receive 100 per cent, rather than 80 per cent, of the costs for the services back as a Medicare benefit from the government, for the rest of that year.
- It also means that if you have spent a total of $2249.80 or more within a given calendar year on all your out-of-pocket medical expenses combined, you will start to receive 80 per cent of all of your future out-of-pocket medical costs that year back as a Medicare benefit from the government. This is unless your out-of-pocket costs are associated with a medical service that has an EMSN benefit cap, and the out-of-pocket costs are more than the benefit cap amount. In this case, you will only receive the benefit cap amount back as a Medicare benefit.
What services have EMSN benefit caps?
- Assisted reproductive technology
- Obstetric services
- Pregnancy ultrasounds
- Midwifery services
- Certain procedures
- Certain consultations
You can use the MBS Online search engine to find out more detailed information.