We recommended that all patient register with Medicare as a family or couple so that all your out-of-pocket costs are counted together towards the Extended Medicare Safety Net thresholds and the PBS Safety Net thresholds.
The calculations and threshold apply from 1 January to 31 December each year.
The Extended Medicare Safety Net can help to lower your out of pocket medical costs for out of hospital services. Once you, your partner or family have spent a certain amount on medical costs (including doctors visits as well as tests) during the year, your Medicare rebates for subsequent services will increase.
Thresholds (May 2022)
|threshold||who is eligible?||What counts?||What do you get back?|
|Extended Medicare Safety Net (EMSN)- General||$2249.80||Everyone in Medicare||Your out of pocket amount for the calendar year.||80% of out of pocket costs (up to the EMSN benefit caps) for out of hospital services|
|Extended Medicare Safety Net (EMSN) – Concessional and Family Tax Benefit Part A||$717.90||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 (up to the EMSN benefits caps) for out of hospital services|
What does it mean?
For a concession card holder or family, once their total out-of-pocket medical costs from 1 January meet the threshold, their Medicare rebates for subsequent doctor’s visits or any rebateable service outside of a hospital will increase, for example:
Standard consult – pay $85 private fee, receive MBS rebate $39.10
The gap payment is still $45.90. 80% of the gap is $36.72
Therefore patient can pay $85 and receive $75.82 back from Medicare. The gap for this visit is now $9.18.