Medicare Safety Nets explained

A reminder (or a lesson!) about a couple of ways you are able to make some savings on your annual healthcare costs.

Extended Medicare Safety Net

We recommend that all patients 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. You should do this even if you are all listed on one Medicare card.

The calculations and thresholds apply from 1 January to 31 December each year.

The Extended Medicare Safety Net can help 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 x-rays and other tests) during the year, your Medicare rebates for subsequent services will increase.

Thresholds (May 2022)

  thresholdwho is eligible?What counts?What do you get back?
Extended Medicare Safety Net (EMSN)- General$2249.80Everyone in MedicareYour 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$717.90Concession cardholders and families eligible for Family Tax Benefit Part AYour 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?

Once an individual of family total out-of-pocket medical costs from 1 January meet the thresholds above, their Medicare rebates for subsequent doctor’s visits or any rebateable service outside of a hospital will increase, for example:

Standard consult – pay $88 private fee, receive MBS rebate $39.70

The gap payment is still $48.30. 80% of the gap is $38.64  This amount is added to the normal rebate.

Therefore, once you have reached the threshold, you can pay $88 for a standard consult and receive $78.34 back from Medicare. The gap for this visit is now $9.66. (note figures current for 1 July 2022)

At the start of each year this re-sets.

PBS Safety Net for prescription medications

The PBS Safety Net for medicines is a separate scheme. Once you have spent a certain amount on medication during the calendar, the co-payment is reduced for the remainder of the year. Please discuss with your pharmacist.

For concessional patients, the PBS safety net threshold  is  $244.80.  This means when a concession card holder reaches the safety net threshold, after 36 full-priced concessional scripts, they will receive PBS medicines at no charge for the rest of the year.
 
For other patients, the threshold is $1457.10 – which means that after the equivalent of about 34 full-priced general co-payments, general patients pay only the concessional co-payment of $6.80 per PBS script (plus any applicable premiums) for the balance of the year.