If you've just come across the Medicare Safety Net, it's probably because you or someone close to you has incurred particularly high medical expenses this year. Sound familiar?
If so, the Medicare Safety Net can help. It kicks in once you spend a certain amount on out-patient healthcare and gives you a bigger rebate from the government.
Medicare has a list of all the treatments and services it covers, called the Medicare Benefits Schedule. There are over 5,700 items on that list and each one has a fee attached to it which the government has decided is a 'fair price' for that treatment.
For treatments or services you get outside of a hospital, Medicare pays 85% of the fee listed or 100% for GP appointments. If there is a gap, or your doctor charges more than the listed fee, you have to cover the rest.
For example, the fee listed for a basic GP appointment is $38.75. Medicare covers 100% of that fee but if your doctor charges more than that, you'll have to cover the gap.
Medicare automatically tracks your spending – including out-of-pocket costs. When your out-of-pocket costs get too high, the Medicare Safety Net kicks in and you get more money off future out-patient healthcare.
There are two levels to the Medicare Safety Net, plus a separate one for concession card-holders and anyone who's eligible for Family Tax Benefit Part A.
| Safety net | Threshold amount | Who it's for | What counts towards the threshold | Benefit you get |
|---|---|---|---|---|
| Original Medicare Safety Net (OMSN) | $495.60 | Everyone who's entitled to Medicare | Just the 15% gap in the MBS fee. You'll still have to pay if your doctor charges more than the MBS fee. | 100% of the fee listed on the MBS. |
| Extended Medicare Safety Net (EMSN) | $2249.80 | Everyone who's entitled to Medicare | All out-of-pocket expenses, including charges that are more than the listed MBS fee. | 80% of all out-of-pocket costs (including your doctor's premiums) for the rest of the year. However, some treatments have a benefit cap. If actual cost of the treatment exceeds the cap, you'll get the cap amount instead of the 80% |
| Extended Medicare Safety Net - Concessional and Family Tax Benefit Part A | $717.90 | Concession cardholders and families eligible for Family Tax Benefit Part A | All out-of-pocket expenses, including charges that are more than the listed MBS fee. | 80% of all out-of-pocket costs (including your doctor's premiums) for the rest of the year. However, some treatments have a benefit cap. If actual cost of the treatment exceeds the cap, you'll get the cap amount instead of the 80% |
Source: https://www.servicesaustralia.gov.au/individuals/services/medicare/medicare-safety-nets/what-are-thresholds
In an ideal world, you won't need to worry about the Medicare Safety Net, because you'll never need to use it. The best way to ensure this is to have adequate coverage from a private health insurance policy.
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The Medicare Safety Net covers a wide range of out-of-hospital doctor visits and medical tests listed on the Medicare Benefits Schedule. This includes:
Out-of-hospital medical services that are not listed in the Medicare Benefits Schedule do not count towards the Medicare Safety Net.
Families, married couples and couples in de facto relationships can register to have their family unit given the same thresholds as a single person would have, but with their out-of-pocket expenses being tallied together. That means you'll reach your thresholds faster and get your additional benefits sooner.
You're not automatically registered for this even if your whole family is already on the same Medicare card. You have to take the separate step of filling out the Medicare Safety Net Registration and Amendment for Couples and Families.
There are a handful of treatments where Medicare might not pay the 80% out-of-pocket expenses usually available under the Extended Medicare Safety Net. Many of these are treatments related to IVF and pregnancy.
These treatments have caps called EMSN benefit caps. If you've already reached your EMSN threshold and need one of these treatments, Medicare will pay the 80% or the EMSN benefit cap, whichever is lower.
They do it this way because before the caps, some doctors in these areas of practice were charging huge premiums to take advantage of Medicare's generous 80% contribution. This isn't possible now that the caps are in place.
Medicare's share of the cost comes in the form of a rebate paid to your bank account. That means you'll have to pay the full cost of the treatment and then lodge a claim with Medicare to get your rebate.
Here's how you can claim:
There are a range of concessions cards available in Australia. See your options for health care support.
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