Medicare Safety Net

• Register Online for the Medicare Safety Net
• Registering as a Safety Net family
• DoHA, Health Budget 2009-2010 A Sustainable Medicare Safety Net

What is the Medicare Safety Net?

The Medicare Safety Net provides families and individuals with financial assistance for high out-of-pocket costs for out-of-hospital Medicare Benefits Schedule (MBS) services. Once you meet a Medicare Safety Net threshold, you may be eligible for additional Medicare benefits for out-of-hospital MBS services for the rest of the calendar year. Also available is the PBS Safety Net if you and your family need a lot of medicines in any year. 

Medicare Safety Net thresholds as at 1 January 2010

	Threshold amount	Who it is for	How it is calculated	What the benefit is
Original	$388.80†	All Medicare cardholders	Based on gap amount	100% of schedule fee for out-of-hospital services
Extended concession and FTB(A)	$562.90†	Concession cardholders and families eligible for FTB(A)	Out-of-pocket costs	80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services
Extended general	$1126.00†	All Medicare cardholders	Out-of-pocket costs	80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services

Out-of-pocket costs—the difference between the Medicare benefit and what your doctor charges you.

Schedule fee—a fee for service set by the Australian Government.

Gap amount—the difference between the Medicare benefit and the schedule fee.

What is an Extended Medicare Safety Net (EMSN) benefit cap?

An EMSN benefit cap is an upper limit on the amount of Medicare Safety Net benefit payable for an out-of-hospital MBS service. Not all Medicare items have an EMSN cap.

For more information about the EMSN benefit cap go to the Extended Medicare Safety Net fact sheet on the Department of Health and Ageing's MBS Online website.

What are the benefits for me?

Once you reach a Medicare Safety Net threshold visiting a doctor or having tests may cost you less.

For example: once you qualify for a threshold and then visit a doctor who charges you $60 for a standard consultation, you will receive your Medicare benefit of $32.80 plus 80 per cent of your out-of-pocket costs ($27.20)—giving you an extra $21.75 in your pocket. So in this example, it will only cost you $5.45 to visit your doctor. However, if the item is subject to the EMSN benefit cap, the amount you receive may be less.

What services are covered?

The Medicare Safety Net covers a range of doctor visits and tests covered by the MBS that you receive out-of-hospital. Having surgery, seeing a doctor or having a test when you are in hospital, or medical services not included in the MBS, do not count towards the Medicare Safety Net.

Some examples of services where costs count towards the Medicare Safety Net are:

• GP and specialist consultations
• blood tests
• CT scans
• MRIs
• pap smears
• psychiatry
• radiotherapy
• tissue biopsies
• ultrasounds
• x-rays.

Who needs to register?

Individuals—do not need to register for the Medicare Safety Net. Just keep your contact details up-to-date with Medicare Australia.

Couples and families—need to register for the Medicare Safety Net, even if all of your family members are listed on your Medicare card.

• Each family member needs to be identified so their medical costs can be counted towards your family’s Medicare Safety Net.
• You only need to register once.
• Registration is free.

How do I register?

• online
• call 132 011*
• visit your local Medicare office

What happens next?

If you pay your doctor in full and then claim your Medicare benefit we will:

• automatically keep a tally of your medical expenses for you
• write to you when you are nearing a threshold.
• If you claim from Medicare Australia before paying
  your doctor:
  • we will send you a cheque payable to the doctor, which you take to your doctor along with any outstanding balance you owe
  • take your receipts to Medicare Australia as proof of payment (that is your receipt and Medicare Statement) and we will keep a tally of your expenses for you.
• contact you when you are nearing a threshold and may ask you to substantiate  any unpaid claims.
• Once you reach a threshold, all further out-of-hospital claims you make for that calendar year may automatically attract a higher benefit.

Note: if you and your partner and/or children are registered for the Medicare Safety Net we will ask you to confirm in writing who is in your Medicare Safety Net family each year before any higher benefits can be paid.

Remember: you need to give Medicare Australia all of your receipts for doctors’ accounts to ensure you get all the benefits that you are entitled to.

What is a Medicare Safety Net family?

For Medicare Safety Net purposes a family consists of:

• a couple legally married and not separated or a couple in a de facto relationship with or without dependant children
• a single person with dependant children.

Note: a dependant child is someone under 16 years of age or a full-time student under 25 years of age attending school, college or university, whom financially you support.

What if my child is a member of two registered families?

If your child is a member of two registered families, for reasons such as separation or divorce, the family that pays the cost of the medical service receives the benefit. Any out-of-pocket costs will count towards that family’s Medicare Safety Net. This is determined by the Medicare card used to claim the benefit.

What is the Medicare Safety Net original threshold?

	Threshold amount	Who it is for	How it is calculated	What the benefit is
Original	$388.80†	All Medicare cardholders	Based on gap amount	100% of schedule fee for out-of-hospital services

For every service that can be claimed from Medicare Australia, the Australian Government has set a fee for the service—this is called the schedule fee. This is not the doctor’s fee.

The Medicare benefit that is paid when you visit a doctor is usually 85 per cent of the schedule fee, other than your General Practitioner (GP) consultation which is 100 per cent of the schedule fee.

The gap amount is the difference between the schedule fee and Medicare benefit.

How do I reach the Medicare Safety Net original threshold?

Medicare Australia calculates all of the gap amounts you have paid during the calendar year.

Once your gap amount reaches the Medicare Safety Net original threshold of $388.80^† and you have confirmed in writing who is in your Medicare Safety Net family, you may be entitled to higher Medicare benefits. We will provide you with the details for you to confirm who is in your Medicare Safety Net family.

What is the EMSN concession threshold?

	Threshold amount	Who it is for	How it is calculated	What the benefit is
Extended concession	$562.90† Concession cardholders	Concession cardholders	Out-of-pocket cost	80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services

The EMSN concession threshold is for concession cardholders. Medicare Australia will pay 80 per cent of the out-of-pocket costs or the EMSN benefit cap for MBS services provided out-of-hospital after a threshold of $562.90^† per family or individual per calendar year is reached. Eligible concession cards are those issued by Centrelink or the Department of Veterans’ Affairs, including:

• Commonwealth seniors' health cards
• Health care cards
• Pensioner cards.

Who is considered a concessional family?

If you are a concession cardholder at any time during a calendar year, you are eligible for the EMSN concession threshold for the remainder of that year starting from your eligibility date.

What is the EMSN Family Tax Benefit (Part A) threshold?

	Threshold amount	Who it is for	How it is calculated	What the benefit is
Extended FTB (A)	$562.90†	Families eligible for FTB(A)	Out-of-pocket costs	80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services

Family Tax Benefit (Part A) (FTB (A)) is an annual tax benefit to help families with the cost of raising children. Medicare Australia will pay 80 per cent of the out-of-pocket costs or the EMSN benefit cap for MBS services provided out-of-hospital after a threshold of $562.90^† per family per calendar year is reached. You may get FTB(A) if you:

• have a dependant child under 21 years of age (including a foster child), in your care for at least 35 per cent of the time, or
• have a dependant full-time student 21 to 24 years of age in your care for at least 35 per cent of the time, and
• have income under a certain amount and permanently live in Australia, and
• you are an Australian citizen, a New Zealand citizen, the holder of a permanent visa or the holder of certain temporary visas.

Eligibility for FTB(A)

Who is considered an FTB(A) family?

If you are eligible for an FTB(A) payment, you and your family are eligible for the EMSN FTB(A) threshold.

How can I claim an FTB(A) payment?

There are two ways families can claim an FTB(A) payment—as a fortnightly instalment or as a lump sum payment.

Fortnightly instalment examples:

• If you claim FTB(A) as a fortnightly instalment through the Family Assistance Office, your EMSN FTB(A) threshold eligibility will start on the date of payment in that calendar year.
• If you claim FTB(A) by deferring your fortnightly instalment payments through the Family Assistance Office, your EMSN FTB(A) threshold eligibility will start on the date of deferment in that calendar year.
• If you claim FTB(A) by deferring your fortnightly instalment payments through Centrelink, your EMSN FTB(A) threshold eligibility will start on the date of deferment in that calendar year.

Lump sum example:

• If you claim FTB(A) as a lump sum payment for a past period, for example the previous financial year, your EMSN FTB(A) threshold eligibility will start the following calendar year.

Note:

• Lump sum payments must be received before 31 December to be eligible for the next entire calendar year. If the payment is made after 31 December, eligibility will start from the date of payment in the eligible calendar year in which it is received.
• A person who has shared care of a child between 14 per cent and 35 per cent will be considered eligible for the Medicare FTB(A) Safety Net threshold

Disclaimer: how you choose to receive your FTB(A) payment/s determines your eligibility for the EMSN FTB(A) threshold. It is your responsibility to understand that your choice of FTB(A) payment can affect your Medicare Safety Net FTB(A) eligibility.

What if I receive only one fortnightly FTB(A) payment?

If you are eligible for FTB(A) at any time during a calendar year, you are eligible for the EMSN FTB(A) threshold for the remainder of that year starting from your date of payment.

What is the EMSN general threshold?

Who is considered an FTB(A) family?

If you are eligible for an FTB(A) payment, you and your family are eligible for the EMSN FTB(A) threshold.

	Threshold amount	Who it isfor	How it is calculated	What the benefit is
Extended general	$1126.00†	All Medicare cardholders	Out-of-pocket costs	80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services

How do I know when I’ve reached a threshold?

We will contact you when you are nearing a threshold.

To check your Medicare Safety Net balance:

• visit our online
• visit your local Medicare office
• call 132 011*

Why do I need to confirm?

We want to make sure your family gets the highest benefits possible. If you are approaching a Medicare Safety Net threshold and you are registered as a couple or family, we will ask you to confirm in writing who is in your Medicare Safety Net family each year. Confirming your details allows us to check your family’s eligibility for higher Medicare benefits. 

Contact details

Medicare: 132 011*

TTY: 1800 552 152 (hearing and speech impaired)

TIS: 131 450 (Translating and Interpreting Service)

Email: medicare@medicareaustralia.gov.au

Mail: GPO Box 9822 in your capital city

^† This figure is adjusted in line with the Consumer Price Index (CPI) on 1 January each year.

* Call charges apply.

**         Call charges apply from mobile and pay phones only.

Last updated: 18 March, 2010