Medicare Safety Net Thresholds from January 2019.
Original Medicare Safety Net.
The Original Medicare Safety Net (OMSN) works in conjunction with the Extended Medicare Safety Net (EMSN).
Under the OMSN, once the annual threshold is reached, Medicare benefits increase to 100 per cent of the Medicare Benefits Schedule (MBS) Fee for all out of hospital services for the rest of the calendar year.
Only the ‘gap amount’ counts towards the OMSN threshold.
The ‘gap amount’ is the difference between the Medicare rebate and the MBS Fee. The OMSN is calculated prior to the EMSN.
The OMSN threshold is indexed by the Consumer Price Index (CPI) on 1 January each year.
From 1 January 2019 the annual OMSN threshold is $470.00.
Extended Medicare Safety Net.
The Extended Medicare Safety Net [EMSN] provides an increased rebate for Australian families and singles who incur out of pocket costs for Medicare eligible out of hospital services.
Once the relevant annual threshold of out of pocket costs has been met, Medicare will pay up to 80% of any future out of pocket costs for out of hospital Medicare services for the remainder of the calendar year.
There is an upper limit on the amount of benefit that can be paid under the EMSN for a small number of Medicare services.
There are two thresholds for the EMSN. These thresholds are indexed by the CPI on 1 January each year.
From 1 January 2019 the annual EMSN thresholds are:
- $680.70 for Commonwealth concession cardholders, including those with a Pensioner Concession Card, a Health Care Card or a Commonwealth Seniors Card, and people who receive Family Tax Benefit (Part A); and
- $2,133.00 for all other singles and families.