Many doctors’ offices aren’t offering bulk billing to their patients anymore, meaning many people are forced to pay out of pocket, when they previously didn’t have to pay anything due to Medicare benefits.
If you’re consistently paying for medical treatment or care yourself, you may have reached the threshold for the Extended Medicare Safety Net (EMSN) and be entitled to receive 80% of your costs back from Medicare.
What is the Extended Medicare Safety Net?
If you spend a lot of money on out of hospital medical services and are covered by Medicare, you may be eligible for the EMSN. If you spend up to or over the threshold on these expenses, you can access higher Medicare benefits and get 80% of your out of pocket expenses back from the government.
Note: An out of pocket cost (AKA gap) is the difference between the amount a doctor charges and what Medicare pays for you.
The EMSN works during a calendar year (1 January to 31 December) and covers medical services such as doctor or specialist visits, and many pathology and radiology tests and appointments.
You may still need to pay the same amount for your doctor’s visit or test at the time, but Medicare will give you more money back for the rest of the year with this initiative.
Note: Some services are capped so you cannot claim more than a certain amount.
However, the initiative does not apply to medical services you receive in hospital, including day surgery.
How does it work?
Medicare will normally pay you a rebate for the medical services that you have accessed through them and if a doctor uses a bulk billing system, you won’t be charged anything out of pocket.
But if your doctor doesn’t provide bulk billing, you will be charged an out of pocket expense because the rebate that Medicare usually provides is no longer applicable to your services with this specific provider.
However, most people don’t realise that if they spend over the threshold in out of pocket expenses, they can apply for the EMSN and get the benefits.
At the start of every year, Medicare sets a threshold for out of pocket expenses. When you reach the threshold from paying for out of hospital appointments and tests, you will receive a higher benefit from Medicare. This will include 80% off the out of pocket amount.
If you’re an individual with no dependants, you won’t have to register once you’ve hit the threshold. Instead, the Government will register you, keep track of your expenses and pay your Medicare benefits if you reach the threshold.
If you’re part of a registered family or couple, you’ll need to confirm who’s in your family or couple before you reach the threshold. Just because you are registered on the same Medicare card doesn’t mean your family members will automatically be listed as family for Safety Net purposes. You will need to register as a family for EMSN purposes via Medicare Express app or Services Australia website. As there are more people involved, you’re more likely to reach the threshold sooner than an individual.
You may be eligible for a lower threshold amount if you’re any of the following:
- a Commonwealth Seniors Health Card holder
- a Health Care Card holder
- a Pensioner Concession Card holder
- eligible for Family Tax Benefit Part A.
For more on what the thresholds are and how they work, click here!