15th May, 2017 | 3 minutes
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What is the Medicare Safety Net?

by Danielle O'Reilly
Health Geek

Just as acrobats use a safety net to catch them if they fall, Medicare has a safety net to catch you if you’ve spent a lot on doctors’ fees. It’s called (surprise, surprise), the Medicare Safety Net.

First, the good news. The Medicare Safety Net pays more back in benefits – so you have less out-of-pocket expenses. It’s designed to provide some financial relief for those with high medical costs. Which points to the bad news. You only get to use Medicare Safety Net when you visit the doctor a lot.

So, while the Medicare Safety Net is certainly a great help, it’s not something one would really aspire to use.

How does the Medicare Safety Net work?

During the course of a calendar year (January to December), Medicare keeps a tally of every time you pay a gap amount or have out-of-pocket costs for some services listed in the Medicare Benefits Schedule (MBS). These services include:

  • Consultations with healthcare professionals
  • Blood tests
  • CT scans
  • Radiotherapy
  • Pap smears
  • Psychiatry
  • Tissue biopsies
  • Ultrasounds
  • X-rays

Once your gap or out-of-pocket expenses reach a certain amount (called the ‘threshold amount’), then you may become eligible for the Medicare Safety Net. For the rest of the year, Medicare may help to pay for some or all of your out-of-pocket expenses.

See the 2017 thresholds and benefits here.

What is the Medicare Safety Net?

Original vs Extended: What’s the difference?

Just to confuse things, there are two categories of safety net: the Original Medicare Safety Net and the Extended Medicare Safety Net.

To be eligible for the Original Medicare Safety Net, you must have tallied up $453.20 in ‘gap amounts’ (the difference between a Medicare rebate and the MBS fee) within a calendar year. Once you have reached this threshold, Medicare will pay 100 per cent of the MBS fee for the remainder of the calendar year. But if your doctor charges above the MBS fee, then you still have out-of-pocket expenses.

To be eligible for the Extended Medicare Safety Net, you must have tallied up $2,056.30 in out-of-pocket costs (or, $656.30 for concession card holders and those on Family Tax Benefit (Part A)) within the calendar year. This higher safety net pays 80 per cent of future out-of-pocket costs for the rest of the year.

Learn more about Original and Extended Medicare Safety Nets.

What about families and couples?

Every member of your family can be counted towards your Medicare Safety Net threshold.

Make sure you register your family, though! Even if you are all listed on one Medicare card, your medical costs won’t be pooled unless you register. A family can consist of:

  • A married couple with or without children
  • A couple in a de facto relationship with or without children
  • A single person with children

The threshold for families and couples is the same as the threshold for individuals. This means that families are more likely to reach the threshold sooner, so it’s important that you register yours.

Simply call Medicare or visit a local Medicare office to register your family for Medicare Safety Net.

For the benefits not covered Medicare, health insurance may cover some of them, depending on the policy you hold and your level of cover.

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