Many people may be unaware of the Medicare Safety Net and what it can do for them, so we’ve put together a quick guide to understanding the Medicare Safety Net.
If you are currently in the market for health insurance, or are considering switching policies, we have provided a comparison table below which provides a snapshot into the current market offerings. This table has been formulated based on the policy holder being a single male located in NSW who is looking for hospital cover, and has been sorted by monthly premium (lowest to highest).
What is Medicare?
Medicare is Australia’s universal health scheme, a government-funded program that provides access to a comprehensive range of health services for all citizens, at little to no cost to the citizen in question.
The range of things it covers includes:
- Consultation fees for doctors, including specialists
- Tests and examinations by doctors needed to treat illnesses, such as x-rays and pathology tests
- Eye tests performed by optometrists
- Most surgical and other therapeutic procedures performed by doctors
- Some surgical procedures performed by approved dentists
- Specific items under the Cleft Lip and Palate Scheme
- Specific items under the Enhanced Primary Care (EPC) program
- Specified items for allied health services as part of the Chronic Disease Management Plan
Medicare doesn’t provide cover for:
- Examinations for life insurance, superannuation or memberships for which someone else is responsible (e.g. a compensation insurer, employer or government authority)
- Ambulance services
- Most dental examinations and treatment
- Most physiotherapy, occupational therapy, speech therapy, eye therapy, chiropractic services podiatry, or psychology services
- Acupuncture (unless part of a doctor’s consultation)
- Glasses and contact lenses
- Hearing aids and other appliances
- Home nursing
For these benefits not covered by Medicare, health insurance may cover some of them, depending on your choice of policy and level of cover.
What is the Medicare Safety Net?
The Medicare Safety Net provides benefits for people who need frequent medical assistance – for example needing to see a doctor often, or needing regular tests and/or check-ups. It exists in order to try to offset the higher medical costs accrued by these people, by providing a higher Medicare benefit for all eligible services once a certain threshold of out-of-pocket expenses has been reached.
The thresholds are as follows:
| Threshold | Threshold amount | Who it’s for | How it’s calculated |
What the benefit is |
| Original | $461.30 | All Medicare cardholders | Based on gap amount | 100% of schedule fee for out of hospital services |
| Extended Medicare Safety Net (EMSN) Concessional and FTB Part A | $668.10 | Concession cardholders and families eligible for FTB Part A | Out of pocket costs | 80% of out of pocket costs or the EMSN benefit caps for out of hospital services |
| Extended general | $2093.30 | All Medicare cardholders | Out of pocket costs | 80% of out of pocket costs or the EMSN benefit caps for out of hospital services |
Source: Australian Government | Department of Human Services
While you won’t pay less for any doctor’s visits or procedures, your Medicare benefits will be larger, so you won’t “run out” of Medicare benefits as quickly. The out-of-pocket expenses that you will need to accrue before becoming eligible for the Medicare Safety Net will depend on your personal circumstances, as shown above.
The Department of Human Services advises that services covered by the Medicare Safety Net include:
- Healthcare professional consultations
- Blood tests
- CT scans
- Pap smears
- Psychiatry
- Radiotherapy
- Tissue biopsies
- Ultrasounds
- X-rays
The Department of Human Services also advises, “If a service is not in the Medicare Benefits Schedule it does not count towards the Medicare Safety Net. If you have surgery, see a doctor or have tests while you are in hospital, these services don’t count towards the Medicare Safety Net.”
Information about your Medicare Safety Net details can be checked online through the government’s myGov service.
Check your Medicare Safety Net balance through #myGov when you link to #Medicare https://t.co/TE7FN3VEFq pic.twitter.com/08UQENlKDO
— myGov (@myGovau) December 1, 2016
The Medicare Safety Net for families
Couples and families need to register as a Medicare Safety Net Family, even if all members of the family are covered on the same Medicare card.
For the purposes of the Medicare Safety Net, a “family” is defined as either:
- A couple who are legally married and not separated, or a couple in a de facto relationship, with or without dependent children; or
- A single person with dependent children
In turn, a “dependant” is defined as someone who is financially dependent on the family and is either:
- A child dependant aged under 16 years; or
- A student dependant aged between 16 and 26 who is studying full-time
In cases where a dependant is part of two Medicare Safety Net families because of separation or divorce, their medical expenses will count towards the Safety Net of the family whose Medicare card is used to claim the benefit.
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