The Extended Medicare Safety Net (EMSN) covers 80% of the patient's out-of-pocket costs once they reach a certain threshold.
The Extended Medicare Safety Net (EMSN) provides a further rebate on top of the Medicare Safety Net for Australian families and singles that incur high out-of-pocket cost for out-of-hospital services.
The difference between the doctor's charge and the Medicare rebate is the patient’s out-of-pocket cost.
The EMSN provides 80% of any further out-of-pocket expenses for out-of-hospital costs in a calendar year, once the relevant thresholds have been met. For concession cardholders and families eligible for Family Tax Benefit A the threshold is $647.90 (as at 1 January 2016). For all other Medicare cardholders the threshold is $2030.00 (as at 1 January 2016). For example:
|EMSN Threshold Met||Doctor’s Fee||MBS Rebate(at 100% Scheduled Fee *)||Out-of-Pocket Cost before EMSN Rebate||EMSN Rebate (80%)||Out-of-Pocket Cost|
|Initial specialist consult||$141.00||$85.55||$55.45||$44.36||$11.09|
* The Medicare benefit is paid at 100% of the Scheduled fee because the Medicare Safety Net threshold has been reached.
Eligibility for the threshold lapses on 31 December each year and must be re-established from January 1 each year. Attached for further information is the Guide to Understanding the Medicare Safety Net.
Upper limits apply to the amount of EMSN payable for:
- all consultation items, such as GP, Specialist, Consultant Physician, Psychiatrists attendances.
- a range of procedural items (see comprehensive list here).
- assisted reproductive technology (ART) services (MBS items 13200-13209 and 13212-13251);
- two services for injections of poly-L-lactic acid (Sculptra) for the treatment of facial lipoatrophy (MBS items 14201 and 14202);
- obstetric services (MBS items 16400-16609, 16618 and 16624-16636);
- two services relating to video conferencing for ART and selected obstetric services (MBS items 13210 and 16399).
- some pregnancy related ultrasounds (MBS items 55700-55730 and 55762-55775).