The Extended Medicare Safety Net (EMSN) is an important part of our public healthcare system. It is an additional rebate for people who incur out-of-pocket costs for out-of-hospital services such as GP and specialist attendances.
Every year, every Australian individual or family is allocated a threshold under the EMSN. Once the threshold for out-of-pocket costs has been met, Medicare will pay for 80% of any future out-of-hospital services for the remainder of the calendar year.
It is important to remember that the EMSN does not apply to services provided in-hospital where Medicare works in tandem with nib and other providers to manage the costs for our customers.
Changes to the Extended Medicare Safety Net effective 1 January 2010
In 2009 the Federal Government announced that there would be an upper limit placed on the amount of benefit that can be paid on a small number of services covered by the EMSN. These changes came into effect 1 January 2010.
The Medicare services that now have an EMSN benefit limit are:
- Obstetrics services
- Some pregnancy related ultrasounds
- Assisted reproductive technology (ART)
- One type of cataract operation
- Injections of therapeutic substances into an eye
- Hair transplants for treatment of hair loss as a result of disease or injury
- One type of varicose vein treatment
Example
Kathleen is pregnant and has been referred by her doctor for her 12 week pregnancy scan. When Kathleen goes for her scan it costs $200. The Medicare Benefit Schedule (MBS) fee for this service is $70. Kathleen will receive $59.90 back from Medicare under the standard Medicare Benefits Schedule rebate (85% of the MBS fee), leaving her $140.10 out-of-pocket.
If Kathleen has reached her Extended Medicare Safety Net threshold for the year she will also receive 80% of her out-of-pocket cost back from Medicare under the EMSN. However, the amount she can claim under the EMSN for this service is now capped at $35.55.
Therefore the maximum Medicare benefit Kathleen can claim is $95.05, which is made up of the standard Medicare rebate of $59.50 plus the capped EMSN benefit amount of $35.55. This means Kathleen’s out-of-pocket cost will be $104.95.
Why has the Government made these changes?
An independent review of the EMSN found that some specialist fees were increasing for out-of-hospital services at the expense of in-hospital services. And that on certain procedures the EMSN was spent on meeting increasing doctor’s fees rather than reducing patient out-of-pocket costs. The report can be found here.
Do you think this may affect you?
As part of the review there has also been an overhaul of maternity services for women. Key improvements are greater support for midwives, enhanced regional and rural services and a 24/7 helpline to access information both before and after birth.
Remember that these changes affect only a small number of services. The best thing to do if you have any concerns about these changes is to call Medicare on 132 011 or visit the Medicare Australia website.
For more information
- Visit the Department of Health and Ageing website
- Visit the Medicare Australia website