A new Medicare Safety Net
A new Medicare Safety Net, with lower thresholds for most patients,
will continue to protect patients from high out-of-pocket costs
Protecting safety nets
The Government will continue to provide a Medicare Safety Net which assists Australian families and singles by contributing towards out-of-pocket costs for Medicare eligible out‑of‑hospital services.
A new safety net
Currently there are multiple Medicare safety nets for out-of-hospital services which help protect patients. They can be very confusing to understand.
From 1 January 2016 a new Medicare Safety Net will simplify existing safety nets for out-of-hospital services whilst continuing to protect vulnerable patients.
Under the new Medicare Safety Net, once the annual thresholds have been met, the Government will contribute additional benefits towards subsequent out-of-pocket costs for the rest of the calendar year.
Safety net benefits will be calculated at 80 per cent of out-of-pocket costs, but the total benefit payable (rebate plus safety net) will be capped at 150 per cent of the MBS (Medicare) set fee.
The new $7 patient contribution will not be included in these safety net arrangements.
The new Medicare Safety Net will have lower thresholds for most people.
This may allow some people to qualify for safety net benefits earlier than under current arrangements.
From 1 January 2017 the thresholds will be adjusted annually in line with inflation.
Original Medicare Safety Net (2016 estimate)
Threshold: $451.80* for all patients and families
Benefit: increases benefits to 100 per cent of the MBS (Medicare fee) for services above the threshold
Extended Medicare Safety Net (2016 estimate)Thresholds:
- $654.30* for concessional patients and Family Tax Benefit Part A families
- $2,050* for all other Medicare card holders (subject to passage of legislation)
- Increases benefits for out-of-pocket costs above the threshold for the remainder of the calendar year
- Benefit caps apply to specified services including all consultation services
The Greatest Permissible Gap (2016 estimate)
Threshold: applies if the gap between the MBS (Medicare fee) and the benefit for a service is more than $80.30*
Benefit: increases Medicare benefits to the rebate minus $80.30*
* Safety net thresholds and figures are estimates and are subject to indexation by the Consumer Price Index.