Changes to the Extended Medicare Safety Net (EMSN)
From the 1st of January 2010, the Australian Federal Government introduced a cap on some services paid through the Extended Medicare Safety Net (EMSN); an additional rebate for individuals or families who incur out-of-pocket costs for out-of hospital services including general practitioners and specialist visits.
Prior to this change, when an individual or a family’s out-of-pocket costs exceed a certain threshold amount in a calendar year, 80% of out-of-pocket costs incurred through the use of out-of-hospital services is paid through the EMSN for the rest of the calendar year.
For example if Jane undergoes a pregnancy scan which costs her $200. She will receive $60 back from Medicare under the standard Medicare benefits Schedule rebate, leaving her with $140 out-of-pocket cost.
Previous to 2010, if Jane had reached her EMSN for the year, she would receive $112 back from Medicare under the EMSN (80% of out-of-pocket). Therefore the maximum Medicare benefit Jane could claim was $172.
However, due to the introduction of benefit limits, she can only claim a capped amount of $35.55 under the EMSN rebate. Add this to the Medicare Benefit Schedule rebate; Jane would be only eligible to claim a maximum Medicare benefit of $95.05.
Services affected by new EMSN Benefit Limits include:
- 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
What does this change mean?
If you or a family member needs to see a doctor or have medical tests regularly you could end up with high medical costs. The new caps on EMSN benefits can have a dramatic affect on out-of-pocket costs. If you or a family member needs to undergo any of the following services in the near future...
- GP and specialist consultations
- Ultrasounds
- Pap tests
- Blood tests
- CT Scans
- X-rays
Its time to consider how your health insurance can continue to provide security for your family.