I want to share with you how to keep more money in your pocket when paying for health care expenses*. There are a few things I will need to explain about Medicare, but I promise this will be an easy read and totally worth it.
I will cover:
- Medicare and Rebates
- Extended Medicare Safety Net (EMSN)
- Medicare Safety Net Registration
To begin with, so that we’re all talking the same language, here are some definitions for common words that will be used.
Fees – the total amount of money you pay for the session or service.
Out of Pocket Fees – this is the difference between the total Fees you pay and the Rebate you get back from Medicare.
Patient Claim – where you pay the total Fees for the session or service and Medicare pay you a Rebate.
Rebate – a partial refund of the Fees paid to you by Medicare.
1. Medicare and Rebates
I want to give an example of how you get money back in your pocket after paying for a health care service such as The Edge. This example is designed to demystify Medicare and Rebates.
Example: You already have a Mental Health Care Plan (MHCP) from your GP. You attend your first session at The Edge with a Mental Health Social Worker. The cost (or Fee) for that session is $250, which you pay in full. You then tell Medicare about the Fee you paid, also known as a Patient Claim. Because you have a MHCP, you are eligible for a Rebate from Medicare. This means Medicare will pay you a partial refund of the Fees you paid, in this instance $77.10. Overall, after having paid the full Fee and then receiving your Rebate, your Out of Pocket Fees were $172.90.
2. Extended Medicare Safety Net
The next part I want to share is about reaching the threshold for the Extended Medicare Safety Net (EMSN). When I checked in with friends whether they knew about the ESMN, nobody knew. That’s why I want to share this with you.
I’ll give you an example of how to reach Extended Medicare Safety Net (EMSN) threshold and how this allows you to get back 80% of Out of Pocket Fees. The Out of Pocket Fees for sessions and GP appointments are added together throughout each calendar year. The accrual of Out of Pocket expenses are added to your EMSN.
Example: You continue to see a Mental Health Social Worker with The Edge on a fortnightly basis. Each session your Out of Pocket Fees are $172.90. You have also attended a few GP appointments where you also had Out of Pocket Fees.
When you have paid $2184.30 in Out of Pocket Fees (or $697 if you are on a Concessional and Family Tax Benefit Part A), you have reached the EMSN threshold. You now become eligible to receive 80% back from Medicare for all remaining Out of Pocket Fees for the rest of the calendar year. The EMSN resets each January.
With that in mind, let’s assume you have reached the EMSN before you attend your next session with The Edge, your Out of Pocket Fee for that session is only $34.58.
3. Medicare Safety Net Registration
One final thing you need to know about with the EMSN safety net, is that couples and families can complete a Medicare Safety Net Registration Form which then links all family health care expenses* together. This will help you reach the EMSN threshold quicker.
* health care expenses for out-of-hospital services: include general practitioner (GP) and specialist attendances, such as therapy under a mental health care plan, many pathology and diagnostic imaging services
Disclaimer: The Out of Pocket Fees once you have reached the EMSN threshold may vary from those listed in the examples and will vary depending on Rebates for other services and Out of Pocket Fees paid by other services.