Changes to Medicare Threshold
personalEYES | 12 Sep 2019
As you are all readers of the personalEyes website, then there is a fair chance you are pretty interested in eye care.
You may have realised by the description of cataracts and their symptoms from our other articles, you could well be a candidate for this surgery. If you are umm-ing and are-ing about getting it done – and it will be necessary if you have been diagnosed with this condition, then it may be helpful to know that there is going to be an increase to the general Extended Medicare Safety Net threshold from next year.
The Government announced as part of the 2013-14 Budget that the general (upper) Extended Medicare Safety Net (EMSN) threshold will be increased to $2,000 on 1 January 2015. It currently sits at $1248.70, so it is quite a hike before the benefits kick in.
Below is the current schedule as shown on the Australian Government Human Services Department website.
2014 Medicare Safety Net Thresholds
|Threshold amount||Who it is for||How it is calculated||What the benefit is|
|Original||$430.90||All Medicare cardholders||Based on gap amount||100% of schedule fee for out of hospital services|
|Extended Concessional and
FTB Part A
|$624.10||Concession cardholders and families eligible for FTB Part A||Out of pocket costs||80% of out of pocket costs or the EMSN benefit cap for out of hospital services|
|Extended general||$1,248.70||All Medicare cardholders||Out of pocket costs||80% of out of pocket costs or the EMSN benefit cap for out of hospital services|
Out of pocket costs is the difference between the Medicare benefit and what your doctor charges you.
Schedule fee is a fee for service set by the Australian Government.
Gap amount is the difference between the Medicare benefit and the schedule fee.
Other information included on this site relating to the increase is a follows:
- This change only affects those on the upper threshold of the EMSN. Families that receive Family Tax Benefits (part A) and all Commonwealth Concession card holders will not be impacted by the change.
- The EMSN provides an additional Medicare benefit once an annual threshold in out-of-pocket costs for out-of-hospital services has been reached. Out-of-hospital services include GP and specialist attendances, as well as many pathology and diagnostic imaging services.
- This measure does not change how much people receive in benefits once they qualify for the EMSN.
- The 2013 Extended Medicare Safety Net thresholds are: $610.70 for Commonwealth Concession cardholders and families who receive Family Tax Benefit (part A) and $1,221.90 for all other singles and families.
- The Extended Medicare Safety Net thresholds are indexed by the Consumer Price Index on 1 January each year.
- If you are in the category which will feel the impact of this increase, and cataract surgery is on your agenda, then clearly there is a financial benefit in having it performed prior to January 1st 2015. After this date it will impact on your out-of-pocket expenses.
For further information on the health of your eyes, contact personalEYES in their clinics at:
- Sydney CBD
Level 11, 33 York Street Sydney NSW 2000
Rivermark Level 6
34 Charles St Parramatta NSW 2150
Level 1, The Realm
18 National Circuit Barton ACT
- Phone Toll Free: 1300 68 3937 [1300 Nu Eyes]