Changes to Medicare Threshold

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 amountWho it is forHow it is calculatedWhat the benefit is
Original$430.90All Medicare cardholdersBased on gap amount100% of schedule fee for out of hospital services
Extended Concessional and
FTB Part A
$624.10Concession cardholders and families eligible for FTB Part AOut of pocket costs80% of out of pocket costs or the EMSN benefit cap for out of hospital services
Extended general$1,248.70All Medicare cardholdersOut of pocket costs80% 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
  • Parramatta
    Rivermark Level 6
    34 Charles St Parramatta NSW 2150
  • Canberra
    Level 1, The Realm
    18 National Circuit Barton ACT
  • Phone Toll Free: 1300 68 3937 [1300 Nu Eyes]