Policy and Advocacy

Changes to the Medicare Safety Net

Changes to Medicare Safety Net arrangements, were introduced to Parliament by the Government on Wednesday 21 October.

This legislation follows up on the Government’s 2014 Budget commitment to create a Single Medicare Safety Net (SMSN) for out-of-hospital services form 1 January 2016.

These changes will significantly increase out of pocket costs for many Victorians.

From 1 January 2016 the Single Medicare Safety Net (SMSN) will have three thresholds:

  1. $400 – for singles with a concession card or families with a concession card
  2. $700 – for singles with no concession card or families receiving Family Tax Benefits Part A with no concession card
  3. $1000 – for families with no concession card.

From 1 January 2016 there will be a limit on the out-of-pocket costs that count towards the threshold.

Once the relevant threshold has been reached Medicare will pay up to 80% of any future out-of-pocket costs for out-of-hospital Medicare Services for the remainder of the calendar year capped at a maximum of 150% of the MBS Fee (this includes both the standard benefit and safety net benefit).

This means that regardless of the fee charged a patient will only receive a maximum of 150% of the MBS Fee in their rebate even where this amount is less than 80% of the out-of-pocket costs. 

From 1 January 2016 some patients will be better off and others will face increased costs.

AMA Victoria has developed an information sheet and calculator for members to use to assess the impact on their patients. The information sheet provides more detailed information on the proposed changes and breaks down the impacts on several item numbers. The Excel file will allow you to calculate the cost impact on your patients of the fee that you charge under the new arrangements.

More information on the changes is also available at the following links:

http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-NewMedicareSafetyNet

http://www.health.gov.au/emsn

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