The Extended Medicare Safety Net (EMSN) is designed by Medicare to assist with health costs for families and individuals. It works just like the safety net for Prescriptions. You may find that suddenly a medical service under Medicare costs much less once you spend enough and become eligible for an increase rebate. The MSN is applied to all Medicare items for doctors, specialists and allied health. This means a visit to your local psychologist at our practice is more affordable once you have reached the MSN. Quite a few of our clients have spent time working through a yearly budget for healthcare, educated themselves on the EMSN and planned and budgeted around the cost.
This is directly quoted from the EMSN page:
Each time you pay an out of pocket cost, it’s calculated towards the EMSN threshold. Out of pocket costs are the difference between both of the following:
- the Medicare benefit you get back
- the doctor’s fee for out of hospital medical services.
The EMSN has 2 thresholds:
- General
- Concessional and Family Tax Benefit Part A
The threshold for those on a concession card is $811.80, and for those who get Family Tax Benefit A, or individuals/families on the same Medicare Card, the threshold is $2,544.00 (thresholds March 2024). These are updated on the 1st of January each year. If you are a family on the same card, you need to let Services Australia know so they can ensure your threshold comes from all your family on the same card. Sometimes the government makes minor changes, so best to always check with them online for details so you know of any more complicated situations and work out if your fits.
Let’s work through an example for an average family
Let’s say 2 adults and 2 children are on the same Medicare Card. One parent has some health issues and sees a doctor and specialist a few times a year. Over the course of the year, and including a few doctors visits that were not bulked billed they have spent about $100 week. In June they log on into their mygov app and check to see how close they are to reaching the threshold. They realise that they have spent about $3,500 and after getting the usual Medicare rebates back they have spent $2,522.30 of their own money on the gaps to an Orthopedic Surgeon, Gynecologist, 15 visits to their preferred GP who is not bulk billing. They also had allied health visits to a psychologist for one of their children.
If the psychologist charges $3000 for a series of consultations under a Mental Health Care Plan (recommended fee for psychology 40+ mins), the patient’s out-of-pocket cost before EMSN benefits are paid is $2166.50 (psychologist’s fee minus the MBS rebate received). Eighty per cent of the out-of-pocket cost would be equal to $1733.20. This amount is lower than the EMSN benefit cap of $3294.00, therefore, assuming the patient has reached the relevant EMSN threshold, the maximum EMSN benefit that the patient will receive is $1733.20. The total MBS benefit for this service is calculated to be $2566.70 (MBS rebate plus the EMSN benefit cap). As a result, the total cost incurred by the patient is $444.30 in 2024 for their full set of MHCP referrals from their GP or Psychiatrist. The effect of the psychologist billing at this rate means that the EMSN benefit cap has impacted on the patient’s out of pocket cost.
If the idea of choosing the best psychologist or allied health practitioner sounds like an affordable idea once you reach your EMSN, then please contact our staff and ask to speak to one of our team that has experience in the EMSN call (07) 3088 5422.
Most of our staff work casually, so when our more experienced administration staff member is on they will call you back for a chat to explain more about how this might work for you. And if you are on a concession/pensioner card then your threshold is easily met within 4-6 psychology visits and then every Medicare health practitioner for the rest of the year will be rebated at a higher rate. For concession card holders it’s budgeting that gap of $811.80 that will give your budgeting a break for the rest of the year.
For those seeking home visits that might be as affordable as about $55 gap fee per home visit under Medicare with a psychologist once the EMSN is reached. We also have flexible repayment plan options for those who need a little help to reach the EMSN. To read more about how to manage fortnightly payments read more here.
Details can be found online on the online MBS website.