What the Medicare Safety Net does

If you have a lot of appointments in one calendar year, the Medicare Safety Net increases what Medicare pays you back once your costs pass an annual threshold. Everything resets on 1 January.

The two safety nets

• The Original Medicare Safety Net counts the difference between your rebate and the government's schedule fee, which is the reference amount Medicare sets for each service. This is a small amount per appointment.
• The Extended Medicare Safety Net, or EMSN, counts what you are actually out of pocket. Its threshold is higher, but because specialist fees sit above the schedule fee, most people reach it first. It is usually the one that makes a real difference.

Reaching the threshold sooner

• The EMSN threshold is significantly lower if you hold a concession card or receive Family Tax Benefit Part A. If that applies to you, you may reach it sooner than you expect.
• Individuals are counted automatically. Couples and families need to register with Services Australia to combine their costs, and you need to register even if everyone is already on the same Medicare card.
• Only appointments you have paid for in full count toward your total. Because we take payment on the day, your costs count straight away.

What you get back

Once you pass the EMSN threshold, Medicare pays back up to 80 percent of your out-of-pocket cost for each further appointment. There is a limit on how much it will pay for any single consultation, so you will usually still have some out-of-pocket cost.

For example: if your appointment fee is $400 and your rebate is $250, you are $150 out of pocket. You pay that $150 each time until you reach the threshold. After that, Medicare pays back 80 percent of it, so the same appointment costs you $30 for the rest of the year.

What applies to your appointments

• Psychiatry. Consultations and reviews attract a rebate with a valid referral from your GP or another specialist.
  If you have seen a psychiatrist in the past 12 months, your rebate for a first appointment may be lower than expected, because Medicare limits how often initial assessment items can be claimed. You can check your eligibility with Medicare on 132 011 before your appointment.
• Psychology. Rebates are available for up to 10 individual sessions per calendar year under the Better Access initiative. You will need a Mental Health Treatment Plan and a referral from the GP at your MyMedicare practice or your usual GP. Your GP reviews your progress before referring you for any further sessions. Without a plan, psychology is still available privately or through private health extras cover.
• TMS. Rebates are available for eligible patients with treatment-resistant depression. Because TMS involves a course of daily sessions, it is the treatment where the Safety Net makes the most difference. Ask us how it is likely to apply to you before you start.

Checking where you are up to

Current thresholds and your running total are on the Services Australia website, in your Medicare online account through myGov, in the Express Plus Medicare app, or by calling 132 011.