Simplifying Medicare safety net arrangements

From 1 January 2016 a Single Medicare Safety Net (SMSN) for out-of-hospital services will replace the Extended Medicare Safety Net (EMSN), the Original Medicare Safety Net (OMSN) and the Greatest Permissible Gap (GPG).

This measure has not started. It is subject to the passage of legislation.

Description of the measure

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

The definition of ‘family’ will also be broadened to include those under 22 years of age that are financially dependent on their parents, as well as couples living apart, due to ill health or injury.

Questions and answers

Who will be affected by this measure?

Patients that previously qualified for the EMSN, OMSN and GPG may be affected by this measure.

A limit will be introduced on the amount of out-of-pocket costs for each service received which accumulates towards a patient’s safety net threshold. The amount of additional Medicare benefit payable once they reach the safety net threshold will also be reduced. Providers that bill patients directly for their services will also need to be aware of these changes.

Am I eligible for this measure?

People eligible for Medicare benefits will be eligible for additional benefits under the Single Medicare Safety Net, once they have reached their threshold.

The measure will change the way people qualify for benefits under the Medicare Safety Net. There will be a limit on how much of their out-of pocket costs can accumulate towards their safety net threshold, and how much additional benefit is payable once they have crossed the safety net threshold.

When will this measure start and finish?

This measure will start on 1 January 2016 and will be ongoing.

Page last updated: 16 March 2016

This information was printed Sunday 2 October 2016 from humanservices.gov.au/corporate/budget/budget-2014-15/budget-measures/health-matters-and-health-professionals/simplifying-medicare-safety-net-arrangements It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.