With bulk-billing GPs becoming harder to find, many of the most vulnerable are delaying medical care or being forced to make tough choices between paying for healthcare, groceries and bills.
But a GP based in Victoria, Dr Sara Marzouk, says many families and couples are not aware that they could be eligible to be reimbursed by Medicare at a higher rate, cutting their out-of-pocket costs.
In order to qualify for the Extended Medicare Safety Net, they need to register their family unit with Services Australia, even if all family members are on the same Medicare card.
So how does it work?
What is the Extended Medicare Safety Net?
The Extended Medicare Safety Net is designed for individuals and families who have high out-of-pocket medical costs, perhaps because they have a chronic disease or a complicated condition.
Once you reach a certain amount in out-of-pocket medical fees each calendar year, the extended safety net kicks in, which means you will get a higher rebate back from the government for Medicare services from that point.
Marzouk says bulk billing is on the decline because doctors are increasingly charging fees due to the Medicare rebate being insufficient for practices to remain viable.
“This results in you being out of pocket a certain amount,” she said. But for people on the extended safety net, Marzouk said: “Medicare will now pay 80% of the out-of-pocket costs, slashing the amount you are paying.”
How do I get it?
If you are an individual with no dependants, Medicare keeps a tally of out-of-pocket costs you have paid and once the threshold is reached, you will receive the higher benefit for the rest of the year. This is why it is important to check your Medicare records to ensure you are being billed correctly by your medical practitioner.
Individuals without a concession card hit the threshold at $2,249.80 in out-of-pocket services.
For families with no concession card, the threshold is reached when the family has paid a combined total of $2,249.80. However, Marzouk says many couples and families don’t realise that having their children or spouse listed on their Medicare card does not automatically register them as a family for safety net purposes.
“You must fill out a form available on the Medicare Express app or the Services Australia website, explicitly stating that your spouse and dependents are one family unit, otherwise Medicare will consider you as seperate independents with a safety net threshold of $2,249.80 each, instead of $2,249.80 cumulatively,” she said.
Then, when your family is close to reaching the threshold, Services Australia will notify the nominated contact person for the family either by a myGov message or by post, and ask for confirmation of who is in the family so you can start receiving the increased rebate.
What’s the threshold for concession card holders?
Marzouk said if at least two people in the registered Extended Medicare Safety Net family have an eligible concession card, or if the family is eligible for Family Tax Benefit Part A, the safety net threshold is $717.90. And one of those two concession card holders must be the primary Medicare card contact.
While your GP visits and tests will still cost the same upfront, once you reach the safety net thresholds, the amount you receive back from Medicare after you have paid will be higher.
What services are covered?
Out-of-hospital services with your GP and specialists will count, as will some tests and scans like blood tests and CT scans.
“But what many people don’t realise is that services like GP-referred psychology also count,” Marzouk says. “Anyone with a mental health care plan knows how cost-prohibitive regular psychology sessions can be.”
