Unmasking Medicare: 3 insights you can't ignore
When I start to discuss Medicare with friends, it's typically the point where the eyes start to glaze over!
So let's lift the veil quickly and uncover the top 3 insights you need to understand. Right now!
1. Understanding Medicare Rebates
These are funds that go either directly to you or to the healthcare professional.
Bulk Billing - If your health professional offers "Bulk Billing", it's a win-win for you – you pay nothing, and Medicare compensates the health professional directly.
Gap Fee / Out of Pocket - If you pay the complete amount due to the health professional upfront, Medicare will then provide you with a partial refund, known as the "Rebate". The actual rebate amount varies depending on the healthcare professional and duration of the visit.
Let's break it down:
Full fee you pay minus minus Medicare rebate you receive = Gap Fee / Out of pocket (the actual amount you're out of pocket)
$275 – $93.35 = $181.65
2. The Extended Medicare Safety Net Threshold (EMSN)
All the gap fees you pay throughout the year accumulate towards your EMSN threshold.
In 2024, for most individuals, the threshold is $2,544.30, but for Concession Card Holders, it's a lower $811.80.
This EMSN threshold resets at the start of each year.
Once you hit the EMSN threshold, you receive 80% back on all gap fees on top of the Medicare Rebate. This means session costs at Rose Phoenix Health fall to between $27.59 - $36.33, depending on the clinician you see.
3. Registering for the Medicare Safety Net
For those who are part of a couple or a family on the same Medicare Card, registration for the EMSN threshold isn't automatic.
It's crucial to register as a couple or family so that all gap fees paid collectively count towards a single EMSN threshold. Get the form here: https://www.servicesaustralia.gov.au/ms016
You can monitor your Safety Net Threshold via your Medicare Online Account or the Express Plus Medicare Mobile App.
Valerie Judge at Rose Phoenix Health is also happy to help with any questions you might have., you can call on 0478 129 135.