Extended Medicare Safety Net (EMSN) concessional threshold 011-43080010

The EMSN Concessional threshold is a lower MSN threshold for Commonwealth concession card holders and is indexed by the Consumer Price Index on 1 January each year.

The EMSN Concessional threshold amount can be found in Table 1 on the Resources page in Medicare Safety Net thresholds.

A customer may be eligible for the EMSN Concessional threshold if they are a:

• Commonwealth Seniors Health Card holder
• Health Care Card holder, or
• Pensioner Concession Card holder

The EMSN Concessional threshold can apply to:

• an individual,
• family where all members of the family are concession card holders, or
• sub-family where 2 or more members of the family are concession card holders, but not all.

A customer’s individual eligibility for the EMSN Concessional threshold commences from the date they become an eligible concession card holder. A customer only needs to be concessional for one day in a calendar year to be eligible for the EMSN Concessional threshold for the remainder of that calendar year. That is even if their entitlement to the concessional card ceases.

Where there are 2 or more concession card holders in a registered MSN family, the eligibility to the EMSN Concessional threshold for their family, or sub-family begins from the date the second members concession status commences.

Information that informs if a customer is a concession card holder is stored within Services Australia’s Pharmaceutical Benefits Scheme (PBS) patient database. The data is sent to Medicare nightly from Centrelink.

Gold or White Cards issued by the Department of Veterans’ Affairs do not provide eligibility to the EMSN Concessional threshold. However, if a Gold or White Card holder also holds a recognised Commonwealth concession card and chooses to be treated under Medicare arrangements, the customer is eligible for the EMSN Concessional threshold.

The Process page contains the procedure on how to check EMSN Concessional status.

Customer may contact Services Australia to enquire why their concessional status is not recognised for MSN purposes.

A Medicare Safety Net escalation form is available for Service Officers to complete when a customer:

• advises they are a concession card holder, and
• their concession is not reflected in CDMS for the relevant calendar year

For the escalation process see Table 3 on Process page.

If a customer holds an eligible concession card and is not part of a registered MSN family, their out-of-pocket (OOP) expenses accumulate toward their individual EMSN Concessional threshold. See When the EMSN Concessional threshold is met for details of the MSN benefits payable once the EMSN Concessional threshold is met.

If a customer is registered in an MSN family and is the only member with eligibility for the EMSN Concessional threshold, they are eligible for the EMSN Concessional threshold as an individual within that family registration. The customer’s OOP expenses accumulate towards:

• their individual EMSN Concessional threshold, and
• the registered Extended Medicare Safety Net (EMSN) family threshold.

Where a customer with eligibility to the EMSN Concession threshold reaches this threshold, while registered to a non-concessional MSN family they:

• will get the Medicare benefit, plus an MSN benefit for eligible services. See When the EMSN Concessional threshold is met, and
• their remaining OOP expense accumulates towards the family's EMSN General threshold

See the Resources page for an example of an eligible EMSN Concessional threshold individual.

To be eligible for the EMSN Concessional threshold as a family, the registered Medicare Safety Net (MSN) family must consist of members who are all eligible concessional card holders.

The family’s concessional status begins from the date the second family member becomes concessional, not from the date the first individual became concessional.

The out-of-pocket (OOP) expenses for all family members will accumulate towards the family EMSN Concessional threshold. See When the EMSN Concessional threshold is met for details of the MSN benefits payable once the EMSN Concessional threshold is met, and the MSN family has been confirmed.

Where not all family members of the registered MSN family hold an eligible concession card, some members may form a EMSN Concessional sub-family. See EMSN Concessional Sub-Family for more information.

See the Resources page for an example of an eligible EMSN Concessional family.

An EMSN Concessional sub-family occurs when:

• 2 or more customers in the registered Medicare Safety Net (MSN) family are eligible concession card holders, and
• one of the customers with a concession card is the MSN family contact (FC) or spouse (SP), and
• there are other members in the MSN family who do not hold an eligible concession card

When the above criteria are met, the family members eligible for the EMSN Concessional threshold form an EMSN Concessional sub-family. Their combined out-of-pocket (OOP) expenses accumulate toward the EMSN Concessional threshold, and the families EMSN General threshold.

All other members of the registered MSN family who do not hold an eligible concession card are only eligible for the EMSN General threshold. Their OOP expenses accumulate only towards the EMSN General threshold.

For concessional sub-families, CDMS displays both the General EMSN threshold as well as an additional Threshold type of CSN Sub Family. The date the sub-family became eligible for the EMSN Concessional threshold also displays.

The sub-family EMSN Concessional status begins from the date the second family member becomes concessional, not from the date the first individual became concessional.

Examples where a registered MSN family also includes an EMSN Concessional sub-family are:

• an FC and SP hold an eligible concession card and their dependents do not. The FC and SP form a EMSN Concessional sub-family. The dependents are not included in the EMSN Concessional sub-family
• a customer is the SP in a registered family and holds a valid concession card. Another member within the same registered family becomes concessional later in the calendar year. These two members form an EMSN Concessional sub-family

Note: where one or more dependents within an MSN family are EMSN Concessional and the FC or SP are not, the dependents are treated as individuals for the EMSN Concessional threshold. That is, they are not a sub-family.

See the Resources page for an example of an eligible EMSN Concessional sub-family.

If an individual or a confirmed registered Medicare Safety Net (MSN) family reaches the EMSN Concessional threshold, they are entitled to MSN benefits for the remainder of the calendar year for out-of-hospital services.

Customers who reach the EMSN Concessional threshold receive the Medicare benefit and the lowest of either:

• 80% of the out-of-pocket (OOP) expense amount
• EMSN benefit caps, see Extended Medicare Safety Net (EMSN) for more information

Note: a registered MSN family must confirm their family composition prior to MSN benefits being payable.

For information on how to view a family’s out-of-pocket expenses, see Table 6 on the Process page in Family registration and confirmation for Medicare Safety Net.