Medicare Safety Net thresholds 011-43080100

MSN have thresholds. These are the dollar amounts that an individual or a registered MSN family must reach in eligible gap amounts or out of pocket (OOP) expenses.

Once reached, they are entitled to get MSN benefits for out of hospital services.

There are 3 thresholds:

• Extended Medicare Safety Net (EMSN) - General
• Extended Medicare Safety Net (EMSN) - concessional and Family Tax Benefit (FTB) Part A
• Original Medicare Safety Net (OMSN)

The Department of Health, Disability and Ageing set threshold amounts each year from 1 January.

See the Resources page for:

• the MSN threshold amounts for current and previous years
• a link to more details about the different MSN threshold types
• examples of how gap amounts and OOP expenses are calculated

The EMSN General threshold applies to all customers enrolled in Medicare.

It includes registered families who are not eligible under the:

• Concessional threshold
• Family Tax Benefit (FTB) Part A threshold

See Extended Medicare Safety Net (EMSN) for more details about eligibility.

Reaching the EMSN General threshold

Each time a customer pays an out of pocket (OOP) expense on an eligible MBS service it contributes towards the EMSN threshold.

An OOP expense is the difference between the:

• doctors fee for out-of-hospital services, and
• Medicare benefit paid

When an individual or a confirmed registered MSN family reaches this threshold, MSN benefits are automatically calculated and paid:

• in addition to the standard Medicare benefit
• for the rest of the calendar year
• for out-of-hospital Medicare services

Note: OOP expenses for out-of-hospital services with a date of service in the calendar year of registration are counted towards the threshold amount. However, no EMSN benefits are paid for services performed before the family registration date.

The Resources page has examples of how OOP expenses are calculated.

See Extended Medicare Safety Net (EMSN) for more details about:

• eligibility for EMSN
• accumulation rules of OOP expenses
• how MSN benefit amounts are calculated

Concessional threshold

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

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

See Extended Medicare Safety Net (EMSN) concessional threshold for more details about:

• Concessional threshold eligibility
• MSN benefits payable

FTB Part A threshold

• Customers that get Family Tax Benefit (FTB) Part A are eligible for this threshold if they are part of a registered MSN family
• The date they are eligible depends on when and how they receive the FTB Part A payment

See Extended Medicare Safety Net (EMSN) - Family Tax Benefit (FTB) Part A threshold for more details about:

• FTB Part A threshold eligibility, including a family's eligibility start date
• accumulation of out of pocket (OOP) expenses

The OMSN threshold applies to all customers enrolled in Medicare, including registered families.

Individual eligibility

An individual is a customer who is not part of a registered MSN family. Their:

• eligibility starts when they enrol in Medicare
• eligible gap amounts accumulate toward their OMSN threshold

When they reach their OMSN threshold, MSN benefits are automatically calculated and paid for eligible out-of-hospital services, for the remainder of the calendar year.

Family eligibility

An MSN family is a family, couple or individual with dependent children who register to combine their expenses. A registered MSN family’s:

• eligibility starts from the date they register for the MSN
• eligible gap amounts accumulate toward their OMSN threshold

MSN benefits are automatically calculated and paid for eligible out-of-hospital services when:

• the registered family reaches the OMSN threshold, and
• members have been confirmed for that calendar year. See Amend or confirm a registered Medicare Safety Net family for more details

Accumulation of verified gap amounts for OMSN

Gap amounts:

• contributes towards the OMSN threshold
• are the difference between the:
• MBS item’s schedule fee for out-of-hospital services, and
• Medicare benefit paid

Schedule fees are set by the Department of Health, Disability and Ageing and may not be the fee the doctor or health professional charges.

The Resources page provides an example of how the gap amount is calculated.

Reaching the OMSN threshold

If an individual or a confirmed registered MSN family reaches the OMSN threshold, the standard Medicare benefit for eligible services will increase from 85% to 100% of the schedule fee for the remainder of the calendar year.

Note: GP services are paid at 100% of the schedule fee, therefore no further benefit applies under the OMSN threshold.

Service Officers can view MSN threshold details for both individuals and registered MSN families in CDMS.

The Process page contains more details.

Customers can view their MSN balance using their Medicare online account if they are:

• an individual, or
• the family contact (FC) or spouse/partner (SP) of a registered MSN family

See Accessing and using Medicare self service.