There are different thresholds for the Medicare Safety net and the benefit paid differs depending on which threshold has been reached. See below:
| Threshold amount | Who it is for | How it is calculated | What the benefit is | |
|---|---|---|---|---|
| Original | $421.70 | All Medicare cardholders | Based on gap amount | 100% of schedule fee for out-of-hospital services |
| Extended Concessional and FTB (A) | $610.70 | Concession cardholders and families eligible for FTB (A) | Out-of-pocket costs | 80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services |
| Extended general | $1,221.90 | All Medicare cardholders | Out-of-pocket costs | 80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services |
Under the extended thresholds, rather than paying 100% of the MBS, Medicare will pay 80% of the out of pocket expenses OR either the entire cap, or 80% of the cap (language is unclear). For an item 23, the extended Medicare safety net (EMSN) cap is $108.90.
A patient classed as Extended General is entitled to 80 % of the out-of-pocket expenses they incur when visiting the doctor, if they have exceeded the yearly threshold ($1221.90). If the doctor charges $100 for the fee then the rebate would be calculated as follows:
Total Practice Fee ($100) = MBS Item 23 ($36.30) + Practice Gap ($63.70)
Patient's Total Out of Pocket Expenses ($63.70) = Practice Gap ($100) - MBS Item 23 ($36.30)
Total Rebate to Patient ($87.26) = 80 % of Patient's Out of Pocket Expenses ($50.96) + MBS Item 23 ($36.30)