{"templateId":"markdown","sharedDataIds":{"sidebar":"sidebar-docs/sidebars.yaml"},"props":{"metadata":{"markdoc":{"tagList":[]},"type":"markdown"},"seo":{"title":"Medicare safety net calculations","llmstxt":{"hide":false,"sections":[{"title":"Table of contents","includeFiles":["**/*"],"excludeFiles":[]}],"excludeFiles":[]}},"dynamicMarkdocComponents":[],"compilationErrors":[],"ast":{"$$mdtype":"Tag","name":"article","attributes":{},"children":[{"$$mdtype":"Tag","name":"Heading","attributes":{"level":1,"id":"medicare-safety-net-calculations","__idx":0},"children":["Medicare safety net calculations"]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["There are different thresholds for the Medicare Safety net and the benefit paid differs depending on which threshold has been reached. See below:"]},{"$$mdtype":"Tag","name":"table","attributes":{},"children":[{"$$mdtype":"Tag","name":"tr","attributes":{},"children":[{"$$mdtype":"Tag","name":"th","attributes":{},"children":[]},{"$$mdtype":"Tag","name":"th","attributes":{},"children":[" Threshold amount"]},{"$$mdtype":"Tag","name":"th","attributes":{},"children":[" Who it is for"]},{"$$mdtype":"Tag","name":"th","attributes":{},"children":[" How it is calculated"]},{"$$mdtype":"Tag","name":"th","attributes":{},"children":[" What the benefit is"]}]},{"$$mdtype":"Tag","name":"tr","attributes":{},"children":[{"$$mdtype":"Tag","name":"td","attributes":{},"children":["Original"]},{"$$mdtype":"Tag","name":"td","attributes":{},"children":["$421.70"]},{"$$mdtype":"Tag","name":"td","attributes":{},"children":["All Medicare cardholders"]},{"$$mdtype":"Tag","name":"td","attributes":{},"children":["Based on gap amount"]},{"$$mdtype":"Tag","name":"td","attributes":{},"children":["100% of schedule fee for out-of-hospital services"]}]},{"$$mdtype":"Tag","name":"tr","attributes":{},"children":[{"$$mdtype":"Tag","name":"td","attributes":{},"children":["Extended Concessional and FTB (A)"]},{"$$mdtype":"Tag","name":"td","attributes":{},"children":["$610.70"]},{"$$mdtype":"Tag","name":"td","attributes":{},"children":["Concession cardholders and families eligible for FTB (A)"]},{"$$mdtype":"Tag","name":"td","attributes":{},"children":["Out-of-pocket costs"]},{"$$mdtype":"Tag","name":"td","attributes":{},"children":["80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services"]}]},{"$$mdtype":"Tag","name":"tr","attributes":{},"children":[{"$$mdtype":"Tag","name":"td","attributes":{},"children":["Extended general"]},{"$$mdtype":"Tag","name":"td","attributes":{},"children":["$1,221.90"]},{"$$mdtype":"Tag","name":"td","attributes":{},"children":["All Medicare cardholders"]},{"$$mdtype":"Tag","name":"td","attributes":{},"children":["Out-of-pocket costs"]},{"$$mdtype":"Tag","name":"td","attributes":{},"children":["80% of out-of-pocket costs or the EMSN benefit cap for out-of-hospital services"]}]}]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Under the extended thresholds, rather than paying 100% of the MBS, Medicare will pay 80% of the out of pocket expenses OR either the entire cap, or 80% of the cap (language is unclear). For an item 23, the extended Medicare safety net (EMSN) cap is $108.90."]},{"$$mdtype":"Tag","name":"Heading","attributes":{"level":3,"id":"example","__idx":1},"children":["Example"]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["A patient classed as Extended General is entitled to 80 % of the out-of-pocket expenses they incur when visiting the doctor, if they have exceeded the yearly threshold ($1221.90). If the doctor charges $100 for the fee then the rebate would be calculated as follows:"]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Total Practice Fee ($100) = MBS Item 23 ($36.30) + Practice Gap ($63.70)"]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Patient's Total Out of Pocket Expenses ($63.70) = Practice Gap ($100) - MBS Item 23 ($36.30)"]},{"$$mdtype":"Tag","name":"p","attributes":{},"children":["Total Rebate to Patient ($87.26) = 80 % of Patient's Out of Pocket Expenses ($50.96) + MBS Item 23 ($36.30)"]}]},"headings":[{"value":"Medicare safety net calculations","id":"medicare-safety-net-calculations","depth":1},{"value":"Example","id":"example","depth":3}],"frontmatter":{"title":"Medicare safety net calculations","seo":{"title":"Medicare safety net calculations"}},"lastModified":"2026-10-02T05:06:47.000Z","pagePropGetterError":{"message":"","name":""}},"slug":"/docs/in-person-payments/pay-in-person/features/medicare-easyclaim/safety-net-calculations","userData":{"isAuthenticated":false,"teams":["anonymous"]},"isPublic":true}