Jump to content

Medicare Safety Net
Please help me understand!


  • Please log in to reply
16 replies to this topic

#1 NinjaMum

Posted 01 January 2013 - 11:16 AM

2012 we hit the medicare safety net due to specialist appointments. I didn't question much, just took it gratefully, and went on our merry way.

However, now it's 2013 and we're back to starting from scratch on the safety net. I have looked at the Dept. Human Services website, and I don't understand it. I am wanting to try and calculate how long it will take us to hit the safety net this year. DH has a weekly Psychiatrist appointment costing $280, plus will probably have a few GP and other specialist appointments in the first few months of the year.

The website talks about 3 different thresholds:

  • Original - $421.70
  • Concessional & FTB A - $610.70
  • Extended General - $1221.90


How do I know which one is the threshold for our family/My DH? We don't qualify for FTB A, so I'm ignoring that one. I'm guessing it will be the Extended General threshold which will apply to us? I'm also looking at keeping tabs on the PBS safety net too, as he has been on a fair bit of medication this past 12 months.

Any help to understand this, is gratefully appreciated!

#2 Acidulous Osprey

Posted 01 January 2013 - 11:23 AM

You would be on the Extended and once you have paid out the $1221.90 in gap fees (the gap between the specialist fee and the medicare refund) you will be eligible for the safety net.

To calculate it, look at how much you paid and the difference in how much you got back.  So if the bill is $280 and medicare refund $120, the remaining $160 goes to the safety net.

The medication one takes a lot to fill.  I've got 3 people on several meds each and we only reach it in October usually.

#3 Isolabella

Posted 01 January 2013 - 11:23 AM

Yep you would be on extended general of $1221.90

So that is out if pocket expenses after Medicare has paid you claim.

Eg Dr bill of $70. Medicare pays $35 so you ave $25 go towards your threshold of $1221.90. Medicare will automatically increase your payments once you reach the threshold.

PBS if you use one pharmacy should be able to tell you where you are at. Also you can ask Medicare how close you are to the threshold.

#4 FeralAlpacasFool

Posted 01 January 2013 - 11:30 AM

Can I please ask what is the difference between original and the extended general? Ie how do I know which applies to us? We reached the threshold months ago.

Edited by lovealpacas, 01 January 2013 - 11:31 AM.


#5 Acidulous Osprey

Posted 01 January 2013 - 11:35 AM

I don't know the difference between general and original.

The safety net resets for meds and medicare on Jan 1 every year so we are all back at ground zero. One year we had paid our safety net by Feb 8.  Certainly hoping for a better year this year.

#6 Isolabella

Posted 01 January 2013 - 11:48 AM

Original Medicare safety net
Under the original Medicare safety net, once an annual threshold in gap costs has been reached, the Medicare rebate for out-of-hospital services is increased to 100% of the schedule fee (up from 85%). Gap costs refer to the difference between the standard Medicare rebate (85% of the schedule fee) and the actual fee paid, but limited to 100% of the schedule fee. The threshold for calendar year 2012 is $413.50. This threshold applies to all Medicare-eligible singles and families.

http://en.wikipedia....care_(Australia)

So there is another sub tier. Normally Medicare pays you 85% of their scheduled fee ( ie Medicare scheduled fee not what Dr charges). So if Medicare says scheduled fee is $50 you initially get $42.50, but once you hit $400 or soo of the $7.50 difference you then get back the full $50. But this will be whether your Dr is charging you $90 for the appt. One you hit the $400 or so of the 15% difference you would get 100% of the Medicare rebate payable....... But you still have to hit the $1221 valve to get 80% of you out of pocket fees back ( ie difference between what Medicare pays you vs what the Dr charges).

So the first threshold will not substantially change what you get back if you Dr charges high above Medicare Sch fee.



#7 Coffeegirl

Posted 01 January 2013 - 11:52 AM

From what I can tell the general is based on the accumulation of the GAP amount, but the Extended General is based on your Out-of-pocket



Out-of-pocket costs—the difference between the Medicare benefit and what your doctor charges you.

Schedule fee—a fee for service set by the Australian Government.

Gap amount—the difference between the Medicare benefit and the schedule fee.





#8 NinjaMum

Posted 01 January 2013 - 01:44 PM

Ugh, it's a bit confusing isn't it.

Thank you so much PPs for taking the time to try and explain it! It sounds like I should just ignore the Original one, and calculate it from the Extended one. This would mean by my estimate we'll hit the safety net during March some time.

We use different pharmacies (it's really whatever pharmacy is on my way to wherever I happen to be going when DH is close to running out of medication) so for the PBS I'm of the understanding I will have to keep a piece of paper with labels on it(?) and keep a physical tally. I'm not sure if we'd reach the PBS or not though, as I honestly don't know how much of it we covered last year. I do know some of DH's medications were capped at $35.40.


#9 JRA

Posted 01 January 2013 - 06:59 PM

you shouldnt need to keep track of the medicare one, the do that, so as soon as you hit, the change the refund

#10 Sloane Peterson

Posted 01 January 2013 - 07:07 PM

I just received a letter from Medicare dated December 28, received December 31, advising me,that my family was 'close' to reaching the safety net threshold for the 2012 year, and could I please confirm some details!  happy.gif

#11 elmo_mum

Posted 01 January 2013 - 07:16 PM

QUOTE
Sloane Peterson Posted Today, 08:07 PM
I just received a letter from Medicare dated December 28, received December 31, advising me,that my family was 'close' to reaching the safety net threshold for the 2012 year, and could I please confirm some details!


doh

#12 NinjaMum

Posted 02 January 2013 - 09:50 AM

JRA - I know I don't need to keep track of it, but it will help with budgeting. It means a couple of really financially tight months for us until the Safety Net kicks in, so it's more of a light at the end of the tunnel kind of thing. The PBS on the other hand, I've been led to believe I do need to keep a track of this one?

Sloane Peterson - At least they're efficient? laughing2.gif

#13 Futureself

Posted 02 January 2013 - 10:02 AM

QUOTE (NinjaMum @ 02/01/2013, 09:50 AM) <{POST_SNAPBACK}>
The PBS on the other hand, I've been led to believe I do need to keep a track of this one?

Yes, you do as there's no centralised prescription system. Pick up your card with your first script and then keep it with your repeats. Every time you get a script done (seperate cards per person), give them the card too to get the script sticker put in. Once you've filled it the pharmacy you've gone to will keep it to process and it will added centrally then. Painful but necessary if you want to be sure. The other option, if you only go to 2 or 3 different places is to stop by and get a printout every few months or half way through the year  from each to see how you're going and you can hand the printoust showing the totals to the one place once you've reached the threshold to be processed.

#14 elizabethany

Posted 02 January 2013 - 10:02 AM

The medication safety net hits once you have filled 52 scripts on PBS in any given year.  Scripts where you pay the full fee do not count towards this safety net.  You need to keep a record of this, and you can get your pharmacist to give you a small folder, so you just present this wherever you fill your scripts.

http://www.humanservices.gov.au/customer/s.../pbs-safety-net

#15 notorico

Posted 04 January 2013 - 04:55 PM

I am not 100% sure how it works, but towards the end of last year we as a family were getting close to the extended limit. DS however, who has a healthcare card, reached some sort of individual limit earlier in the year so I was getting the extra back for him only, but appointments for the rest of the family were only getting the basic medicare entitlement.

Hope this helps, perhaps you could call and ask. DS starts back at his regular psych appointments next week and I am not looking forward to the out of pockets now the safety net has been reset.

#16 FeralLIfeHacker

Posted 04 January 2013 - 07:53 PM

I am confused as well, I've never worried about it before but since I now take handfuls of meds daily I thought I should check it out.  I think I will ask about the PBS one at the pharmacy. I think dh asked him last year and he said to come in January and he'd give us a card to keep and present when filling the scripts.

#17 leo the lioness

Posted 13 January 2013 - 03:34 PM

QUOTE (Sloane Peterson @ 01/01/2013, 08:07 PM) <{POST_SNAPBACK}>
I just received a letter from Medicare dated December 28, received December 31, advising me,that my family was 'close' to reaching the safety net threshold for the 2012 year, and could I please confirm some details!  happy.gif



Same thing happened to me except mine was dated 21 December and I didn't receive it until the 3 January 2013!




1 user(s) are reading this topic

0 members, 1 guests, 0 anonymous users

 

Win a Mountain Buggy Swift

To celebrate Essential Baby reaching half a million Facebook fans, we have a Mountain Buggy Swift to giveaway to a lucky fan.

Shopping with kids: breaking the pester-power cycle

You're out shopping with your little one and they're incessantly whining that they want a treat. It's easy to say no ... the first time, at least.

eBay jacket may hold clue to murdered girl's identity

A jacket similar to the one found with the remains of a brutally murdered little girl in South Australia has been identified on eBay.

New mum forced back to work early due to paid parental leave 'technicality'

Shelley Parker had to keep driving buses until the date her baby was due and will have to rush back to work at the end of this week after being denied paid parental leave on a "technicality".

Pregnant Amanda Palmer poses naked for book drive

It has to be the most original way ever of promoting a children's book donation day.

The conception dilemma facing many parents today

Some parents who conceived through a sperm donor will be wary of telling the child, while others prefer to deal with it early on. But recent research suggests it makes little difference either way.

The wedding photo the bridesmaid would rather forget

We've probably all seen a passed-out bridesmaid at one wedding or another, but it usually happens towards the end of the night.

Pregnant TV meteorologist takes on haters

Pregnant TV meteorologist Katie Fehlinger has hit back at haters who called her a "sausage in casing".

Honest words from first-time mums

I didn't want to say anything negative to my pregnant friend, but I wish I'd been more honest.

Adorable baby experiences rain for the first time, couldn't be happier

Harper had seen rain from the comfort of indoors before, but had never had the pleasure of being outside and experiencing it first hand.

What it's really like to start a family in your fifties

Many people suppose that it must be much more tiring to have a baby in middle age, but all the mothers in the playground look exhausted, whatever their age.

'Biggest hypocrite ever': Josh Duggar admits to Ashley Madison account

An American reality TV star has been busted with a cheating website account, according to US media.

Long recovery ahead for girl hit by car weeks after baby brother's death

A little girl is more alert and starting to talk after being hit by a car a week ago, but still faces a long recovery.

How to react when a toddler lies

Q: My almost-3-year-old is starting to figure out that he can lie when asked if he ripped the book, threw the food, hit his brother, etc. Totally normal, I know. How do we respond?

The circular experience of a Centrelink client

A mum-to-be experiences the frustration of dealing with Centrelink, myGov and everything in between.

Kelly Clarkson announces live on stage: 'I'm pregnant!'

Singer Kelly Clarkson has announced she is pregnant with her second child during a concert in Los Angeles.

Hack

How to search the leaked Ashley Madison data

At least three sites are republishing Ashley Madison's user data on the public-facing internet.

Mum dances her way through labour

There are a fair few ways to distract yourself and beat pains while in labour, but it's probably a rare woman who chooses her dance her way through it.

'Rest in peace, my little lion': premmie baby Jacob passes away

Baby Jacob, whose photo of him born at just 27 weeks was deemed 'too graphic' for a fundraising site, has died.

Mum killed three young sons 'to help her daughter', prosecutor says

Niall Pilkington's death last summer apparently raised little alarm in Bellefontaine, Ohio. Tragic accidents happen, after all.

Shorter women have shorter pregnancies: study

When a group of researchers studied nearly 3500 mothers and their babies, they noticed a curious pattern.

Get your FREE Baby & Toddler Show ticket!

Get your free ticket to the Sydney Essential Baby & Toddler Show for September 25-27 - register online now.

 
Advertisement
 
Advertisement
 
 
 

What's hot on EB

The worst 20 minutes of my life

Thirty seconds was all it took to turn a shopping trip into my worst nightmare.

Top baby names for England and Wales in 2014

George has overtaken William in the official rankings of most popular British baby names - and Game of Thrones is still having an impact on parents.

Baseball or baby? Dad's tough choice

What's more important, a baby or a baseball? That's a question this dad seems to struggle with.

Childbirth choices: five star or free?

It's not often you hear the words labour and luxury in the same sentence but for some, a 5-star start to parenthood is exactly what they seek. And with a number of private hospitals now offering packages which include a post-birth stay at a sumptuous first class resort, many mums are choosing to recover in style.

'Where did your boobies go, Mummy?' and other soul-destroying comments from kids

Most women carry a smidge of baby weight after giving birth. If you're lucky enough to have an older child in the house, they can keep you on track with your weight loss goals.

Do you read me, baby?

Is it too soon to be reading to my two-month-old son? If not, what should I read?

Minimising sibling rivalry when you've got a baby

Sibling rivalry is an act of competition, but if your children feel involved and special, this type of jealousy will be minimised.

Will studying on maternity leave take you away from your most important job?

I remember when I was trying to decide if I could combine motherhood and furthering my university education.

Win a Pacapod this Father's Day

To celebrate dads and families, we are giving away a Picos Pack from Pacapod Australia filled with a few extra goodies ENTER NOW

Preschooler hit by car shortly after baby brother's death

A mother has had a frantic race to the hospital after her daughter was hit by a car, just four weeks after her infant son died.

Gay couple and Thai surrogate in custody tug-of-war

A six-month-old baby girl is trapped in the Thai capital in a bitter custody wrangle between her Thai surrogate mother and her biological father.

Couple denied IVF over parenting concerns

A mother of six has been denied access to IVF treatment in order to have another child over concerns about her parenting skills.

The book that promises to put your children to sleep

Exhausted parents from around the world are singing the praises of a "miracle" book which promises to put even the most restless child to sleep in just minutes.

5 things every parent who feels guilty needs to know

Parenthood can make you feel bad, but you're not alone.

Royals criticise 'dangerous' attempts to photograph Prince George

The British royal family criticized paparazzi on Friday for what it called their increasingly dangerous attempts to photograph young Prince George.

'No jab, no play' rule to cover Victorian kindergartens and childcare centres

"Anti-vaxxers" face not being able to send their children to childcare centres or kindergarten if they refuse to have them immunised.

15,000 birthing kits on their way to developing countries

Giving birth in a hospital surrounded by medical experts is tough enough, but some women deliver babies without a clean sheet to lie on.

Photo of premmie 'too graphic', fundraising site says

When their son Jacob was born at just 27 weeks, Christina and Jeff Hinks were thrown into an uncertain world.

The latest Bugaboo collections: cool chevron and runner prams

Bugaboo sure likes to keep things fresh, and with the Australian spring/summer season coming up, there are two new Bugaboo pram releases.

Making room for two in the bed

Mum's room or their own room? Cot or bassinets? Deciding where twins will sleep can be tricky.

 

FREE TICKET

See Hi-5 LIVE in Sydney!

Get your free ticket to The Essential Baby & Toddler Show and save $20 - register online now!

 
Advertisement
 
 
Essential Baby and Essential Kids is the place to find parenting information and parenting support relating to conception, pregnancy, birth, babies, toddlers, kids, maternity, family budgeting, family travel, nutrition and wellbeing, family entertainment, kids entertainment, tips for the family home, child-friendly recipes and parenting. Try our pregnancy due date calculator to determine your due date, or our ovulation calculator to predict ovulation and your fertile period. Our pregnancy week by week guide shows your baby's stages of development. Access our very active mum's discussion groups in the Essential Baby forums or the Essential Kids forums to talk to mums about conception, pregnancy, birth, babies, toddlers, kids and parenting lifestyle. Essential Baby also offers a baby names database of more than 22,000 baby names, popular baby names, boys' names, girls' names and baby names advice in our baby names forum. Essential Kids features a range of free printable worksheets for kids from preschool years through to primary school years. For the latest baby clothes, maternity clothes, maternity accessories, toddler products, kids toys and kids clothing, breastfeeding and other parenting resources, check out Essential Baby and Essential Kids.