Medicare Safety Net Threshold

[miamunchkin]

First of all - apologies Mods is this is in the wrong place. Please feel free to move.

I wonder if anyone can help me regarding the Medicare Safety Net Threshold and give me an answer, rather than the theoretical answers I have gotten from Medicare.

I am currently pregnant, seeing a private obstetrician. The fees for the private obstetrician are around $3300 or $900 if you reach the safety net.

I will not have reached the safety net threshold by the time this is payable, so I assume we have to pay this in full.

After we have paid this $3300, we will have reached the safety net threshold so will we get the rest back to bring it down to $900? Or will we be out of pocket for the whole $3300?

Thanks in advance!

[tk1999]

I can only tell you about my experience... I paid my $3000 fee in full to the obstetrician and was told I would recieve about $1800 back from Medicare. At some point (I think with the $3000 claim) I made it over the threshold so when I took that claim to Medicare I actually got about $2200 back.

Hope that makes sense

[HollyC]

The limit is usually about $1100, but you can check this with medicare.

Once you have spent more than your limit out of pocket (so all your payments minus rebates), you will then get 80% of any further out of pocket costs back.

So your $3300 fee will definitely take you over the limit and any portion over the limit will attract the higher rebate. So you won't have to pay the full amount, but it probably won't be the minimum amount.

Ask your OB for the item numbers and then medicare should be able to give you more accurate info.

Also the safety net is counted over the calendar year and goes back to zero on 1st Jan, so you would want to pay the big bill before then if you can.

Also, the safety net for fertility treatment and obstetrics is changing a bit at the end of the year. There is some info on the gov health website, but it is a bit confusing and I haven't figured it out.

[miamunchkin]

Thanks for your replies ladies!

What I really want to know is if we will get any of the $3300 back, or whether it just applies to claims made after we have reached the threshold?

Sorry if I'm not explaining properly - I don't really fully understand the system here in Aus

[Muppity]

Ok here goes

Fee is $3300
I don't know what the actual medicare rebate on it is - lets say $500
So you are left with $2800 out of pocket.
This takes you over the medicare safety net (lets assume that you have claimed nothing all year) and you get nothing of the first $1100 out of pocket back, which leaves us with $1700
Once you have reached the safety net you get 80% of out of pockets back so you will get 80% of the $1700 back - which is $1360

So in this ficticious example, you will get $500 (the actual rebate) and $1360 (the safety net figure) back so a total of $1860 of the $3300 that you spent.

This is all assuming that you reach 20 weeks before 1 January next year when everything will most likely change (I've got tickers turned off so I can't see when you are due sorry)

[miamunchkin]

Thanks Muppity - that's exactly what I wanted to know (and hear)!

I will be 20 weeks next week; I think the Ob said payment at 22 weeks, so should def pay it before the end of the year.

Thanks again