Pharmaceutical Benefits and Medicare Safety Nets

Pharmaceutical Benefits Scheme (PBS) Safety Net

Information from:
http://www.medicareaustralia.gov.au/.../scripts/pbs.jsp

A standard PBS prescription cost from 1st Jan 2010 is $33.30 for general patients, Adults and Children.
This should be the Maximum figure you pay for a standard Pharmaceutical Benefits Scheme (PBS) prescription. Sometimes the figure will be lower, depending on the actual item. I had some anti-biotics in 2008 that cost me $6.90 on prescription.

There are two PBS safety net thresholds - one for general patients and the other for Concession Card patients.

The general patient safety net threshold for 2010 is $1,281.30 (2009 was $1,264.90).

When patients and/or their families have spent that amount, they can apply for a Safety Net Concession Card and pay only $5.40 per prescription for the rest of that calendar year.

The concession card holders safety net threshold for 2010 is $324.00 (this also applies to gold, white and orange card-holders under the RPBS).
Once patients and/or their families reach this amount, they can apply for a Safety Net Entitlement Card and receive items free of charge for the rest of the calendar year.

Brand premiums, therapeutic group premiums and special patient contributions do not count towards the safety net thresholds.

There are some prescriptions that are not covered under the PBS scheme, and are therefore not subsidised at all, meaning that these can be quite expensive.

• Schedule of Pharmaceutical Benefits

The thresholds are normally adjusted on 1 January each year in line with inflation.

Medicare Safety Net

Details at:
http://www.medicareaustralia.gov.au/.../msn/index.jsp

If you need to see doctors or have tests regularly you could end up with high medical costs�the Medicare Safety Net is designed to help you when you need it most. It means that once you reach a safety net threshold, visits to your doctor or having tests may end up costing you less.

All families and couples need to register. Even if all your family members are listed on your Medicare card you still need to register for the safety net.

• Each family member needs to be identified so their medical costs can be counted toward your family�s safety net.
• You only need to register your family once.
• Registering is free.

Some examples of services where costs count towards the Medicare safety net are:

• GP and specialists consultations
• ultrasounds
• pap smear
• blood tests
• CT scans
• x-rays

The basic benefit is that once you reach the threshold, any further qualifying medical expenses are reduced by Medicare covering 80% of the extra payments you need to make.

eg:

Before you reach the Threshold, the cost may be:

Doctors fee of $50 less the $32.30 standard Medicare rebate = $17.70 your NET
Cost.

After you reach the Threshold, the cost may be:

Doctors fee of $50 less the $32.30 standard Medicare rebate = $17.70, less
another 80% of that cost ($17.70 - $14.16) = $3.54 your NET cost

Obviously if your Doctor bulk bills you, then this may not apply in your case, except for specialists consultations etc.

Medicare Safety Net Thresholds from Jan 1st 2010
• General $1,126.00
• Concession & FTB(A) $562.90
• Gap $388.80

How does the Medicare safety Net work ?
• http://www.medicareaustralia.gov.au/.../1856-24-how-does-the-medicare-safety-net-work.pdf