A cap is now in place on benefits payable by the Extended Medicare Safety Net (EMSN) for out-of-pocket treatment costs for injections. The vast majority of people should be unaffected by this new cap.
The change means that if your eye doctor is charging $556.40 or less for item 42738 or 42739, you will be unaffected by the capping of the EMSN and you will continue to get an 80% rebate on out-of-pocket costs on the item from the EMSN once you qualify each year, in addition to the standard rebate. If your doctor is charging more than $556.40 for item 42738 or 42739 (not including other fees such as a consultation) Medicare will no longer rebate any of the additional costs above this level.
If you still have concerns after raising this with your eye specialist or wish to discuss concerns related to your ongoing treatment please call the Foundation on 1800 111 709 to discuss the matter.
Read the Macular Disease Foundation’s Fact Sheet on Changes to the Extended Medicare Safety Net.
5 November 2012