Medicare Safety Net Explained

If you are receiving fertility treatment for the first time, you are unlikely to have reached the Medicare Safety Net threshold before the start of your treatment. As a result, you will be out of pocket more for your first treatment than for subsequent treatment cycles in a calendar year (this is why there are price ranges indicated on the clinic price schedules below).

Out of pocket expense is the difference between the Medicare rebate for a service and the clinic's fee for that service. Once these expenses have reached around $1,550 in a calendar year (the Medicare Safety Net Threshold), 80% of the additional out of pocket expenses will be refunded.

For example if you had $2000 out of pocket expenses in a calendar year you would receive a $400 rebate (note this is 80% of $500, not 80% of $2,000 - the threshold is not counted).

However since Jan 1st 2010 there is a catch! Following the Government's 2009 budget there is a cap to the maximum amount that will be refunded for procedures listed below using this formula. For example if you incur $8,000 out of pocket expenses for item 13200, Medicare will only rebate the maximum benefit of $4,420 rather than the $5,160 that would have been the case prior to Jan 1st, 2010 (80% of $6.450).

In summary things you need to know about the Medicare rebate:

For more information on the Medicare Safety Net and how to calculate your safety net threshold, please contact Medicare at 13 20 11 or visit their website at

Extended Medicare Safety Net (EMSN) Review 2009

As discussed the maximum benefit payable for expenses incurred after the Medicare Safety Net Threshold has been reached is now capped for the items listed below. This cap is the EMSN cap column. To convert this benefit to what would have been the clinic fee simply multiply this number by 1.25. For example in the case of item 13200 (basic IVF) this would be $5,526 (max benefit x 1.25).

Finally if price is a consideration for selecting a clinic then a simple method of comparing clinics (on price) is to ring each clinic and ask their fee for the Medicare item 13200 (basic IVF).

This is a simple way of effectively comparing clinic prices as they all use the same Medicare item numbers.

Medicare Benefits Schedule
Item Description Scheduled Fee* A: Benefit* B: EMSN Cap* Maximum Benefit
13200 ART services - super ovulated treatment cycle proceeding to oocyte retrieval – initial cycle in a calendar year 2,940.00 2,870.90 1675 (1,550*) 4,420.90
13201 Item 13200 – subsequent cycle in a calendar year 2,750.00 2,680.90 2,432 (2,250*) 4,930.90
13202 ART services – superovulated cycles that is cancelled prior to oocyte retrieval 440.00 374.00 64 (60*) 434.00
13203 Ovulation monitoring services for artificial insemination 460.00 391.00 108 (100*) 491.00
13206 ART services - natural treatment cycle or treatment cycle where oocyte growth and development is induced using oral medication only 440.00 374.00 65 (60*) 434.00
13209 Planning and management of an ART treatment cycle 80.00 68.00 11 (10*) 78.00
13212 Oocyte retrieval 335.00 284.75 70 (65*) 349.75
13215 Transfer of embryos to the female reproductive system 105.00 89.25 48 (45*) 134.25
13218 Preparation of frozen or donated embryos 750.00 680.90 702 (650*) 1,330.90
13221 Preparation of semen for artificial insemination 48.00 40.80 22 (20*) 60.80
13251 Intracytoplasmic sperm injection 395.00 335.75 108 (100*) 435.75

* 1st Jan, 2010. Out-of-hospital. EMSN updated 2013 to refelect CPI



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