crunching 

the numbers

The following examples will serve as a practical guide to help you:   

......

Example 1

Jane and John spent more than $2,169.20 Out-of-Pocket (OOP) expenses on specialists consultations and medical investigations earlier in the year. This meant they have reached the EMSN threshold.

 

They plan to have IVF treatment before the year ends. They are looking at the published fee of an IVF centre below which estimates the OOP to be $3,130.20.

Is this a reasonable estimated total Out-of-Pocket cost to allocate?

IVF Centre's website published fee as at 1 Jan 2019

Fee is based on 1st IVF cycle in calendar year AND:

  • meeting Extended Medicare Safety Net   

  • not including Day Surgery Hospital fees ?

  • with private health insurance (incl IVF) ?​   

  • not including IVF medications ?

  • not including embryo freezing ?

Example 1

the numbers...

Published upfront cycle cost (as published on website)

Potential Medicare rebate after EMSN is met (see Table B)

In-patient egg collection (with OR without insurance)

Standard IVF medications

Initial embryo freezing and storage (approx 6 months)

Add (+)  $8,397.00

Subtract (-)  $5,217.10

Add (+)  $200 or 2,000 (approx)

Add (+)  $200 (approx)

Add (+)  $200-$800 (approx)

Reasonable total estimate Out-Of-Pocket to allocate

(=) min. $3,780 - $6,180  

Verdict: Jane & John should allocate $6,180 (approx) if they are considering embryo freezing and do not have private health insurance. 

......

Example 2

Anne and Arthur had spent $500 OOP medical expenses earlier in the year. They have not met the EMSN threshold but they worked out their Balance of Safety Net is $1,669.20 (ie $2,169.20-$500) which is important when considering treatment later this year.

They are considering an IVF centre's published fees below with estimated OOP of $3,130.20.

How much would their estimated total Out-of-Pocket cost be?

IVF Centre's website published fee as at 1 Jan 2019

Fee is based on 1st IVF cycle in calendar year AND:

  • meeting Extended Medicare Safety Net X   

  • not including Day Surgery Hospital fees ?

  • with private health insurance (incl IVF) ?​   

  • not including IVF medications ?

  • not including embryo freezing ?

Example 2

the numbers...

Published upfront cycle cost (as published on website)

 

Potential Medicare benefits:

  • Standard Medicare benefits (see Table B)

  • Formula for EMSN benefit before threshold is met: 

80% x (OOP for current expense - Balance of Safety Net)

80% x ($4,893.25 - $1,669.20) = $3,224.05 

Note: OOP = (a) - (b)

EMSN Benefit Cap imposed (see Table B): $1,713.35

In-patient egg collection (with OR without insurance)

Standard IVF medications

Initial embryo freezing and storage (approx 6 months)

Add (+)  $8,397 (a)

Subtract (-)  $3,503.75 (b)

 

Subtract (-)  $1,713.35 

Add (+)  $200 OR 2,000 (approx)

Add (+)  $200 (approx)

Add (+)  $200-$800 (approx)

Reasonable total estimate Out-Of-Pocket to allocate

(EMSN met)

(=) min. $3,780 - $6,180  

Verdict: Anne & Arthur should allocate $6,180 (approx) if they are considering embryo freezing and do not have private health insurance.