What is the Medicare Safety Net?
The Medicare Safety Net is a scheme that reduces out-of-pocket expenses for people who need frequent medical care. If you find you require regular GP visits or blood tests, for example, then you may well be ‘caught’ by the safety net.
In essence, the safety net means that once an individual or family hits a certain threshold of payments in a calendar year, they will be entitled to get more money back from Medicare, in order to offset their medical costs and provide some financial relief.
How does the Medicare Safety Net work?
When an individual or family meets a certain threshold of out-of-pocket and ‘gap’ payments in a calendar year, you automatically become eligible for higher Medicare benefits. While you won’t pay less for any doctor’s visits or procedures, you will receive higher reimbursement once you hit the relevant 'threshold' for you situation.
There are three different 'threshold' amounts for the Medicare Safety Net, of which access depends on the individual or family circumstances.
The three thresholds are as follows:
Original
- Who is it for? All Medicare card holders
- What is the annual threshold amount? $576
- How is it calculated? Based on gap amount
- What does it cover? 100% of the schedule fee for out-of-hospital services
Extended Medicare Safety Net (EMSN) Concessional and FTB Part A
- Who is it for? Concession card holders and families eligible for Family Tax Benefit Part A
- What is the annual threshold amount? $834.50
- How is it calculated? Based on out-of-pocket costs
- What does it cover? 80% of out-of-pocket costs or the EMSN benefit caps for out-of-hospital services
Extended General
- Who is it for? All Medicare card holders
- What is the annual threshold amount? $2,615.50
- How is it calculated? Based on out-of-pocket costs
- What does it cover? 80% of out-of-pocket costs or the EMSN benefit caps for out of hospital services
These threshold amounts are set on January 1 each year, and are calculated based on the Consumer Price Index. The figures shown above are current as of January 2025.
What services are covered by the Medicare Safety Net?
The Medicare Safety Net applies to a range of out-of-hospital medical services and tests. These are listed under the MBS, and can include such things as:
- Consultations with GPs and specialists
- Some tests like blood tests and CT scans
- Pap smears
- X-rays
What services are not covered by the Medicare Safety Net?
The Medicare Safety Net does not cover:
- Medical services that are not included in the Medicare Benefits Schedule, such as physiotherapy, occupational therapy and speech therapy
- Treatments received in hospital
This means that if you are admitted to hospital, the services you receive there, such as surgeries, doctor’s visits and tests, are not covered by the Medicare Safety Net. As mentioned earlier, however, public patients can still receive free treatment in public hospitals under Medicare.
It is important to note that some procedures such as day surgeries may be considered as hospital treatments, even if they are not actually conducted in hospitals.
If you are due to undergo a procedure and are unsure whether it’s considered an out-of-hospital service, you can ask your doctor for clarification.
How do I access the Medicare Safety Net?
Anyone who is enrolled in Medicare is automatically eligible for the Medicare Safety Net. If you’re single, then you don’t need to do anything – the government’s Services Australia advises that Medicare will automatically pay you higher benefits once you reach your threshold.
If you are part of a couple or a family, though, then you will need to register if you want Medicare to keep track of your combined medical expenses over the course of the year and count them all towards the same Medicare Safety Net threshold.
How does the Medicare Safety Net work for families?
If you are part of a couple or family and want to combine your healthcare costs to reach a safety net threshold sooner, Services Australia says you’ll need to register as a Medicare Safety Net Family, even if all members of your family are already covered on the same Medicare card.
Families can register or advise of changes in their family situation by filling out the Medicare Safety Net Registration and Amendment for Couples and Families (MS016) form, available on the Services Australia website, or by calling Medicare on 132 011, 24 hours a day.
For the purposes of the Medicare Safety Net, a “family” is defined as either:
- A couple who are legally married and not separated, or a couple in a de facto relationship, with or without dependent children; or
- A single person with dependent children
In turn, a “dependant” is defined as someone who is financially dependent on the family and is either:
- A child dependant aged under 16 years; or
- A student dependant aged between 16 and 25 who is studying full-time
In cases where a dependant is part of two Medicare Safety Net families because of separation or divorce, their medical expenses will count towards the Safety Net of the family whose Medicare card is used to claim the benefit (i.e. the family paying for their out-of-pocket medical costs).
How do I check my Medicare Safety Net balance?
Information about your Medicare Safety Net details, including your claims history and how close you are to meeting your annual threshold, can be found online. You can check it by logging into your myGov account or by using the Express Plus Medicare mobile app.
What is Medicare?
Medicare is Australia’s universal, publicly funded health care system, covering many primary health services through three main components: hospital, pharmaceutical, and medical.
- Hospital: If you are treated as a public patient in a public hospital, Medicare covers all hospital costs, and you will be treated by a doctor chosen by the hospital. Even if you have private health insurance, you can still choose public treatment to access these benefits.
- Pharmaceutical: The Pharmaceutical Benefits Scheme (PBS) helps make prescription medicines more affordable. Medicare covers most prescribed medicines, so you only pay a portion of the cost, while the PBS covers the rest.
- Medical: Medicare covers a wide range of medical services, including consultations with GPs and specialists, diagnostic tests such as x-rays and pathology, eye exams by optometrists, most surgical procedures performed by doctors, COVID-19 vaccinations, and certain allied health services under chronic disease management plans.
The Medicare Benefits Schedule (MBS) underpins the medical component of Medicare, listing all services eligible for rebates. Medicare covers part of the scheduled fee for each service, but if your doctor charges more than this amount, the remaining balance—known as the gap—is what you may need to pay out of pocket.
Understanding the MBS and potential gaps can help you plan for costs that Medicare doesn’t fully cover and highlight where private health insurance or gap cover might be useful.
What Medicare doesn’t cover
Medicare does not cover ambulance services (except in some states), most dental care, physiotherapy, occupational therapy, chiropractic care, glasses, contact lenses, hearing aids, acupuncture (unless part of a doctor visit), or home nursing. Private health insurance may cover many of these services, depending on your policy.
