What is the Medicare Safety Net?

Medicare Safety Net explained

The Medicare Safety Net is the mechanism the Australian Government uses to ensure your medical costs are affordable.

If you see a doctor or get medical tests regularly, you could end up with high medical costs.

When you spend over a certain amount in a calendar year, Medicare gives you back a higher amount through the Medical Safety Net.

If you satisfy the requirements, it could help lower your gap amounts and/or out-of-pocket amounts.

Medicare Safety Nets cover:

• seeing a general practitioner (GP)
• seeing a specialist
• blood tests
• CT scans
• pap smears
• psychiatry services
• radiotherapy
• tissue biopsies
• x-rays and ultrasounds.

They do not cover out-of-hospital services that are not listed in the Medicare Benefits Schedule (MBS).

The Australian Department of Health calculates the Safety Nets each calendar year (1 January to 31 December).

How do Medicare Safety Nets work?

The Medicare Safety Nets work on thresholds for medical expenses that are set by the Australian Department of Health.

Everyone who is enrolled in Medicare is eligible to apply for a Medicare Safety Net.

To receive a higher amount back from Medicare under a Medical Safety Net, gap amounts and out-of-pocket costs for your healthcare must reach a certain amount.

If you reach the required thresholds, you will start receiving higher Medicare Benefits for certain Medicare services.

There are 2 types of Medicare Safety Net: 

• Original Medicare Safety Net (OMSN)
• Extended Medicare Safety Net (EMSN).

What is the Original Medicare Safety Net (OMSN)?

The Original Medicare Safety Net (OMSN) is based on your gap amount for the calendar year. 

The threshold amount for 2024 is: $560.40

If your gap amount is more than $560.40 for the calendar year, you can claim the Original Medicare Safety Net (OMSN).

If successful, you will get back a higher amount when you claim your Medicare Benefit  – 100% of the schedule fee for out-of-hospital services for the rest of the calendar year.

What is the Extended Medicare Safety Net (EMSN) (General)?

The Extended Medicare Safety Net (EMSN) (General) is based on your out-of-pocket amount for the calendar year. 

The threshold amount for 2024 is: $2,544.30. 

If your total out-of-pocket amount is more than $2,544.30 for the calendar year, you can claim the Extended Medicare Safety Net (EMSN). 

If successful, you will get back a higher amount when you claim your Medicare Benefit (80% of out-of-pocket costs) or, alternatively, the Extended Medicare Safety Net for out-of-hospital services for the rest of the calendar year.

What is the Extended Medicare Safety Net (EMSN) (Concessional and Family Tax Benefit Part A)?

The Extended Medicare Safety Net (EMSN) (Concessional and Family Tax Benefit Part A) is based on your ‘out-of-pocket amount’ for the calendar year. 

Only concession cardholders (such as Commonwealth Seniors Health Card holders, Health Care Card holders and Pensioner Concession Card Holders) and families eligible for Family Tax Benefit Part A are eligible to apply.

The threshold amount for 2024 is: $811.80. 

If your total out-of-pocket amount is more than $811.80 for the calendar year, you can claim the Extended Medicare Safety Net (EMSN) (Concessional and Family Tax Benefit Part A). 

If successful, you will get back a higher Medicare Benefit when you claim your Medicare rebate (80% of out-of-pocket costs) or, alternatively, the Extended Medicare Safety Net for out-of-hospital services for the rest of the calendar year.

Do you need to register for Medical Safety Nets?

Individuals

If you are an individual with no dependants, you do not need to register for Medicare Safety Nets because Medicare does that for you. They will keep a tally of your out-of-pocket and gap amounts and will automatically pay you a higher Medicare Benefit when you reach a threshold.

Families and couples

If you are part of a family or couple, you can register as a family to combine your out-of-pocket and gap amounts.

This means you will be more likely to reach the required thresholds sooner.

Even if all your family members are on the same card, you still need to register.

There are two ways to register:

How to register for your Medicare Safety Net benefit 

To register for your couples and families Medicare Safety Net benefit, you have 2 options: 

How to claim your Medicare Safety Net benefit

To claim your Medicare Safety Net benefit, you need to pay the full cost of the treatment and then lodge a claim with Medicare.

You have 2 options to claim your rebate: