Medicare Safety Net
Financial assistance for high costs for out of hospital medical services that attract a Medicare benefit.
You need to know
If you see a doctor often, or have tests regularly, your medical costs could be high. Visiting a doctor or having tests may cost you less once you reach a Medicare Safety Net threshold.
Once you reach the relevant threshold, the Medicare Safety Net may provide a higher Medicare benefit for all eligible services for the rest of the calendar year. This may mean that visits to your doctor or having tests could cost you less. For example, once you reach the relevant threshold, you still pay the same amount upfront to your doctor, however you may receive a higher Medicare benefit, making your out of pocket expenses much less.
If your family is close to reaching a Medicare Safety Net threshold, we will ask you to confirm the members of your Medicare Safety Net family for that year. Confirming your details allows us to check your family’s eligibility for higher Medicare benefits.
The Medicare Safety Net covers a range of out of hospital doctor visits and tests covered by the Medicare Benefits Schedule.
- Healthcare professional consultations
- blood tests
- CT scans
- pap smears
- tissue biopsies
If a service is not in the Medicare Benefits Schedule it does not count towards the Medicare Safety Net. If you have surgery, see a doctor or have tests while you are in hospital, these services don’t count towards the Medicare Safety Net.
If you pay your doctor before claiming your Medicare benefit, we’ll automatically keep a tally of your out of pocket medical expenses.
If you claim from us before paying your doctor:
- we will send you a cheque made payable to the doctor, which you take or send to your doctor with any outstanding balance you owe
- bring us the doctor’s receipt and the Medicare statement you received with our cheque and we will add your out of pocket amount to your Medicare Safety Net balance
- we will contact you when you are nearing a Medicare Safety Net threshold and may ask you to verify any unpaid claims
If you only pay the gap amount to the doctor we usually add your out of pocket amount to your Medicare Safety Net threshold for you.
Once you reach the relevant threshold, the Medicare Safety Net may provide a higher Medicare benefit for all eligible services for the rest of the calendar year.
Couples and families need to register as a Medicare Safety Net family, even if you are all on the same Medicare card, in order for us to keep a total of the medical expenses you have as a family.
For Medicare Safety Net purposes, a family consists of:
- a couple who are legally married and not separated, or a couple in a de facto relationship, with or without dependent children
- a single person with dependent children
A dependant is someone who the family contact or spouse supports financially and is either a:
- child dependant aged under 16 years, or
- student dependant aged between 16 and 25 who is in full time education
Dependants who are members of 2 families
Dependants may be a member of 2 Medicare Safety Net families, for example because of separation or divorce. The out of pocket medical expenses will count towards the Medicare Safety Net of the family whose Medicare card is used to claim the Medicare benefit. Only the family that pays the cost of the medical service receives the Medicare benefit.
An Extended Medicare Safety Net benefit cap is the maximum amount you can get back under the Medicare Safety Net for some out of hospital Medicare services. Not all Medicare items have a benefit cap.
Read more about the benefit cap and the Extended Medicare Safety Net on the Department of Health website.
Individuals don't need to register for the Medicare Safety Net, we will automatically keep a total of your out of pocket medical expenses. Just keep your contact details up to date with us.
Couples and families must register for the Medicare Safety Net, even if all of your family members are listed on the same Medicare card.
You only need to register once, but you need to let us know if your family members change. For example, if a student dependant is no longer studying or you have a newborn baby.
To register for the Medicare Safety Net:
- download a Medicare Safety Net couples and families registration and amendment form
- visit a service centre
- call 132 011
There are different Medicare Safety Net thresholds depending on your circumstances.
The Medicare Safety Net Original threshold applies to all Medicare card holders. For every service listed in the Medicare Benefits Schedule, the Australian Government has set a fee for the service. This is called the schedule fee. This is not the doctor’s fee.
The gap amount is the difference between the schedule fee and Medicare benefit.
We keep a total of all the gap amounts during the calendar year. Once your total reaches the Medicare Safety Net Original threshold, you may be eligible for higher Medicare benefits.
The Extended Medicare Safety Net (EMSN) Concessional and Family Tax Benefit Part A (FTB Part A) threshold applies to certain concession card holders and families eligible for FTB Part A.
Once a family or individual has reached the EMSN concessional threshold, we will pay a higher benefit for eligible out of hospital Medicare Benefits Schedule services for the rest of the calendar year. The payment amount is calculated as the lesser amount of either the:
- Medicare benefit and 80% of the out-of-pocket costs, or
- EMSN benefit cap
Individuals and families who hold the following concession or health care cards are eligible for the EMSN concessional threshold:
- the Commonwealth Seniors Health Card
- the Health Care Card
- pensioner cards
If you are a concession cardholder at any time during a calendar year, you are eligible for the concessional threshold for the remainder of that year, starting from your eligibility date.
EMSN and FTB Part A
FTB Part A is an annual tax benefit to help families with the cost of raising children. The start date of your EMSN FTB Part A eligibility will depend on how and when you get your FTB Part A payment.
One of the following examples will apply.
|How you receive your FTB Part A payment||How it will affect your eligibility|
|If you receive your payment as a fortnightly instalment||You’re eligible for the EMSN FTB A threshold for the remainder of the calendar year from the date of your first FTB A payment|
|If you receive your lump sum payment in the current financial year||You’re eligible for the EMSN FTB A threshold for the following calendar year; for example, if for the 2015‑16 financial year you receive your FTB A payment on 21/09/16, you are eligible for the EMSN FTB A threshold from 1/1/17 to 31/12/17|
|If you receive a lump sum payment for a previous financial year||You will be eligible from the date you receive the payment for the remainder of the calendar year, for example, if for the 2015-16 financial year you receive an FTB A payment on 3/3/2017, you are eligible for the EMSN FTB A threshold from 3/3/2017 to 31/12/2017|
More information about the Extended Medicare Safety Net is available on the Department of Health website.
Eligibility for FTB Part A
Read more about Family Tax Benefit Part A and check your eligibility to receive it.
The Extended Medicare Safety Net General threshold applies to all Medicare card holders, who are not otherwise entitled to the Extended Medicare Safety Net concession threshold.
Once a family or individual has reached the Extended Medicare Safety Net General threshold, we will pay the Medicare benefit and 80% of the out of pocket costs, or the benefit cap, whichever is the lower amount, for eligible out of hospital Medicare Benefit Schedule services for the rest of the calendar year.