Who the Medicare Safety Net is for

If you’re single, you don’t need to do anything - you’re automatically registered. If you’re a couple or part of a family, you need to register.

Families and couples only have to register once. Read more under Medicare Safety Net for families.

Original Medicare Safety Net (OMSN)

The OMSN applies to anyone who is enrolled in Medicare.

How it works

You get 100% of the schedule fee once you reach the OMSN threshold.

If you’re single we’ll automatically pay you the higher benefit when you reach the threshold.

For a Family Safety Net, confirmation of who the family members are needs to occur before we can pay higher benefits.

The Medicare Benefits Schedule lists the schedule fee set amount.

The amount that counts towards your OMSN threshold is the gap amount.

The OMSN gap amount

The Medicare benefit we pay you is 85% of the schedule fee for eligible services. For GP consultations, we pay you 100% of the schedule fee.

The difference between the schedule fee and the Medicare benefit we pay you is the gap amount.

Extended Medicare Safety Net (EMSN)

The EMSN provides an extra benefit for eligible families and singles who have high out of pocket costs for out of hospital services.

How it works

The amount you pay your doctor includes:

  • the schedule fee – the Medicare Benefits Schedule lists the schedule fee set amount, and
  • an out of pocket amount – the difference between the Medicare benefit we pay you and what the doctor charges

When you reach the threshold we’ll pay the Medicare benefit plus the lower amount of either:

  • 80% of the out of pocket amount, or
  • EMSN benefit caps

If you’re single we’ll automatically pay you the higher benefit when you reach the threshold.

For a Family Safety Net, confirmation of who the family members are needs to occur before we can pay higher benefits.

Read more about the EMSN benefit caps on the Department of Health website.

The EMSN out of pocket expense

The out of pocket expense is the difference between what the doctor charges you and the Medicare benefit we pay you.

It’s the out of pocket amount that counts towards your Medicare Safety Net threshold.

Reaching the out of pocket threshold

Each time you or your family claim from Medicare we keep a tally of the out of pocket amounts during the calendar year.

When your family gets close to the threshold amount we’ll tell you. You can then confirm your family members and get the higher Medicare benefit when your family reaches the threshold.

If you’re single we’ll automatically pay you the higher benefit when you reach the threshold.

The Medicare Safety Net threshold is indexed annually from 1 January.

You can check your Medicare Safety Net balance any time using your Medicare online account through myGov or the Express Plus Medicare mobile app.

Page last updated: 27 August 2017