Medicare Safety Net

Provides a higher Medicare benefit for out of hospital costs. Your doctor’s visit will still cost the same, but we’ll give you a higher benefit back.

You need to know

What a safety net is

The Medicare Safety Net provides a higher Medicare benefit for out of hospital costs. Your doctor’s visit will still cost the same, but we’ll give you a higher benefit back.

You must meet certain rules before you’re eligible for us to pay a Safety Net benefit.

We calculate the Safety Net on a calendar year, 1 January to 31 December.

It applies to singles, or members of a registered Medicare Safety Net family.

If you’re registered as a family or couple, we combine your medical costs so that you are more likely to reach the thresholds sooner.

Types of safety nets

There are 2 Medicare Safety Nets:

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

Types of thresholds

There are 3 Medicare Safety Net thresholds:

  • OMSN – Original threshold
  • EMSN – Extended Medicare Safety Net General threshold
  • EMSN – Concessional and FTB Part A threshold

Who it's 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.

Read more about who the Medicare Safety Net is for

Medicare Safety Net for families

Couples and families must register as a Medicare Safety Net family. This includes those on the same Medicare card.

If you’re registered as a family or couple, we combine your medical costs so that you’re more likely to reach the thresholds sooner.

A family is:

  • a married couple - not separated, with or without dependent children
  • a couple in a de facto relationship, with or without children
  • a single person with dependent children

Dependants

A dependant is someone who the family supports financially and is a:

  • child under 16 years, or
  • full time student between 16 and 25 years

Dependants who are members of 2 families

Dependants can be members of 2 families. For example, because of separation or a child in care.

The out of pocket and gap amounts will count towards the Medicare Safety Net thresholds that are linked to the patient’s Medicare card that was used to claim the Medicare benefit.

Only the Medicare registered Safety Net family that pays the cost of the medical service gets the higher Medicare Safety Net benefit.

Confirming who’s in your family

When your family gets close to the threshold amount we’ll tell you, so you can confirm who’s in your family and get the higher Medicare benefit.

Register

Singles

You’re automatically registered if you’re single with no dependent children, you don't need to register for the Medicare Safety Net.

We’ll record your out of pocket medical expenses.

Couples and families

Couples and families must register as a family for the Medicare Safety Net.

If all family members are on the same Medicare card, you still need to register.

You only register once.

To register for the Medicare Safety Net:

Thresholds

Original threshold

The Original Medicare Safety Net (OMSN) applies to all Medicare cardholders.

Benefits

Once you’ve reached the threshold of $453.20 we’ll pay you 100% of the schedule fee for the out of hospital services you claim.

Reaching the gap threshold

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

When your family gets close to the threshold amount we’ll tell you, so you can confirm who’s in your family 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 and works on a calendar year, 1 January to 31 December.

We calculate the Safety Net on a calendar year, 1 January to 31 December.

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

Extended general threshold

The Extended Medicare Safety Net (EMSN) general threshold is for all Medicare cardholders who don’t have concession cards or get Family Tax Benefit Part A.

Benefits

Once you reach the Extended general threshold of $2,056.30, for the rest of the calendar year you’ll get the Medicare benefit plus whichever is lowest of the following:

  • 80% of the out of pocket amount, or
  • EMSN benefit caps - read more about the EMSN benefit caps on the Department of Health website

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, so you can confirm who’s in your family 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.

We calculate the Safety Net on a calendar year, 1 January to 31 December.

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

Extended concessional threshold

The Extended Medicare Safety Net (EMSN) concessional threshold applies to:

  • Commonwealth Seniors Health Card holders
  • Health Care Card holders
  • Pensioner Concession Card holders

Concession card holders

If you have a card during the calendar year you’re eligible for the concessional threshold for rest of that year.

Concessional family

To be considered a concessional family:

  • 2 or more people in your safety net family must have an eligible concession card, and
  • 1 of the people with a concession card must be the safety net family contact or spouse

Only members of your registered safety net family, who have a concession card, are eligible for the concessional safety net threshold.

All other members of your safety net family, without a concession card, aren’t part of the concessional family. They’re not eligible for the concessional safety net threshold.

For example:

  • a registered safety net family contact has a concession card, so they’re a concessional individual
  • their dependant, who’s also part of their registered safety net family, has a concession card too

The family contact and dependant form a concessional family and are eligible for the concessional safety net threshold.

Another example:

  • the partner of the registered safety net family contact is also part of their safety net family
  • however the partner doesn’t have a concession card

The partner isn’t part of the concessional family and isn’t eligible for the concessional safety net threshold.

Extended Family Tax Benefit Part A threshold

If you get Family Tax Benefit Part A you’re eligible for the FTB Part A threshold.

Payment of FTB Part A Safety Net benefits

The start date of your Extended Medicare Safety Net (EMSN) FTB Part A eligibility depends on how and when you get your FTB Part A payment.

How you get your FTB Part A payment Eligibility
fortnightly You’re eligible for the rest of the calendar year, starting from the date of your first FTB A payment
in a lump sum payment in this financial year You’re eligible for this threshold for the following calendar year. For example if, for the 2016-17 financial year you receive your FTB A payment on 21 September 2017, you’re eligible for this threshold from 1 January 2018 to 31 December 2018
in a lump sum payment for a previous financial year You’re eligible for the rest of the calendar year, from the date you get the payment. For example, if you got a lump sum payment in 2016-17, and then get an FTB A payment on 3 March 2018, you’re eligible for the threshold from 3 March 2018 to 31 December 2018

Read more about Family Tax Benefit Part A and check your eligibility to get it.

Benefits

Once you’ve reached the concessional and FTB Part A threshold of $656.30, you’ll get the Medicare benefit plus whichever is lowest of the following:

  • 80% of the out of pocket amount, or
  • EMSN benefit caps - read more about the EMSN benefit caps on the Department of Health website

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, so you can confirm who’s in your family 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.

We calculate the Safety Net on a calendar year, 1 January to 31 December.

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

2017 table of thresholds

There are different Medicare Safety Net thresholds depending on your circumstances.

Threshold Threshold amount Who it's for How it's calculated What the benefit is
Original $453.20 All Medicare cardholders Based on gap amount 100% of schedule fee for out of hospital services
Extended Medicare Safety Net (EMSN) Concessional and FTB Part A $656.30 Concession cardholders and families eligible for FTB Part A Out of pocket costs 80% of out of pocket costs or the EMSN benefit caps for out of hospital services
Extended general $2,056.30 All Medicare cardholders Out of pocket costs 80% of out of pocket costs or the EMSN benefit caps for out of hospital services

Page last updated: 27 August 2017