What are the thresholds

Find the threshold amounts for Medicare Safety Nets.

Medicare Safety Nets have thresholds. When you spend certain amounts in gap and out of pocket costs, you’ll reach the thresholds. Once you’ve reached the thresholds, you’ll start getting higher Medicare benefits. This means you’ll get more money back from us for certain Medicare services. 

Only verified costs count towards the threshold. Verified costs are when you pay your doctor’s fee before you claim from us.  If you have unverified costs, you’ll need to pay them before they will count towards your threshold. Unverified costs are when you don’t pay your doctor’s fee before you claim from us.  Read more about the difference between verified and unverified costs.

The threshold amounts are set each year from 1 January.

2019 Medicare Safety Nets thresholds

Thresholds Threshold amount Who it’s for What counts towards the threshold What benefit you’ll get back
Original Medicare Safety Net (OMSN) $470 Everyone in Medicare Your gap amount for the calendar year. 100% of the schedule fee for out of hospital services.
Extended Medicare Safety Net (EMSN)- General $2133 Everyone in Medicare Your out of pocket amount for the calendar year. 80% of out of pocket costs or the EMSN benefit caps for out of hospital services.
Extended Medicare Safety Net (EMSN) - Concessional and Family Tax Benefit Part A $680.70 Concession cardholders and families eligible for Family Tax Benefit Part A Your out of pocket amount for the calendar year. 80% of out of pocket costs or the EMSN benefits caps for out of hospital services.

Page last updated: 3 July 2019