What Is The Medicare Safety Net?

The Medicare Safety Net is a scheme that can help you reduce your out-of-pocket medical costs for out-of-hospital services, such as seeing a doctor or specialist, or some types of tests and scans such as CT scans and blood tests. 

If you or your family have a lot of doctor and specialist visits in a single calendar year, once you’ve reached the threshold (spent a certain amount), you may be entitled to get more back from Medicare, even though your doctor’s costs will stay the same.

What services does the Medicare Safety Net (MSN) cover?

The MSN applies to out-of-hospital Medicare services and tests listed under the Medicare Benefits Schedule (MBS).  

It’s important to talk to your doctor before your consultation or treatment to confirm if it’s considered an out-of-hospital service under the MBS.  

For example, if you undergo a procedure as day surgery, it may be considered hospital treatment. Avoid any nasty invoice surprises and ask the question about coverage and gap fees before you go ahead.

Helpful Tip:

You can use Private Health Insurance alongside the Medicare Safety Net. For instance, let’s say you need a cavity filled at the dentist.  Medicare does not generally cover the costs of dental procedures, but certain Extras policies can. After the procedure, for example if you had a complication and you need to follow up with a doctor or surgeon as an outpatient, the visit would contribute towards your  Medicare Safety Net.   That is just one way you can get the most out of your benefits!

Dr. Jill Gamberg

GP, Coach and Lifestyle Medicine Coach

How are Medicare benefits calculated and paid? 

Every service eligible for a Medicare rebate is listed on the Medicare Benefits Schedule (MBS), with a set scheduled fee amount. 

Medicare pays a proportion of the scheduled fee, and you’re responsible for the difference. If your doctor or specialist charges a higher fee than the total MBS fee, the difference is known as the ‘gap’ and you’re required to pay it. 

This ‘gap’ affects how the different types of Safety Nets and thresholds work. 

What are the types of Medicare Safety Nets?

1. Original Medicare Safety Net (OMSN)

If you’re enrolled in Medicare, you will get back 100% of the scheduled fee for your doctor or specialist visit after you have reached the OMSN threshold – that is, once you have already spent more than the threshold amount in a single calendar year. 

If you’re single, you will automatically receive the 100% benefit when you reach the threshold while families and couples can register as a family which combines all your costs and means you are more likely to reach the threshold sooner.   

The ‘gap’ between the MBS schedule fee and benefit paid by Medicare is how your threshold amount is calculated throughout the year – not by the total of the fees you pay.  

When you’re eligible for the OMSN, you receive a Medicare benefit of 85% – 100% of the scheduled fee, and 100% of the scheduled fee for bulk-billing GP consultations.

2. Extended Medicare Safety Net (EMSN)

The EMSN provides extra benefits for families and singles with high out-of-pocket medical costs.  

When you reach the general threshold, your benefit will apply to out-of-hospital medical services for the rest of the calendar year.

You’ll get the Medicare benefit and the lowest of either: 

• 80% of the out-of-pocket amount
• EMSN benefit caps 

For 2024, the EMSN thresholds are:¹Australian Government Department of Health and Aged Care – Medicare Benefits Schedule – Note GN.10.27

• $811.80 for people who have a concession card or get Family Tax Benefit Part A
• $2,544.30 for others. 

You may also be eligible for a lower threshold if you: 

• are a Commonwealth Seniors Health Card holder
• a Health Care Card holder
• a Pensioner Concession Card holder
• Are eligible for Family Tax Benefit Part A. 

What is an EMSN benefit cap?

Some services are capped with a limit on how much you can be reimbursed by Medicare.  

When you reach the EMSN threshold, benefits for capped items are 80% of your out-of-pocket cost. If the out-of-pocket cost is higher than the EMSN benefit cap, you receive the smaller benefit amount (the EMSN benefit cap).

What are the types of Medicare Safety Net thresholds?

Three different thresholds (how much you need to have been left out of pocket or paid in ‘gap fees’ before receiving a higher Medicare benefit for services) apply to match the different types of Medicare Safety Nets.

2024 MSN thresholds

Different MSN thresholds apply depending on your circumstances, income and which type of MSN you’re eligible for:  

• Original Medicare Safety Net (OMSN)
• Extended Medicare Safety Net (EMSN) – General
• Extended Medicare Safety Net (EMSN) – Concessional and Family Tax Benefit (FTB) Part A 

Service Australia’s Threshold Amounts for Medicare Safety Nets

Source: Services Australia – What are the thresholds

Do I have to register to be eligible for the Medicare Safety Net?

No, not if you’re single.  Medicare keeps track of your claims throughout the year. If you’re single, have no dependents, and enrolled in the Medicare system, you don’t have to register for the Safety Net. Your higher benefits will be applied automatically if you reach the threshold. 

However, couples and families must register as a Medicare Safety Net family, even if you’re already listed together on the same Medicare card. This means your medical costs are combined so you reach the threshold and receive higher benefits sooner. You only have to register once.  

You can register as a family if you’re a married or de facto couple (with or without dependent children), or a single person with dependent children. 

Families are notified if they’re close to reaching the threshold. You can then confirm your family members with Medicare to receive the higher benefit when you reach the threshold.

How do I check my Medicare Safety Net balance?

Log in to your Medicare account online via your myGov account, or use the Express Plus Medicare mobile app for instant access to your Safety Net balance and claims history.

Is prescription medication covered under the MSN? 

No, the costs of many prescription medications are covered under the Pharmaceutical Benefits Scheme (PBS). 

Under the PBS, the Australian Government subsidises the cost of medicine for most medical conditions, which means you can have access to a wide range of medication without paying full price for them. 

To buy PBS medication from a pharmacist, you’ll need a doctor’s prescription. Your pharmacist can tell you if your medicine is cheaper under the PBS.

Comfortable with your cover?  

For the right mix of Medicare benefits and private health insurance peace of mind, start comparing a range of policies and providers online today, or call us on 1800 784 772.