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What is Medicare Safety Net?
The Medicare Safety Net is a safeguard for individuals and families facing substantial out-of-pocket medical expenses. It is designed to provide additional financial assistance once you reach a certain threshold of out-of-pocket costs within a calendar year. This safety net ensures that Australians can access necessary medical services without experiencing excessive financial strain.
The safety nets do not apply to services that are not listed on the Medicare Benefits Schedule (MBS) or to MBS services that are delivered in hospital.
How does this work?
Once your medical costs reach a certain amount, Medicare gives you a higher amount back for the rest of the year. The increased benefits apply to either your:
- ‘gap expenses’ – the difference between the Medicare benefit you get and the schedule fee.
- ‘out-of-pocket expenses’ – the difference between the Medicare benefit you get and what your medical practitioner charges.
How to know the schedule fee ?
A schedule fee is the dollar amount the Australian Government sets for each medical service.
- You can search the service keyword on the Medicare Benefits Schedule (MBS) and note its item number as shown below:
- Give the keyword or item number here at MBS to find the schedule fee amount.
- The MBS Online website lists the schedule fee amount.
Now that you know the schedule fee, you can calculate how much expense will count towards OMSN and EMSN.
Original Medicare Safety Net (OMSN)
Your gap expenses count towards the OMSN.
Once your gap expenses reach the threshold in a calendar year, Medicare will reimburse you 100% of the schedule fee for any further out-of-hospital medical services you need that are subsidised under the MBS.This post is sponsored by our partners Wigs
If your medical practitioner charges more than the schedule fee, you may still incur an out-of-pocket cost.
Extended Medicare Safety Net (EMSN)
Your out-of-pocket expenses count towards the EMSN.
Once your out-of-pocket expenses reach its threshold in a calendar year, Medicare will cover up to 80% of any further out-of-pocket expenses you have for out-of-hospital medical services that are subsidised under the MBS.
Medicare’s payment for some out-of-hospital services is capped. This implies that your reimbursement could be less than 80% if your out-of-pocket costs exceed that cap.
The EMSN has 2 thresholds:
- General
- Concessional and Family Tax Benefit Part A.
Concessional and Family Tax Benefit Part A
Concessional Family
You’re a Concessional Safety Net family when your family meets both of these conditions:
- 2 or more people in your registered Medicare Safety Net family have an eligible concession card
- 1 of the people with a concession card must be the Medicare Safety Net family contact or spouse.
Only registered Medicare Safety Net family members with a concession card are eligible for the Concessional Safety Net threshold.
Eligible Concession Cards for this benefit –
- a Commonwealth Seniors Health Card holder
- a Health Care Card holder
- a Pensioner Concession Card holder
Family Tax Benefit Part A
If you get Family Tax Benefit Part A you’re eligible for the FTB Part A Medicare Safety Net threshold.
The date you’re eligible for the Extended Medicare Safety Net (EMSN) FTB Part A threshold depends on:
- when you get your FTB Part A payment
- how you get your FTB Part A payment.
Read more about threshold start date and check your eligibility to get it.
Medicare Safety Net Threshold
| Thresholds | Threshold amount | Who it’s for | What counts towards the threshold | What benefit you’ll get back |
| Original Medicare Safety Net (OMSN) | $531.70 | 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 | $2414.00 | 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 | $770.30 | 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. |
How to register for medicare safety net?
If you’re an individual, you are enrolled in Medicare Safety Net automatically and, upon meeting the eligibility requirements, you will get the higher Medicare benefit.
If you’re part of a family or couple, you can register as a family to combine your costs. You’re therefore more likely to reach the threshold sooner. Even if all family members are on the same Medicare card, you’ll still need to register. You only need to register once by either:
- filling in the Medicare Safety Net couples and families registration and amendment form
- calling the Medicare program.