Medicare Safety Net

Extended Medicare Safety Net Threshold

To assist with costs of healthcare, the government will subsidise 80% of your out of hospital costs or “Gap payment” ONCE a threshold is reached. This is called the Extended Medicare Safety Net.

Each time you pay an out of pocket cost, it’s calculated towards the EMSN threshold. Out of pocket costs are the difference between both of the following:

the Medicare benefit you get back
the doctor’s fee for out of hospital medical services.

For 2023, the EMSN thresholds are:

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

This example below explains how the EMSN works once the threshold has been reached.

Example A shows a suggested fee for a consult – total cost $100 paid to the doctor.

Example B shows the same complete fee of $100 paid to the doctor but the patient receives a rebate of $50 and has an out of pocket cost (gap payment) of $50.

Example C shows a patient on the EMSN. They still pay the $100 to the doctor but they receive the initial $50 rebate AND 80% of the out of pocket cost (gap payment) is also paid back as a rebate. Therefore, the patient receives a $90 rebate and is only left with a $10 out of pocket fee.

Reaching the Concessional and Family Tax Benefit Part A Threshold

You may be eligible for the lower threshold if you’re any of the following:

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

How to Register:

Individuals

You don’t need to register if you’re an individual with no dependants. Services Australia will register you for Medicare Safety Nets. Services Australia keep a tally of your out of pocket and gap amounts. Services Australia will pay you higher Medicare benefits when you reach a threshold. This means you’ll get more money back from them for certain Medicare services. Services Australia will keep paying you the higher benefit for the rest of the calendar year.

Families and couples

If you’re part of a family or couple, you can register as a family to combine your costs. This means you’re more likely to reach the thresholds sooner. Even if all family members are on the same Medicare card, you’ll still need to register.

You only need to register once.

If you’re registered and your family situation changes, you’ll need to let Services Australia know. This includes having a child or separating from your partner.

You can register or tell Services Australia about a change in your family situation by either:

filling in the Medicare Safety Net couples and families registration and amendment form
calling the Medicare program.

Families and dependants

For Medicare Safety Nets purposes, a family is any of these:

a married couple, not separated, with or without dependants
a couple in a de facto relationship, with or without dependants
a single person with dependants.

For Medicare Safety Nets purposes, a dependant is someone the family supports financially and either a:

child under 16 years
full time student between 16 and 25 years.