If you're visiting the doctor regularly or dealing with ongoing health conditions, your medical bills can add up quickly. The good news? The Medicare Safety Net is designed to help Australians reduce out-of-pocket medical expenses once you've spent a certain amount in a calendar year.
This comprehensive guide explains everything you need to know about the Medicare Safety Net, who qualifies, and how you can maximise your benefits in 2025.
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What is the Medicare Safety Net?
The Medicare Safety Net is a government program that provides higher Medicare rebates for out-of-hospital medical services once your medical costs exceed certain thresholds in a calendar year. Think of it as a financial safety cushion that kicks in when your healthcare costs start to pile up.
There are actually two separate safety nets that work together to provide extra support:
1. Original Medicare Safety Net (OMSN)
The Original Medicare Safety Net helps with your gap expenses – the difference between what Medicare pays (85% of the schedule fee) and the full schedule fee.
2. Extended Medicare Safety Net (EMSN)
The Extended Medicare Safety Net helps with your out-of-pocket costs – the difference between what your doctor charges and what you get back from Medicare.
How it works:
- Once your out-of-pocket costs reach the threshold, Medicare will pay up to 80% of any future out-of-pocket costs
- This applies for the rest of the calendar year
- Some services have benefit caps, which means there's a maximum amount Medicare will pay
2025 EMSN Thresholds:
General threshold: $2,615.50 (for singles, couples, and families)
Concessional threshold: $834.50 (for concession card holders and Family Tax Benefit Part A recipients)
Click here for example of how these 2 safety nets work.Â
Who is Eligible for the Extended Medicare Safety Net?
You're eligible if you:
- Are enrolled in Medicare
- Are a single person, OR
- Are part of a registered couple or family
- Hold a Pensioner Concession Card or Commonwealth Seniors Health Card (for the lower concessional threshold)
- Receive Family Tax Benefit Part A (for the lower concessional threshold)
Couples and families must register with Services Australia to combine expenses. This helps you reach the threshold faster and access benefits sooner!
2025 Medicare Safety Net Thresholds at a Glance
| Original Medicare Safety Net (OMSN) | $576.00 | 100% of schedule fee | Everyone on Medicare |
| Extended Medicare Safety Net (EMSN) - General | $2,615.50 | 80% of out-of-pocket costs | Singles, couples, families |
| Extended Medicare Safety Net (EMSN) - Concessional | $834.50 | 80% of out-of-pocket costs | Concession card holders, FTB Part A recipients |
Note: Thresholds are reviewed annually on January 1st and adjusted based on the consumer price index.
What Medical Services Are Covered?
The Medicare Safety Nets apply to out-of-hospital Medicare services including:
- GP and specialist consultations
- Services in private clinics
- Private emergency department visits
- Many pathology tests
- Diagnostic imaging services (X-rays, ultrasounds, MRIs)
What's NOT covered:
- In-hospital services
- Services not listed on the Medicare Benefits Schedule (MBS)
- Day surgery facilities classified as hospitals
- Dental services (unless specifically listed on MBS)
- Ambulance services
- Allied health services not covered by Medicare
Important: The distinction between in-hospital and out-of-hospital isn't always obvious. Many day surgery facilities are classified as hospitals. Always check with your GP or specialist about whether a service qualifies.
Understanding Verified vs. Unverified Payments
This is essential! Only verified payments count towards your Safety Net thresholds.
Verified Payments
- You pay your doctor's fee in full before making a Medicare claim
- The payment is automatically tracked and counts towards your threshold
- Most common when you pay at the time of service
Unverified Payments
- You don't pay before claiming from Medicare (e.g., bulk billing or doctor bills Medicare directly)
- These payments do NOT count towards your threshold until you pay them
- If you have unverified payments, you'll need to pay them before they count
Ask your doctor's reception whether you need to pay upfront for the payment to be verified and count towards your Safety Net.
How to Register for the Medicare Safety Net
If you're single, you're automatically enrolled in the Original Medicare Safety Net – nothing to do.
However, couples and families must register to combine their medical expenses for the Extended Medicare Safety Net. Registration helps you reach the threshold faster.
Click here to find out how to register.
Who Can Be Included in a Family Registration?
Couples:
- Married couples
- De facto couples (same-sex or opposite-sex)
Dependants:
- Children under 16 years
- Full-time students aged 16-25 years
Important notes:
- You only need to register once
- If your family situation changes (new baby, separation, child turns 26), you must notify Medicare
- Dependants can be registered under two different Safety Net families, but their expenses only count towards the family that pays for their medical services
Log into your myGov account or contact Services Australia if you'd like to find out how close you are to reaching the threshold.
Click here for real world examples of how much you can save.
Tips to Maximise Your Medicare Safety Net Benefits
1. Register as a Family
If you're a couple or have dependents, register to combine expenses. This helps you reach the threshold faster.
2. Keep All Receipts
Even though Medicare tracks most payments automatically, keep your receipts just in case. This helps if there are any discrepancies.
3. Always Pay Before Claiming
Make sure your payments are verified by paying your doctor's fee before claiming from Medicare. Unverified payments don't count towards your threshold.
4. Check Your Progress Regularly
Monitor your Safety Net balance using myGov. Knowing when you're close to the threshold can help you plan medical appointments.
5. Update Your Family Details
If you have a baby, get married, separate from a partner, or your child finishes studying, update your Medicare Safety Net family registration immediately.
6. Understand EMSN Benefit Caps
Some services have caps on how much Medicare will pay. Ask your doctor if there's a benefit cap on your specific service.
Take Action: Register Today
Don't miss out on potential savings. If you're part of a couple or family, registering for the Medicare Safety Net takes just a few minutes and could save you hundreds or even thousands
of dollars in medical expenses.
Need Help?
Services Australia Contact:
- Phone: 132 011 (Medicare general enquiries)
- Website: www.servicesaustralia.gov.au
- In person: Visit your nearest Services Australia Centre
Medical Billing Questions
Always feel free to ask our reception team about:
- Whether payments will be verified
- How much your out-of-pocket costs will be
- The Medicare rebate amount on consultations and treatments you book
The Medicare Safety Net is a valuable benefit that can significantly reduce your medical expenses, especially if you or your family members need regular medical care. By understanding how it works, registering as a family if applicable, and keeping track of your
expenses, you can make the most of this important safety net.
There's no better time to check your eligibility, register if needed, and start tracking your progress towards these money-saving benefits.
Make sure you're getting every dollar back that you're entitled to.
This information is current as of November 2025. For the most up-to-date information, visit the Services Australia website or contact them on 132 011. This blog post is for informational purposes only and should not be considered financial or medical advice.