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What is the Medicare Safety Net?
If you need to spend a lot of money on out-of-hospital medical appointments or tests, you may be eligible for the Medicare Safety Net. This means once you have spent up to a certain amount then you will get more money back from the government for your out-of-pocket expenses.
The Medicare Safety Net provides a higher Medicare benefit to people who have spent over a certain threshold on medical expenses during a calendar year (1 January to 31 December).
You will still need to pay the same amount for your doctor’s visit or test, but Medicare will give you more money back for the rest of the year.
The medical services covered include visits to your GP or a specialist, services provided in private clinics and private emergency departments, and many pathology and diagnostic tests. Some services are capped so you cannot claim more than a certain amount.
The Medicare Safety Net does not apply to medical services you receive in hospital, including day surgery.
You can ask your doctor whether the services they are recommending are covered by Medicare, and what your out-of-pocket expenses are likely to be.
How the Medicare Safety Net works
You can either qualify for the Medicare Safety Net as an individual person or as part of a couple or family.
Medicare calculates how much you are out of pocket each calendar year (the difference between what the doctor charges you and what you can normally claim back from Medicare).
When your out-of-pocket expenses go above a certain threshold, you will be able to claim higher benefits from Medicare. The more you spend, the more you can claim back.
If you qualify for the Medicare Safety Net as a family, everyone’s costs are combined so you reach the threshold sooner. Medicare will tell you when your family gets close to the threshold. You will then need to confirm your family members.
Different thresholds apply depending on your circumstances. You can find out which threshold applies to you on the Services Australia website.
You can check your Medicare Safety Net balance any time using your Medicare online account or the Express Plus Medicare mobile app.
Registering for the Medicare Safety Net
If you are single, you do not need to do anything. You will automatically receive the Medicare Safety Net when you have spent over the threshold.
If you are in a couple or family, you need to register. You only need to do it once and then the Medicare Safety Net will apply to everybody listed on the Medicare card.
To register for the Medicare Safety Net as a couple or family you can:
- download the form
- call the Medicare general enquiries line on 132 011, 7 days a week, 24 hours a day
A couple or family means a married couple or couple in a de facto relationship, with our without dependents, or a single person with dependants. For Medicare Safety Net purposes, a dependant is someone the family supports financially and is a child under 16 or a full-time student between 16 and 25 years.
Read more on how to register on the Services Australia website.
PBS Safety Net
The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of medicine for most medical conditions.
If you spend a lot of PBS medicines during a calendar year, you may reach the PBS Safety Net. This will mean you pay less for PBS medicines for the rest of the year.
When you reach the threshold, you can apply for a PBS Safety Net Card. This card lets you get cheaper medicine for the rest of the year.
