What are the Medicare Safety Nets?

If you spend a lot of money on healthcare, you may be eligible for the Medicare Safety Nets.

The Medicare Safety Nets give a higher amount of money back. This happens once you have spent over a certain amount on medical expenses. This lasts for the rest of the calendar year (1 January to 31 December).

How do the Medicare Safety Nets work?

There are 2 Medicare Safety Nets:

1. the Original Medicare Safety Net — which is reached through your gap expenses
2. the Extended Medicare Safety Net — which is reached through your out-of-pocket expenses

The Medicare benefit is the amount of money Medicare gives you when you’ve made a claim for a medical service you’ve received. This is usually 85% to 100% of the schedule fee.

The schedule fee is the dollar amount the Australian Government sets for each medical service.

Gap expenses are the difference between the Medicare benefit you get and the schedule fee.

Out-of-pocket expenses are the difference between the Medicare benefit you get and what your health practitioner charges.

What services are covered by the Medicare Safety Nets?

The Medicare Safety Nets only cover services listed on the Medicare Benefits Schedule. You can look at these at MBS Online.

The Medicare Safety Nets do not cover medical services you get in hospital, including day surgery.

You can ask your doctor whether the services they are suggesting are covered by Medicare. It’s also a good idea to ask what your out-of-pocket expenses will be.

How do I get the Medicare Safety Nets?

If you are single and don’t have children, you do not need to do anything. You will automatically get the Medicare Safety Nets when you have spent over the threshold.

If you are in a couple or family, you need to register for the Medicare Safety Nets. This will combine the costs of everyone in your family. It means that you are more likely to reach the threshold sooner.

What is considered a family?

For the Medicare Safety Nets, a family can be 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

A dependant is someone the family supports financially and is either a:

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

How do I register for the Medicare Safety Nets?

You only need to register once for the Medicare Safety Nets. This will apply to everybody listed on the Medicare card.

To register for the Medicare Safety Nets 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

You can read more on how to register on the Services Australia website.

Different thresholds apply depending on your circumstances. You can find out which threshold applies to you on the Services Australia website.

How do I check my Medicare Safety Nets balance?

You can check your Medicare Safety Nets balance by using your

• Medicare online account
• Express Plus Medicare mobile app

What is a Concessional Safety Net family?

You’re a Concessional Safety Net family when:

• 2 or more people in your family have a concession card
• one of the concession card holders is the Medicare Safety Net family contact or spouse

Only family members with a concession card are eligible for the Concessional Safety Net threshold.

Can I get the Family Tax Benefit Part A Medicare Safety Net?

If you get Family Tax Benefit Part A you can get the Family Tax Benefit Part A Medicare Safety Net.

What is the PBS Safety Net?

The Pharmaceutical Benefits Scheme (PBS) lets you get prescribed medicines without paying the full price.

If you spend a lot of money on medicines, the Australian Government will support you through the PBS Safety Net. Once you reach the PBS Safety Net threshold, the cost of your medicines is reduced.

This is separate from the Medicare Safety Nets.

You can find out more about the PBS Safety Net, on healthdirect’s Pharmaceutical Benefits Scheme page.

Resources and support

You can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.