The Medicare Safety Net is a government program that helps protect people and families who have high out-of-pocket medical costs - but it only applies to out-of-hospital expenses.
It works via a threshold system. Once you reach certain spending limits, Medicare increases its contribution to your medical expenses for the remainder of the calendar year, making your ongoing healthcare more affordable.
There are two distinct safety nets to be aware of:
Original Medicare Safety Net (OMSN): This increases Medicare benefits to 100% of the Medicare Benefits Schedule (MBS) fee once you reach the threshold. It means you won't have to pay anything if you go to doctors who bulk-bill or don't charge above the MBS fee.
Extended Medicare Safety Net (EMSN): This provides additional benefits when doctors charge above the MBS fee. Medicare will pay up to 80 per cent of any future out-of-pocket costs for eligible services for the remainder of the calendar year.
Understanding the Medicare Safety Net thresholds
Each safety net has different thresholds, and what counts towards the thresholds are calculated in different ways. The benefit you get back also varies between safety nets.
Safety net
Threshold
Who it's for
What counts towards the threshold
What you'll get back
Original Medicare Safety Net (OMSN)
$576
Everyone in Medicare
Your gap amount for the calendar year
100% of the schedule fee for eligible out-of-hospital services
Extended Medicare Safety Net (EMSN)
$2,615.30
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
$834.50
Concession cardholders, pensioners, 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.
Who benefits most from the Medicare Safety Net?
The Medicare Safety Net provides the greatest value to individuals who incur high out-of-hospital medical costs, including:
People with chronic conditions: People managing chronic conditions or in need of ongoing specialist care typically incur significant medical expenses. The Medicare Safety Nets gives them more financial support once they reach the thresholds.
Pensioners and concession cardholders: Pensioners typically require more ongoing healthcare but have lower incomes to cover the costs. However, as concession cardholders have a lower threshold for the Extended Medicare Safety Net ($834.50 vs $2,615.30), they see savings much earlier than other groups.
Patients requiring expensive procedures: Anyone in need of costly diagnostic procedures or multiple specialist consultations can benefit significantly once thresholds are met.
Large families: Families can combine their medical expenses, making it easier to reach thresholds when multiple family members require medical care.
How to check and track your safety net status
It's easy to keep track of how close you are to reaching Medicare Safety Net thresholds:
Log into your Medicare online account through myGov
Navigate to the "Safety Net" section and click "View details"
You'll be able to see your current out of pocket costs and your relevant threshold.
Other ways to check your threshold
Download the Express Plus Medicare app: You can access the same information via Medicare's free app, making it easy to check thresholds on-the-go and at medical appointments.
Call Medicare directly: Prefer to speak with someone? You can call Medicare on 132 011 for immediate threshold information. Have your Medicare card ready.
Eight-year-old Cilla has cystic fibrosis. Managing Cilla's health condition can get very expensive, due to the ongoing cost of medical equipment, prescription drugs, physiotherapy, psychology, and other specialist doctors fees.
However, Cillla's family is eligible for the Extended Medicare Safety Net (EMSN) - Concessional and Family Tax Benefit Part A. This means once the family's out-of-pocket expenses reach $834.50, Medicare will start to cover 80% of all of their eligible out-of-pocket costs, or the EMSN benefits caps for out of hospital services.
Cilla's family reaches the $834.50 threshold by March. For the rest of the year, they know they can rely on more substantial support from Medicare, which saves them thousands of dollars.
This is a fictional case study for demonstrative purposes only.
Our expert says
"The Medicare Safety Nets aren't just about saving money. They help people access the healthcare they need, without incurring an unfair financial burden. Keep track of your spending through your Medicare account or the app, to ensure you're getting the benefit if you need it."
There are a few differences between the original and extended Medicare Safety Nets but the primary difference is that the Original Medicare Safety Net is reached through your gap expenses, while the Extended Medicare Safety Net is reached through your out-of-pocket expenses.
You can check if you have reached the Medicare Safety Net threshold by logging into your Medicare account via the MyGov website, or through the Express Plus Medicare app.
Yes. The threshold pensioners must reach before they can access the Extended Medicare Safety Net (EMSN) is significantly lower than the general population. In 2025, the threshold for concessional cardholders was $834.50 compared to the standard of $2,615.30.
For the Original Medicare Safety Net (OMSN), your gap amount counts towards the threshold. For the Extended Medicare Safety Net (EMSN), your out-of-pocket costs count towards the threshold.
Nicola Middlemiss is a journalist with nearly a decade of experience in personal finance and insurance. She has contributed to Domain, Yahoo Finance, Money Magazine and Insurance Business Australia, offering in-depth insights into commercial insurance in the Australian market. Nicola holds a Bachelor’s degree in English from the University of Leeds and a Tier 1 General Insurance (General Advice) certification, which complies with ASIC standards.
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