Medicare Safety Net

If you need to see a doctor or have medical tests regularly you could end up with high medical costs. The Medicare Safety Net is designed to provide additional financial relief for people with high medical costs by reducing their out-of-pocket costs.

When an individual or family receives many services in a year the Medicare Safety Net reduces their out-of-pocket costs for services received out-of-hospital.

How does the Medicare Safety Net work?

When an individual or a family's "gap" payments exceed a certain threshold amount in a calendar year, 100% of the Medicare Benefits Schedule (MBS) fee for out-of-hospital services is reimbursed through Medicare. However, this is not necessarily 100% of the out-of-pocket costs as the treatment fee may be higher than the schedule fee which means there will still be an out-of-pocket cost.

Medicare Safety Net for families

So that Medicare can keep track of the total medical expenses of your family, you'll need to register as a Medicare Safety Net family. You'll need to do this even if you and your family are all on the same Medicare card.

According to Medicare, for the purposes of the Medicare Safety Net, a family is:

  • a couple who are legally married and not separated, or a couple in a de facto relationship, with or without dependent children
  • a single person with dependent children

Please be aware Medicare defines a dependant a bit differently to how we define them. For the Medicare Safety Net for families, this is someone who the family contact or spouse supports financially and is either a:

  • child dependant aged under 16 years, or
  • student dependant aged between 16 and 25 who is in full time education

What services count toward the Medicare Safety Net Threshold?

The Medicare Safety Net covers a range of doctor visits and tests that you receive out-of-hospital. Some examples of services that count towards the Safety Net are:

  • GP and specialist consultations
  • Ultrasounds
  • Pap tests
  • Blood tests
  • CT Scans
  • X-rays

What services do not count toward the Safety Net?

Medical services that are not covered by Medicare and in-hospital services are not included in the Safety Net. For example, having surgery, seeing a doctor or having a test when you are admitted to hospital are not included.

For more information about the Medicare Safety Net visit the Medicare Australia website.