How does the Medicare Safety Net work?

The Medicare Safety Net increases your rebates once your out-of-hospital medical costs reach a threshold in a calendar year.

The Medicare Safety Net is designed to help people who have high medical costs outside hospital. Once your costs for the year reach a set level, called a threshold, Medicare pays a higher rebate for the rest of that calendar year. The count starts again on 1 January.

What counts towards the safety net

Only out-of-hospital Medicare services count. These include:

• GP and specialist appointments in their rooms
• Many blood tests, X-rays and scans
• Some allied health sessions claimed through Medicare

Costs for services as a private patient in hospital don't count, and neither do medicines, which have their own separate PBS Safety Net. Services that have no Medicare rebate, such as most allied health sessions paid only through private health extras, also don't count.

The two parts of the safety net

There are two parts, and you may reach one before the other:

• Original Medicare Safety Net: once you reach its threshold, Medicare pays the full schedule fee for out-of-hospital services for the rest of the year. You still pay anything the doctor charges above the schedule fee.
• Extended Medicare Safety Net: once you reach its threshold, Medicare pays back a large share of your out-of-pocket costs for the rest of the year. For some services there is a cap on how much extra Medicare will pay.

The thresholds change each year. The Extended Medicare Safety Net threshold is lower for concession card holders and families getting certain family payments. Services Australia publishes the current amounts.

Registering as a family or couple

If you are single with no dependants, Medicare tracks your costs automatically. Couples and families need to register as a family with Services Australia, even if everyone is already on the same Medicare card. Once registered, everyone's costs are added together, so you reach the threshold sooner.

You can register through your Medicare online account or the Express Plus Medicare app. It only needs to be done once, but update it if your family changes.

Tips to make the most of it

• Make sure all your claims go through Medicare, including those for each family member.
• Check your safety net progress in your Medicare online account.
• If you are close to the threshold late in the year, it may help to know before you plan tests or procedures, but don't delay care you need.
• Ask about fees before you book, so you understand the gap. See Bulk billing, rebates and gap fees explained.

General information only, not medical advice. Everyone's situation is different, so check with your GP or the provider. In an emergency call 000.