Medicare Safety Nets have thresholds. When you spend certain amounts in gap and out of pocket costs, you’ll reach the thresholds. Once you’ve reached the thresholds, you’ll start getting higher Medicare benefits. This means you’ll get more money back from us for certain Medicare services.
Only verified payments count towards the threshold. Verified payments are when you pay for your health professional service in full, before you make a claim from us. If you have unverified payments, you’ll need to pay them before they count towards your threshold. Unverified payments are when you don’t pay your doctor’s fee before you claim from us. Read more about the difference between verified and unverified payments.
The threshold amounts are set each year from 1 January.
2024 Medicare Safety Nets thresholds
| Thresholds | Threshold amount | Who it’s for | What counts towards the threshold | What benefit you’ll get back |
|---|---|---|---|---|
| Original Medicare Safety Net (OMSN) | $560.40 | Everyone in Medicare | Your gap amount for the calendar year. | 100% of the schedule fee for out of hospital services. |
| Extended Medicare Safety Net (EMSN)- General | $2544.30 | 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 | $811.80 | Concession cardholders 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. |