Medicare Safety Net Thresholds for 2026: What Counts and When You Get More Back

Medicare Safety Net thresholds are set each year from 1 January. For 2026, there are three separate thresholds depending on which Safety Net applies to you and what type of cost you've incurred:

The key distinction between the two Extended Safety Net thresholds is that concession cardholders and families receiving Family Tax Benefit Part A reach the higher level of Medicare support at a much lower spending threshold ($861.20) than everyone else ($2,699.10).

The Original Medicare Safety Net counts your gap amount — the shortfall between the standard Medicare Benefits Schedule fee and what Medicare pays back under the standard rebate, before any Safety Net benefit applies.

The Extended Medicare Safety Net counts your out-of-pocket amount — what you actually paid the doctor or provider above the Medicare benefit, which can be higher than the scheduled gap if your provider charges above the Medicare Schedule fee (which many specialists do).

This is why some people reach the Extended Safety Net threshold faster than the maths might initially suggest: if your specialist charges well above the Medicare Schedule fee, your actual out-of-pocket cost each visit is larger than the "gap" calculation alone would show.

Bulk-billed services don't contribute to either Safety Net threshold, because there's no gap or out-of-pocket cost when a provider bulk bills — the full cost is billed directly to Medicare. If you're trying to track how close you are to a threshold, only your verified, non-bulk-billed payments count; unverified payments don't count toward the total.

Medicare Safety Net thresholds accrue within a calendar year, from 1 January to 31 December, under the Health Insurance Act 1973. This means your progress toward the threshold resets every 1 January, regardless of when in the previous year you crossed it. If you have a significant medical event in December, it's worth being aware that any progress toward your threshold doesn't carry over into the new year.

Even after you cross a Safety Net threshold, there's a cap on the benefit per attendance: attendance items are capped at 300% of the Medicare Benefits Schedule fee, or $500, whichever is lower. This prevents very large benefit payments on a single expensive consultation, even once your Safety Net benefit rate applies.

To get any Safety Net benefit at all, your family group generally needs to be registered together with Medicare so that your combined gap and out-of-pocket costs are tracked as one household total, rather than as separate individuals. If you're not sure whether your family is registered as a single Medicare Safety Net group, this is worth checking directly with Medicare or through your myGov account, since separated tracking could mean your household takes longer to reach a threshold than it should.

Consider a concession cardholder who sees a specialist multiple times through the year, paying an out-of-pocket amount of $100 each visit above the Medicare rebate. Once their cumulative out-of-pocket costs for the calendar year reach $861.20 — roughly nine visits at that rate — they move onto the concessional Extended Safety Net, and Medicare pays 80% of further out-of-pocket costs (subject to the benefit caps) for the rest of that calendar year. A non-concessional patient with the same specialist and the same per-visit cost would need to reach $2,699.10 in out-of-pocket costs — a much higher bar — before the same 80% benefit kicks in.

1. Check whether your family is correctly registered as a single Medicare Safety Net group.
2. Keep track of your non-bulk-billed medical costs through the calendar year, particularly if you or a family member sees specialists regularly.
3. If you hold a concession card or receive Family Tax Benefit Part A, be aware you reach the higher benefit level at $861.20 in out-of-pocket costs, considerably lower than the general threshold of $2,699.10 — worth factoring into planning for elective or ongoing specialist care.
4. Remember thresholds reset on 1 January each year, so costs incurred late in one calendar year don't carry forward.

Do bulk-billed visits count toward my Medicare Safety Net threshold? No. Since there's no out-of-pocket or gap cost when a service is bulk billed, it doesn't contribute to either Safety Net threshold.

Which threshold applies to me if I hold a concession card? You would be assessed under the concessional Extended Medicare Safety Net threshold of $861.20 in out-of-pocket costs for the calendar year, rather than the general threshold of $2,699.10.

Does the Safety Net cover hospital costs? The benefits described here apply specifically to out-of-hospital Medicare services, such as GP visits, specialist consultations, and diagnostic tests. Hospital costs are assessed under different arrangements.