Have you had a heavy year of medical bills?
Once your out-of-pocket costs pass a threshold in a calendar year, Medicare pays more of every visit after it. Couples and families have to register to be counted together.
$594.40
in gap costs in a calendar year, after which Medicare pays 100% of the schedule fee for out-of-hospital services (2026 threshold)
What this is
Medicare pays a set benefit for out-of-hospital services, and the gap is what you pay on top. The safety nets exist so a heavy year does not compound: once your gap costs pass a threshold within a calendar year, Medicare pays more of everything after it. The catch is that couples and families are treated as separate individuals until they register as a family, so costs that should be adding up together are not.
Does it apply to you?
- Anyone having a year of specialist appointments, scans or tests
- Couples and families, who need to register to be counted together
- Concession card holders and Family Tax Benefit Part A families, who have lower thresholds
How to do it
- Check what you have already spent this calendar year in your Medicare online account through myGov.
- If you are a couple or family, register as a family. Individuals are counted separately until you do, and the register is what makes your costs add up together.
- Confirm your details are current: the safety net counts only what Medicare has a record of.
- The thresholds reset on 1 January and are reviewed each year.
Where people lose the money
Assuming the family registration happens automatically.
Being on the same Medicare card is not the same as being registered for the safety net. It is a separate step and it is not retrospective in the way people expect.
Not claiming a Medicare rebate because the gap was small.
Only what Medicare has a record of counts towards the threshold. An unclaimed service is invisible to the safety net.
Expecting it to cover hospital costs.
The safety nets apply to out-of-hospital services. Costs as a private inpatient are a matter for your health cover.
Questions
When does the threshold reset?
On 1 January each year. Spending does not carry over, which is why a heavy year is worth watching from about the middle of the year onwards.
How do I know how much I have spent?
Your Medicare online account through myGov shows your year to date against each threshold.
Does it cover the gap at any doctor?
It applies to out-of-hospital Medicare services. What you get back above the threshold depends on which safety net you reach and the benefit caps that apply to the item.
Do I have to apply once I reach it?
No. Once you are registered correctly, Medicare applies the higher benefit automatically for the rest of the calendar year.
Where these numbers come from
- Services Australia, What are the Medicare Safety Nets thresholds · read 2026-09-22
Last gone over 2026-09-22. Figures change; the link above is always the current one.