The Medicare Safety Net System is not the easiest system to understand. This information is an attempt to explain in simple language how it works.
Firstly, there are two Medicare Safety Nets – the Original Medicare Safety Net (OMSN ) and the Extended Medicare Safety Net (EMSN).
1. Original Medicare Safety Net (OMSN)
If you are enrolled in Medicare you are eligible for the OMSN.
Your gap amount counts towards your OMSN threshold. A gap amount is the difference between both of the following:
- the Medicare benefit you get
- the schedule fee for out of hospital medical services.
When you reach the OMSN threshold, you’ll get a higher benefit back. You’ll get 100% of the schedule fee for out of hospital services for the rest of the calendar year.
2. Extended Medicare Safety Net (EMSN)
If you are enrolled in Medicare you are eligible for the EMSN.
Each time you pay an out of pocket cost, it’s calculated towards the EMSN threshold. Out of pocket costs are the difference between both of the following:
- the Medicare benefit you get back
- the doctor’s fee for out of hospital medical services.
The EMSN has 2 thresholds:
- General
- Concessional and Family Tax Benefit Part A.
2026 Medicare Safety Net Threshold Amounts
| Safety Net | Concessional individuals and families* | Non-concessional individuals and families |
| Original Medicare Safety Net (OMSN) | $594.00 | $594.00 |
| Extended Medicare Safety Net (EMSN) | $861.20 | $2699.10 |
Once the EMSN threshold is reached, you will receive either 80% of your out-of-pocket costs back or the EMSN cap amount, whichever is the lower amount.
These thresholds are updated on the 1st of January each year. If you are a family on the same card, you need to let Services Australia know so they can ensure your threshold comes from all your family on the same card. Sometimes the government makes minor changes, so best to always check with them online for details. The information here is not a replacement for checking your specific situation with Services Australia particularly if you have a unique or complicated situation.
3. EMSN Benefit Cap Amounts
If an item has an EMSN Benefit Cap, the cap is typically 300% of the Medical Benefit Scheme (MBS) fee for psychologists and allied health services.
4. What does it all mean in plain English?
The Extended Medicare Safety Net (EMSN) is designed by Medicare to assist with health costs for families and individuals. It works just like the safety net for Prescriptions.
You may find that a medical service under Medicare costs much less once you spend enough and become eligible for an increased rebate. The Medicare Safety Nets (OMSN & EMSN) are applied to all Medicare items for doctors, specialists and allied health. This means that a visit to a psychologist at our practice is more affordable once you have reached the relevant Medical Safety Net Threshold.
Quite a few of our clients spend time working through a yearly budget for healthcare, educating themselves on the Medicare Safety Net system and particularly the EMSN in order to plan and budget around the cost of visits to their therapist.
Let’s work through an example for an average family
Let’s say 2 adults and 2 children are on the same Medicare Card. One parent has some health issues and sees a doctor and specialist a few times a year. Around the mid – end June they log on into their mygov app and check to see how close they are to reaching the threshold and realise that they have spent about $3500 so far. Once they take account of the usual Medicare rebates they have spent over $2,699.10 of their own money on the gaps to an Orthopedic Surgeon, Gynecologist, 15 visits to their preferred GP who is not bulk billing. They also had allied health visits to a psychologist for one of their children.
If the psychologist charges over the course of a year $3,200 for a series of consultations (10 sessions x $320, Rebate $101.55) under a Mental Health Care Plan (recommended fee for psychology 40+ mins), the patient’s out-of-pocket cost before EMSN benefits are paid is $2184.50. This is the psychologist’s fee ($3,200) minus the MBS rebate received ($1,105.50). Eighty per cent of the out-of-pocket cost of $2,184.50 is equal to $1747.60.
This amount of $3,200 is lower than the EMSN benefit cap. Therefore, assuming the patient has reached the relevant EMSN threshold, the maximum EMSN benefit that the patient will receive is $1,747.60. The total MBS benefit for this service is calculated to be $2,853.10 (MBS rebate plus the EMSN benefit).
As a result, the final total cost incurred by the patient is $346.90 ($3,200 minus $2,853.10) in 2026 for their full set of Mental Health Care Plan (MHCP) referrals from their GP or Psychiatrist. This is less than $35 per session.
This example demonstrates how with some forethought and budgeting you can afford the best psychologist or allied health practitioner once you reach your EMSN.
If this idea is appealing and you would like to see what the numbers look like for your situation, please contact us on (07) 3088 5422 and ask to speak to one of our team that has experience in the EMSN.