Editing Medicare (Australia) (section)

== Payments for health services ==
The [[Department of Health and Aged Care]] sets a schedule of fees for services that Medicare will contribute to the costs of, called the Medicare Benefits Schedule or MBS.<ref>{{cite web |title=MBS Online |url=http://www.mbsonline.gov.au/ |publisher=Australian Government Department of Health and Ageing |language=en |access-date=8 April 2020 |archive-date=14 April 2020 |archive-url=https://web.archive.org/web/20200414124903/http://www.mbsonline.gov.au/ |url-status=live }}</ref> The minister for health and aged care determines the items on the MBS, based on the recommendation of the Medicare Services Advisory Committee.<ref>{{Cite web |title=Medicare Benefits Schedule - Note GN.8.22 |url=https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=GN.8.22&qt=noteID |access-date=8 June 2024 |website=MBS Online |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071158/https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=GN.8.22&qt=noteID |url-status=live }}</ref> The MBS lists what the government considers a standard cost of that service (the ''schedule fee'') and a percentage of that standard fee that Medicare will cover. The dollar value of the percentage of the schedule fee that Medicare will pay is called the ''Medicare benefit''.<ref name=":6">{{Cite web |title=Medicare Benefits Schedule - Note GN.10.26 |url=https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=GN.10.26&qt=noteID |access-date=8 June 2024 |website=MBS Online |archive-date=31 March 2024 |archive-url=https://web.archive.org/web/20240331074740/https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=GN.10.26&qt=noteID |url-status=live }}</ref> For example:
{| class="wikitable"
|+Example Medicare benefit calculations
!MBS item
!Schedule fee
!Benefit percentage
!Medicare benefit payment
|-
|Item 23 – GP appointments lasting less than 20 minutes<ref>{{Cite web |date=1 November 2023 |title=Medicare Benefits Schedule - Item 23 |url=https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=23&qt=item&criteria=23 |access-date=8 June 2024 |website=MBS Online |archive-date=20 June 2024 |archive-url=https://web.archive.org/web/20240620222829/https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=23&qt=item&criteria=23 |url-status=live }}</ref>
|$42.10
|100%
|$42.10
|-
|Item 65070 – [[Full blood count]] (pathology tests)<ref>{{Cite web |date=1 July 2020 |title=Medicare Benefits Schedule - Item 65070 |url=https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=65070&qt=item&criteria=65070 |access-date=8 June 2023 |website=MBS Online |archive-date=24 March 2023 |archive-url=https://web.archive.org/web/20230324063917/http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=65070&qt=item&criteria=65070 |url-status=live }}</ref> Claimed for a hospital inpatient
|$16.95
|75%
|$12.75
|}
The percentage of the schedule fee will be either 100%, 85%, or 75% depending on the circumstances of the "episode of care":<ref name=":6" />

* 100% – for general practice services provided by general practitioners, or a practice nurse on behalf of a GP for [[Aboriginal and Torres Strait Islander|Aboriginal or Torres Strait Islander]] patients.
* 85% – for specialist services, such as specialist appointments, pathology tests, and medical imaging.
* 75% – for services provided to a patient admitted in a recognised hospital, or a hospital-substitution services covered by private health insurance.

=== Bulk billing and gap payments ===
Service providers can choose how much to charge patients for services, including above or below how much Medicare will pay, with patients responsible for the difference. A 2012 study of the OECD found that Australia was the only country out of the 29 surveyed that gave service providers the right to charge more or less than the rebate amount.<ref>{{cite journal |last1=Paris |first1=Valérie |last2=Devaux |first2=Marion |last3=Wei |first3=Lihan |date=28 April 2010 |title=Health Systems Institutional Characteristics: A Survey of 29 OECD Countries |url=https://www.oecd-ilibrary.org/social-issues-migration-health/health-systems-institutional-characteristics_5kmfxfq9qbnr-en;jsessionid=TSmilSnVSuyMGrrOcmC9_oZU.ip-10-240-5-84 |series=OECD Health Working Papers |language=en |publisher=OECD |doi=10.1787/5kmfxfq9qbnr-en |doi-access=free |website=OECD iLibrary |access-date=8 April 2020 |archive-date=10 July 2024 |archive-url=https://web.archive.org/web/20240710002136/https://www.oecd-ilibrary.org/social-issues-migration-health/health-systems-institutional-characteristics_5kmfxfq9qbnr-en;jsessionid=TSmilSnVSuyMGrrOcmC9_oZU.ip-10-240-5-84 |url-status=live }}</ref>

When a provider chooses to only charge the patient as much as the Medicare rebate for an eligible service, and directly charges Medicare instead of the patient, this is called a "bulk billed" service. As Medicare covers the entire cost of the service, the individual patient does not have to pay anything. Most providers will only bulk bill concessional patients (people with concession cards, or aged 16 years or under), although some will bulk bill all eligible services for all eligible patients. The government pays an additional subsidy, called the ''Bulk Billing Incentive Payment'', to providers when they bulk bill services for concessional patients.<ref>{{Cite web |date=6 February 2024 |title=Increases to Bulk Billing Incentive Payments |url=https://www.health.gov.au/our-work/increases-to-bulk-billing-incentive-payments |access-date=8 June 2024 |website=[[Department of Health and Aged Care]] |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071157/https://www.health.gov.au/our-work/increases-to-bulk-billing-incentive-payments |url-status=live }}</ref>

If a provider chooses to charge above the Medicare rebate amount (whether that be above the schedule fee, or if Medicare does not pay 100% of the schedule fee), the individual patient is charged a "gap payment". For most services, the patient is responsible for paying the gap.

Many industry and professional groups, such as the [[Australian Medical Association]] (AMA), maintain their own list of recommended fees that their members can use to base their charges off. For example, the AMA's ''List of Medical Services and Fees'' recommends that general practitioners charge $102 for appointments lasting less than 20 minutes. The Medicare schedule fee for the corresponding item code is $41.40, with Medicare paying 100% of the schedule fee for GP services. A doctor that elects to charge the AMA fee will result in the patient being charged the difference of $60.60 as an out-of-pocket cost for the appointment.<ref>{{Cite news |last=Winter |first=Velvet |date=1 November 2023 |title=GP appointment fees are likely to rise from today. Here's what that means for your next visit to the doctor |url=https://www.abc.net.au/news/2023-11-01/why-are-gp-fees-increasing-medicare-bulk-billing-incentives/103038704 |url-status=live |access-date=8 June 2024 |work=[[ABC News (Australia)|ABC News]] |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071157/https://www.abc.net.au/news/2023-11-01/why-are-gp-fees-increasing-medicare-bulk-billing-incentives/103038704 }}</ref> If a doctor charges less than the AMA recommended fee, the gap payment will decrease, and vice versa.

=== Fee indexation ===
Since the introduction of the MBS, the items listed have been subject to annual indexation aimed at keeping the Medicare benefit in-line with the costs of delivering care. At the inception of the Medicare system, the MBS schedule fees were the same as the AMA List of Fees. Since then, the difference between MBS schedule fees and actual service fees, particularly AMA fees, has grown significantly with increasing costs to patients.

In 2012, the [[Gillard government|Gillard Government]] introduced a two-year freeze on indexation as a temporary budget measure. This freeze was however repeatedly extended by the [[Turnbull government|Turnbull]] and [[Morrison government]]s until July 2020. It is estimated that the prevented indexations saved the scheme a total of $3.9 billion.<ref>{{Cite web |last=Bowles |first=Martin |date=6 May 2016 |title=MBS indexation freeze (answers to estimates questions on notice) |url=https://www.aph.gov.au/~/media/Committees/clac_ctte/estimates/bud_1617/Health/Answers/SQ16-000356.pdf |access-date=23 November 2020 |website=[[Australian Parliament House]] |archive-date=30 November 2020 |archive-url=https://web.archive.org/web/20201130185015/https://www.aph.gov.au/~/media/Committees/clac_ctte/estimates/bud_1617/Health/Answers/SQ16-000356.pdf |url-status=live }}</ref>  While the rate of bulk billed services remained steady during this period, the gap payment for providers already charging above the MBS amount increased.<ref>{{Cite web |last=Biggs |first=Amanda |date=18 May 2017 |title=Medicare Budget Review 2017–18 |url=https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/BudgetReview201718/Medicare |access-date=8 June 2024 |website=[[Australian Parliament House]] |archive-date=30 September 2023 |archive-url=https://web.archive.org/web/20230930064415/https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/BudgetReview201718/Medicare |url-status=live }}</ref> On 25 March 2018, the Labor Party announced that, if elected, it would remove all remaining indexation freezes, noting how the [[Morrison government]]'s continued indexation freezes were leaving "families paying higher out-of-pocket costs to visit the doctor."<ref>{{Cite news |last=Dickinson |first=Helen |date=26 March 2019 |title=What is the Medicare rebate freeze and what does it mean for you? |url=https://theconversation.com/what-is-the-medicare-rebate-freeze-and-what-does-it-mean-for-you-114169 |access-date=23 November 2020 |work=[[The Conversation (website)|The Conversation]] |archive-date=12 November 2020 |archive-url=https://web.archive.org/web/20201112024937/https://theconversation.com/what-is-the-medicare-rebate-freeze-and-what-does-it-mean-for-you-114169 |url-status=live }}</ref>

In the [[2017 Australian federal budget|2017–18 federal budget]], the [[Turnbull government]] began to re-fund indexation after reaching agreements with the AMA and [[Royal Australian College of General Practitioners]] for their continued support of government projects such as the [[My Health Record]] system.<ref>{{Cite web |date=21 January 2020 |title=Medicare Indexation Schedule |url=https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-MedicareIndexationSchedule |access-date=8 June 2024 |website=MBS Online |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071158/https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-MedicareIndexationSchedule |url-status=live }}</ref> Indexation resumed by providing $1 billion to index GP items from July 2017, specialist consultation items from July 2018, specialist procedures and allied health from July 2019, and diagnostic imaging from July 2020.<ref name="Biggs Medicare budget">{{Cite web |last=Biggs |first=Amanda |date=18 May 2017 |title=Medicare |url=https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/BudgetReview201718/Medicare |access-date=23 November 2020 |website=[[Australian Parliament House]] Parliamentary Library |archive-date=30 November 2020 |archive-url=https://web.archive.org/web/20201130145856/https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/BudgetReview201718/Medicare |url-status=live }}</ref>

The 2024 indexation rate is 3.5% and is applied to most general practitioner, allied health and medical imaging services from 1 July 2024.<ref>{{Cite web |date=24 May 2024 |title=July 2024 News |url=https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-240701 |access-date=8 June 2024 |website=MBS Online |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071202/https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-240701 |url-status=live }}</ref>

The AMA continues to petitions yearly for increases to MBS payments for services provided by its members, taking the stance that the MBS payments are decreasing in real terms due to annual inflation and that MBS indexation has not kept up. Their annual "Gaps Poster" calculates that despite average Consumer Price Index growth of around 3% each year, the MBS has only increased between 1.2% and 2.5% for most items between 1995 and 2012 (with no increase to medical imaging or pathology services).<ref>{{Cite web |date=2023 |title=AMA Gaps Poster |url=https://feeslist.ama.com.au/resources-ama-gaps-poster |access-date=8 June 2024 |website=[[Australian Medical Association]] Fees List |archive-date=20 March 2024 |archive-url=https://web.archive.org/web/20240320025946/https://feeslist.ama.com.au/resources-ama-gaps-poster |url-status=live }}</ref>

=== Private hospital and allied health services ===
All patients that are eligible for Medicare are also eligible for state and territory public hospital services, which are typically free for most patients and funded under an agreement between the federal government and state and territory governments called the [[National Health Reform Agreement]].

Patients in public hospitals that elect to be treated as private patients and patients in private hospitals will have some costs charged by doctors covered at the admitted patient rate (currently 75% of the schedule fee). Hospital costs not listed on the MBS, or where the cost is greater than the Medicare benefit, can be paid by private health insurance or by the patient.<ref>{{Cite web |date=22 January 2024 |title=Medicare costs |url=https://www.health.gov.au/topics/medicare/about/costs#hospital-costs |access-date=8 June 2024 |website=[[Department of Health and Aged Care]] |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071157/https://www.health.gov.au/topics/medicare/about/costs#hospital-costs |url-status=live }}</ref> For MBS listed services provided to hospital inpatients, where the patient also holds private health insurance for that service, the private health insurer must contribute at least the remaining 25% of the schedule free. If a doctor chooses to charge more than the schedule fee, the private health insurer may contribute towards the gap depending on the insurance policy.<ref>{{Cite web |date=5 March 2024 |title=Out of pocket costs |url=https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs?language=und#costs-for-inhospital-services |access-date=8 June 2024 |website=[[Department of Health and Aged Care]] |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071158/https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs?language=und#costs-for-inhospital-services |url-status=live }}</ref>

Some allied health rebates are limited to patients with a chronic disease where the GP has initiated a General Practitioner Management Plan, Team Care Arrangements, a Mental Health Case Conference, or is related to a specific disease or diagnosis. Referrals made for conditions covered by one of these may attract Medicare benefits where the service would otherwise not be eligible.<ref>{{Cite web |date=3 January 2024 |title=Chronic disease GP Management Plans and Team Care Arrangements |url=https://www.servicesaustralia.gov.au/chronic-disease-gp-management-plans-and-team-care-arrangements |access-date=8 June 2024 |website=[[Services Australia]] |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071158/https://www.servicesaustralia.gov.au/chronic-disease-gp-management-plans-and-team-care-arrangements |url-status=live }}</ref> These include services such as physiotherapy, [[podiatry]] and audiology. Optometry services can be provided without referral, while dentistry is not covered at all.<ref>{{Cite web |title=Education guide – Chronic disease individual allied health services Medicare items 10950-10970 – Australian Government Department of Human Services |url=https://www.humanservices.gov.au/organisations/health-professionals/topics/education-guide-chronic-disease-individual-allied-health-services-medicare-items-10950-10970/33196 |access-date=2019-11-27 |website=humanservices.gov.au}}{{Dead link|date=November 2023|bot=InternetArchiveBot|fix-attempted=yes}}</ref> Where the service is not covered by Medicare, private health insurance policies may provide an "extras" or ancillary benefit (typically up to an annual cap) towards these costs.<ref>{{Cite web |title=Private health insurance |url=https://ahpa.com.au/advocacy-priorities/private-health-insurance/ |access-date=8 June 2024 |website=Allied Health Professions Australia |archive-date=8 June 2024 |archive-url=https://web.archive.org/web/20240608071158/https://ahpa.com.au/advocacy-priorities/private-health-insurance/ |url-status=live }}</ref>

For patients receiving [[Mental health in Australia|mental health]] care, Medicare provides up to 10 fully covered individual and group counselling sessions per year as part of the [[Better Access Scheme]]. To access these, a general practitioner, in collaboration with the patient, needs to issue a "mental health care plan" outlining the diagnosed mental health condition, treatment and support options, and goals of care.<ref>{{Cite web |date=August 2019 |title=Mental health care plan |url=https://www.healthdirect.gov.au/mental-health-care-plan |access-date=4 December 2019 |website=Healthdirect Australia |archive-date=30 December 2019 |archive-url=https://web.archive.org/web/20191230213003/https://www.healthdirect.gov.au/mental-health-care-plan |url-status=live }}</ref> The [[Better Access Scheme]] also covers the cost of other mental health supports, including care from related professions such as occupational therapists, social workers, general practitioners and psychiatrists.<ref>{{Citation |last=Australian Government Department of Health |first=Health Services Division |title=Better access to mental health care: fact sheet for patients |url=https://www1.health.gov.au/internet/main/publishing.nsf/Content/mental-ba-fact-pat |access-date=2019-12-04 |publisher=Australian Government Department of Health |language=en |archive-date=4 December 2019 |archive-url=https://web.archive.org/web/20191204060124/https://www1.health.gov.au/internet/main/publishing.nsf/Content/mental-ba-fact-pat |url-status=live }}</ref>

=== Medicare Safety Net ===
The first Medicare Safety Net, setting a maximum amount per year someone could pay for MBS-listed out-of-hospital services, was added in 1991. (It is now known as the Original Medicare Safety Net). The Extended Medicare Safety Net was added in 2004, providing similar assistance for heavy users of scheduled medical services.

To provide additional relief to those who incur higher than usual medical costs, Medicare safety nets have been set up. These provide singles and families with an additional rebate when an annual threshold is reached for out-of-hospital Medicare services.<ref>{{Cite web|url=http://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=G10.2&qt=noteID&criteria=medicare+safety+nets|title=Note G10.2 &#124; Medicare Benefits Schedule|website=www9.health.gov.au|access-date=16 October 2020|archive-date=10 April 2022|archive-url=https://web.archive.org/web/20220410001641/http://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=G10.2&qt=noteID&criteria=medicare+safety+nets|url-status=live}}</ref> A basic safety net exists for all Australians, with an extended safety net for some families.

The thresholds for both safety nets are indexed on 1 January each year to the [[Consumer Price Index]].

====General safety net====
Under the original Medicare safety net, once an annual threshold in gap costs has been reached, the Medicare rebate for out-of-hospital services is increased to 100% of the schedule fee (up from 85%).  Gap costs refer to the difference between the standard Medicare rebate (85% of the schedule fee) and the actual fee paid, but limited to 100% of the schedule fee. The threshold applies for all Medicare cardholders and is $576.00 for 2025.<ref name="2025 safety net">{{Cite web |title=MBS Online - January 2025 News |url=https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-250101 |publisher=[[Department of Health and Aged Care]] }}</ref>

{| class="wikitable sortable"
|-
! Year !! Threshold value
|-
| 1 January 2006 || style="text-align: center;" | $345.50<ref name="health.gov.au">[http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/News-20070101-Medicare_Safety_Net Medicare Safety Net Thresholds – Effective 1 January 2007] {{Webarchive|url=https://web.archive.org/web/20100308085829/http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/News-20070101-Medicare_Safety_Net |date=8 March 2010 }}. Department of Health. Retrieved 4 June 2014.</ref>
|-
| 1 January 2007 || style="text-align: center;" | $358.90<ref name="health.gov.au"/>
|-
| 1 January 2008 || style="text-align: center;" | $365.70<ref>[http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/News-20080101-Safety_Net 1 January 2008 Medicare Safety Net Thresholds] {{Webarchive|url=https://web.archive.org/web/20100308085833/http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/News-20080101-Safety_Net |date=8 March 2010 }}. Department of Health. Retrieved 4 June 2014.</ref>
|-
| 1 January 2009 || style="text-align: center;" | $383.90<ref>[http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/News-2009-Jan-01-Safety-Net 1 January 2009 Medicare Safety Net Thresholds and Information] {{Webarchive|url=https://web.archive.org/web/20100308085827/http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/News-2009-Jan-01-Safety-Net |date=8 March 2010 }}. Department of Health. Retrieved 4 June 2014.</ref>
|-
| 1 January 2010 || style="text-align: center;" | $388.80<ref name="2010 safety net A">[http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/News-20091111-Safety-Net 1 January 2010 Medicare Safety Net Thresholds] {{Webarchive|url=https://web.archive.org/web/20100413100023/http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/News-20091111-Safety-Net |date=13 April 2010 }}. Department of Health. Retrieved 4 June 2014.</ref>
|-
| 1 January 2011 || style="text-align: center;" | $399.60<ref name="2011 safety net A">[http://www.medicareaustralia.gov.au/public/services/msn/index.jsp#N10059 Medicare Safety Net] {{Webarchive|url=https://web.archive.org/web/20110218120808/http://www.medicareaustralia.gov.au/public/services/msn/index.jsp#N10059 |date=18 February 2011 }}. Department of Human Services. Retrieved 4 June 2014.</ref>
|-
| 1 January 2012 || style="text-align: center;" | $413.50<ref name="2012 safety net A">(18 December 2013). [http://www.humanservices.gov.au/customer/enablers/medicare/medicare-safety-net/medicare-safety-net-thresholds 2014 Medicare Safety Net thresholds] {{Webarchive|url=https://web.archive.org/web/20140616135557/http://www.humanservices.gov.au/customer/enablers/medicare/medicare-safety-net/medicare-safety-net-thresholds |date=16 June 2014 }}. Department of Human Services. Retrieved 4 June 2014.</ref>
|-
| 1 January 2013 || style="text-align: center;" | $421.70<ref name="2013 safety net">{{cite web|url=http://www.humanservices.gov.au/customer/enablers/medicare/medicare-safety-net/medicare-safety-net-thresholds |title=2013 Medicare Safety Net thresholds |date=17 January 2013 |url-status=bot: unknown |archive-url=https://web.archive.org/web/20130117053433/http://www.humanservices.gov.au/customer/enablers/medicare/medicare-safety-net/medicare-safety-net-thresholds |archive-date=17 January 2013 }}</ref>
|-
| 1 January 2014 || style="text-align: center;" | $430.90<ref name="2014 safety net">{{cite web|url=http://www.humanservices.gov.au/customer/enablers/medicare/medicare-safety-net/medicare-safety-net-thresholds |title=2014 Medicare Safety Net thresholds |date=30 January 2014 |url-status=bot: unknown |archive-url=https://web.archive.org/web/20140130134008/http://www.humanservices.gov.au/customer/enablers/medicare/medicare-safety-net/medicare-safety-net-thresholds |archive-date=30 January 2014 }}</ref>
|-
| 1 January 2015 || style="text-align: center;" | $440.80<ref name="2015 safety net A">{{cite web|url=http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/news-2014-10-07-latest-news-EMSNJan2015|title=Medicare Safety Net Thresholds from 1 January 2015|first=Australian Government Department of|last=Health|access-date=8 March 2015|archive-date=2 April 2015|archive-url=https://web.archive.org/web/20150402125837/http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/news-2014-10-07-latest-news-EMSNJan2015|url-status=live}}</ref>
|-
| 1 January 2016 || style="text-align: center;" | $447.40<ref name="2016 safety net">{{cite web|url=https://www.humanservices.gov.au/customer/enablers/2016-medicare-safety-net-thresholds|title=Medicare Safety Net – Australian Government Department of Human Services|access-date=6 March 2016|archive-date=10 March 2016|archive-url=https://web.archive.org/web/20160310174329/https://www.humanservices.gov.au/customer/enablers/2016-medicare-safety-net-thresholds}}</ref>
|-
| 1 January 2017 || style="text-align: center;" | $453.20<ref name="2017 safety net">{{cite web|url=https://www.humanservices.gov.au/customer/services/medicare/medicare-safety-net|title=Medicare Safety Net Thresholds from 1 January 2017|first=Australian Government Department of|last=Health|access-date=8 July 2017|archive-date=10 July 2017|archive-url=https://web.archive.org/web/20170710160431/https://www.humanservices.gov.au/customer/services/medicare/medicare-safety-net}}</ref>
|-
| 1 January 2018 || style="text-align: center;" | $461.30<ref name="2018 safety net">{{cite web|url=http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-2018-01-01-latest-news-January|publisher=Australian Government Department of Health|title=The following changes to the Child Dental Benefits Schedule will take effect from 1 January 2018|quote=2018 OMSN Threshold – $461.30|access-date=5 September 2020|archive-date=25 July 2020|archive-url=https://web.archive.org/web/20200725103554/http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-2018-01-01-latest-news-January|url-status=live}}</ref>
|-
| 1 January 2019 || style="text-align: center;" | $470.00<ref name="2019 safety net">{{cite web|url=https://www.humanservices.gov.au/individuals/services/medicare/medicare-safety-net/thresholds/2019-table-thresholds|title=Medicare Safety Net Thresholds from 1 January 2019|first=Australian Government Department of|last=Health|archive-url=https://web.archive.org/web/20190322225630/https://www.humanservices.gov.au/individuals/services/medicare/medicare-safety-net/thresholds/2019-table-thresholds|archive-date=22 March 2019}}</ref>
|-
| 1 January 2020 || style="text-align: center;" | $477.90<ref name="2020 safety net">{{cite web|url=http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-2020-01-01-latest-news-January|title=MBS online – The Revised 1 January 2020 MBS XML and Book files (PDF, DOC and ZIP) are available to download|website=mbsonline.gov.au|access-date=2021-02-07|archive-date=26 February 2021|archive-url=https://web.archive.org/web/20210226045310/http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-2020-01-01-latest-news-January|url-status=live}}</ref>
|-
| 1 January 2021 || style="text-align: center;" | $481.20<ref name="2021 safety net">{{cite web|url=http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-210101|title=MBS online – January 2021 News|website=mbsonline.gov.au|access-date=2021-02-07|archive-date=21 January 2021|archive-url=https://web.archive.org/web/20210121174245/http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-210101|url-status=live}}</ref>
|-
| 1 January 2022 || style="text-align: center;" | $495.60<ref name="2022 safety net">{{cite web |title=MBS online – January 2022 News |url=http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-220101 |access-date=2022-01-15 |website=mbsonline.gov.au |archive-date=6 January 2022 |archive-url=https://web.archive.org/web/20220106011344/http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-220101 |url-status=live }}</ref>
|-
| 1 January 2023 || style="text-align: center;" | $531.70<ref name="2023 safety net">{{Cite web |date=2022-12-12 |title=MBS Online - January 2023 News |url=http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-230101 |access-date=2023-03-06 |publisher=[[Department of Health and Aged Care]] |archive-date=6 March 2023 |archive-url=https://web.archive.org/web/20230306134412/http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-230101 |url-status=live }}</ref>
|-
| 1 January 2024 || style="text-align: center;" | $560.40<ref name="2024 safety net">{{Cite web |date=2023-12-15 |title=MBS Online - January 2024 News |url=https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-240101 |publisher=[[Department of Health and Aged Care]] |access-date=16 January 2024 |archive-date=16 January 2024 |archive-url=https://web.archive.org/web/20240116015727/https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-240101 |url-status=live }}</ref>
|-
| 1 January 2025 || style="text-align: center;" | $576.00<ref name="2025 safety net"/>
|}

====Extended safety net====
The extended Medicare safety net was first introduced in March 2004. Once an annual threshold in out-of-pocket costs for out-of-hospital Medicare services is reached, the Medicare rebate will increase to 80% of any future out-of-pocket costs (now subject to the extended safety net fee cap) for out-of-hospital Medicare services for the remainder of the calendar year. Out-of-pocket costs are the difference between the fee actually paid to the practitioner (subject to the fee cap) and the standard Medicare rebate.

When introduced, the general threshold for singles and families was $700, or $300 for singles and families that hold a concession card and families that received Family Tax Benefit Part A. On 1 January 2006, the thresholds were increased to $1,000 and $500 respectively. From then the extended safety net was indexed by the Consumer Price Index on 1 January each year.<ref>[http://www.health.gov.au/internet/main/publishing.nsf/Content/Review_%20Extended_Medicare_Safety_Net/$File/ExtendedMedicareSafetyNetReview.pdf Extended Medicare Safety Net Review]</ref>

Since 1 January 2010, some medical fees have been subject to a safety net fee cap, so that the out-of-pocket costs used in determining whether the threshold has been reached are limited to that cap.<ref>{{cite web|url=http://www.health.gov.au/internet/main/publishing.nsf/Content/EMSN2011-ExecutiveSummary|title=Extended Medicare Safety Net Review of Capping Arrangements Report 2011: Executive Summary|first=Australian Government Department of Health and|last=Ageing|access-date=12 December 2012|archive-date=28 February 2012|archive-url=https://web.archive.org/web/20120228120725/http://www.health.gov.au/internet/main/publishing.nsf/Content/EMSN2011-ExecutiveSummary|url-status=live}}</ref><ref>{{Cite web|url=http://hpm.org/en/Surveys/CHERE_-_Australia/14/The_Medicare_Safety_Net__review_and_response.html|title=HealthPolicyMonitor – Surveys- CHERE – Australia- 14- The Medicare Safety Net: review and response|access-date=12 December 2012|archive-date=6 June 2014|archive-url=https://web.archive.org/web/20140606221640/http://hpm.org/en/Surveys/CHERE_-_Australia/14/The_Medicare_Safety_Net__review_and_response.html}}</ref> The extended safety net fee cap also applies for any rebate that is paid once the EMSN threshold is reached. The items subject to a cap has expanded since 2010, the latest being in November 2012.<ref>[http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-EMSN-Summary_1_Nov_2012 Summary of the changes to the Extended Medicare Safety Net – 1 November 2012] {{Webarchive|url=https://web.archive.org/web/20240710003102/https://www1.health.gov.au/Internet/main/publishing.nsf/content/404ref.htm |date=10 July 2024 }}. Department of Health. Retrieved 4 June 2014.</ref>

{| class="wikitable sortable"
|+Thresholds for the extended Medicare safety net
|-
! Year !! Concession and Family
Tax Benefit Part A 
! General threshold
|-
| 1 January 2006 || style="text-align: center;" | $500.00 || style="text-align: center;" | $1,000.00
|-
| 1 January 2007 || style="text-align: center;" | $519.50 || style="text-align: center;" | $1,039.00<ref name="2007 safety net">{{cite web|url=http://www.medicareaustralia.gov.au/public/services/msn/files/1856-24-how-does-the-medicare-safety-net-work.pdf|archive-url=https://web.archive.org/web/20071202055659/http://www.medicareaustralia.gov.au/public/services/msn/files/1856-24-how-does-the-medicare-safety-net-work.pdf|archive-date=2 December 2007|title=How does the Medicare Safety Net Work?|date=2 December 2007}}</ref>
|-
| 1 January 2008 || style="text-align: center;" | $529.30 || style="text-align: center;" | $1,058.70<ref name="2008 safety net">{{cite web|url=http://www.medicareaustralia.gov.au/public/services/msn/thresholds.jsp |title=Medicare Safety Net Thresholds – Medicare Australia |date=29 May 2008 |url-status=bot: unknown |archive-url=https://web.archive.org/web/20080529075247/http://www.medicareaustralia.gov.au/public/services/msn/thresholds.jsp |archive-date=29 May 2008 }}</ref>
|-
| 1 January 2009 || style="text-align: center;" | $555.70 || style="text-align: center;" | $1,111.60<ref name="2009 safety net">{{cite web|url=http://www.medicareaustralia.gov.au/public/services/msn/thresholds.jsp |title=Medicare Safety Net Thresholds – Medicare Australia |date=25 December 2009 |url-status=bot: unknown |archive-url=https://web.archive.org/web/20091225092820/http://www.medicareaustralia.gov.au/public/services/msn/thresholds.jsp |archive-date=25 December 2009 }}</ref>
|-
| 1 January 2010 || style="text-align: center;" | $562.90 || style="text-align: center;" | $1,126.00<ref name="2010 safety net">{{cite web|url=http://www.medicareaustralia.gov.au/public/services/msn/index.jsp |title=Medicare Safety Net – Medicare Australia |date=11 January 2010 |url-status=bot: unknown |archive-url=https://web.archive.org/web/20100111203258/http://www.medicareaustralia.gov.au/public/services/msn/index.jsp |archive-date=11 January 2010 }}</ref>
|-
| 1 January 2011 || style="text-align: center;" | $578.60 || style="text-align: center;" | $1,157.50<ref name="2011 safety net">{{cite web|url=http://www.medicareaustralia.gov.au/public/services/msn/index.jsp |title=Medicare Safety Net – Medicare Australia |date=18 February 2011 |url-status=bot: unknown |archive-url=https://web.archive.org/web/20110218120808/http://www.medicareaustralia.gov.au/public/services/msn/index.jsp |archive-date=18 February 2011 }}</ref>
|-
| 1 January 2012 || style="text-align: center;" | $598.80 || style="text-align: center;" | $1,198.00<ref name="2012 safety net">{{cite web|url=http://www.medicareaustralia.gov.au/public/services/msn/index.jsp |title=Medicare Safety Net – Medicare Australia |date=13 March 2012 |url-status=bot: unknown |archive-url=https://web.archive.org/web/20120313123213/http://www.medicareaustralia.gov.au/public/services/msn/index.jsp |archive-date=13 March 2012 }}</ref>
|-
| 1 January 2013 || style="text-align: center;" | $610.70 || style="text-align: center;" | $1,221.90<ref name="2013 safety net" />
|-
| 1 January 2014 || style="text-align: center;" | $624.10 || style="text-align: center;" | $1,248.70<ref name="2014 safety net" />
|-
| 1 January 2015 || style="text-align: center;" | $638.40 || style="text-align: center;" | $2,000.00<ref name="2015 safety net">{{cite web|url=http://www.humanservices.gov.au/customer/enablers/medicare/medicare-safety-net/medicare-safety-net-thresholds |title=2015 Medicare Safety Net thresholds – Department of Human Services |date=3 February 2015 |url-status=bot: unknown |archive-url=https://web.archive.org/web/20150203110953/http://www.humanservices.gov.au/customer/enablers/medicare/medicare-safety-net/medicare-safety-net-thresholds |archive-date= 3 February 2015 }}</ref>
|-
| 1 January 2016 || style="text-align: center;" | $647.90 || style="text-align: center;" | $2,030.00<ref name="2016 safety net" />
|-
| 1 January 2017 || style="text-align: center;" | $656.30 || style="text-align: center;" | $2,056.30<ref name="2017 safety net" />
|-
| 1 January 2018 || style="text-align: center;" | $668.10 || style="text-align: center;" | $2,093.30<ref>{{Cite web|url=http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-2018-01-01-latest-news-January|title=The 1 January 2018 MBS files (XML, DOC, PDF and ZIP) are now available to download|first=Australian Government Department of|last=Health|publisher=Australian Government Department of Health|via=mbsonline.gov.au|access-date=5 September 2020|archive-date=25 July 2020|archive-url=https://web.archive.org/web/20200725103554/http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/news-2018-01-01-latest-news-January|url-status=live}}</ref>
|-
| 1 January 2019 || style="text-align: center;" | $680.70 || style="text-align: center;" | $2,133.00<ref name="2019 safety net"/>
|-
| 1 January 2020 || style="text-align: center;" | $692.20 || style="text-align: center;" | $2,169.20<ref name="2020 safety net"/>
|-
| 1 January 2021 || style="text-align: center;" | $697.00 || style="text-align: center;" | $2,184.30<ref name="2021 safety net"/>
|-
| 1 January 2022 || style="text-align: center;" | $717.90 || style="text-align: center;" | $2,249.80<ref name="2022 safety net"/>
|-
| 1 January 2023 || style="text-align: center;" | $770.30 || style="text-align: center;" | $2,414.00<ref name="2023 safety net" />
|-
| 1 January 2024 || style="text-align: center;" | $811.80 || style="text-align: center;" | $2,544.30<ref name="2024 safety net"/>
|-
| 1 January 2025 || style="text-align: center;" | $834.50 || style="text-align: center;" | $2,615.50<ref name="2025 safety net"/>
|}