[Guides](/guides) Medicare safety nets explained: original and extended (EMSN) thresholds for 2026 ================================================================================ Updated 28 October 2026 Medicare has two safety nets for **out-of-hospital** services. Once a person or registered family reaches a threshold of costs in a calendar year, Medicare pays more. For **2026** the thresholds are **$594.40** for the Original Medicare Safety Net and **$2,699.10** for the Extended Medicare Safety Net, or **$861.20** for concession card holders and families getting Family Tax Benefit Part A. The 2026 thresholds ------------------- Safety net2026 thresholdWhat counts towards itWhat Medicare pays once it’s reachedOriginal Medicare Safety Net$594.40 (everyone)Gap amounts: the difference between the schedule fee and the Medicare benefit100% of the schedule fee for out-of-hospital servicesExtended Medicare Safety Net (EMSN)$2,699.10 generalOut-of-pocket costs: the difference between the fee charged and the Medicare benefit80% of out-of-pocket costs, or the item’s EMSN benefit cap if lowerEMSN, concessional$861.20 for concession card holders and Family Tax Benefit Part A familiesAs aboveAs above Thresholds are indexed every 1 January in line with the CPI, and they reset at the start of each calendar year. Neither safety net applies to services delivered in hospital or to services not listed on the MBS. The PBS Safety Net for medicines is separate, with its own thresholds. Gap amount vs out-of-pocket cost -------------------------------- The two safety nets count different things: - **Gap amount** (Original safety net): schedule fee − Medicare benefit. This is fixed for each item, whatever you charge. - **Out-of-pocket cost** (EMSN): fee charged − Medicare benefit. This depends on what you charge. > A specialist charges $180 for [item 104](/items/104) (schedule fee $103.95, benefit $88.40). The gap amount is $15.55 and the out-of-pocket cost is $91.60. How EMSN benefit caps work -------------------------- Many items have an **EMSN benefit cap**, which limits the extra EMSN benefit for one service no matter what is charged. Once the threshold is reached, the patient gets back 80% of their out-of-pocket cost or the cap, whichever is lower. - **Attendance items** are capped at **300% of the schedule fee or $500, whichever is lower**. For [item 23](/items/23) (fee $45.05), the cap is $135.15. - **Procedural items** can be capped at a fixed amount or a percentage of the schedule fee. For example, [item 30071](/items/30071) is capped at 80% of its fee. - Items without a cap pay the full 80%. The cap for each item is shown on its page in MBS Search. Families and couples -------------------- Individuals are registered automatically. Families, including couples, must register with Services Australia to combine their costs towards one threshold. Concessional EMSN eligibility applies when the person or family holds a concession card or receives Family Tax Benefit Part A. Frequently asked questions -------------------------- ### What are the Medicare Safety Net thresholds for 2026? The Original Medicare Safety Net threshold is $594.40. The Extended Medicare Safety Net threshold is $2,699.10, or $861.20 for concession card holders and families receiving Family Tax Benefit Part A. ### What is the difference between the original and extended safety nets? The original safety net counts gap amounts (schedule fee less benefit) and then pays 100% of the schedule fee. The extended safety net counts out-of-pocket costs (fee charged less benefit) and then pays 80% of out-of-pocket costs, up to each item’s EMSN benefit cap. ### Do in-hospital services count towards the Medicare Safety Net? No. The Medicare safety nets only apply to out-of-hospital services listed on the MBS. ### What is an EMSN benefit cap? It is the most the Extended Medicare Safety Net will pay for one service of an item. Attendance items are capped at 300% of the schedule fee or $500, whichever is lower. Procedural items can have a fixed or percentage cap. ### Do families need to register for the safety net? Yes. Individuals are registered automatically, but families and couples must register with Services Australia to have their costs combined. Sources ------- - [Services Australia: Medicare Safety Net thresholds](https://www.servicesaustralia.gov.au/what-are-medicare-safety-nets-thresholds?context=22001) - [MBS general explanatory note GN.10.27: Medicare safety nets](https://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&q=GN.10.27) - [MBS Online fact sheet: Medicare Safety Net arrangements from 1 January 2026](https://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-Medicare+Safety+Net+Arrangements+-+1+January+2026) - [Health Insurance (Extended Medicare Safety Net) Determination 2017](https://www.legislation.gov.au/F2017L01082/latest/text) - [Department of Health: Medicare safety nets](https://www.health.gov.au/topics/medicare/about/safety-nets) More guides ----------- - [How Medicare benefits work: schedule fees, 75%, 85% and 100%](/guides/how-medicare-benefits-work) - [In-hospital billing: the 75% benefit, the 25% fund benefit, and no-gap and known-gap schemes](/guides/in-hospital-billing-and-gap-cover) - [Bulk billing incentives and BBPIP explained: 2026 amounts by MM area](/guides/bulk-billing-incentives) - [The MBS multiple operation rule and surgical assistant fees](/guides/multiple-operation-rule) - [Assignment of benefit for bulk billing: the changes from 1 July 2026](/guides/assignment-of-benefit-2026) - [MBS telehealth rules: the eligible telehealth practitioner and phone items](/guides/mbs-telehealth-rules) - [GP chronic condition management plans: items 965 and 967 explained](/guides/chronic-condition-management-plans) - [Medicare billing compliance: claim time limits, records and the 80/20 rule](/guides/medicare-billing-compliance) General information for health professionals, not legal or financial advice. Check MBS Online and Services Australia for the rules that apply to your circumstances.