If you see a psychiatrist or psychologist regularly, the cost of appointments can add up quickly, even with Medicare rebates. The Medicare Safety Net is the system that can lift your rebates later in the year once your out-of-pocket spending passes a set amount. It does not reduce what your clinician charges. It increases how much Medicare pays you back.
This guide explains how the Medicare Safety Net works for mental health care in 2026, what counts toward your threshold, how to register your family, how to check your balance in myGov, and what the numbers look like in real examples for psychiatry and psychology.
Medicare Safety Net Threshold 2026 at a Glance
Australia has two Medicare safety nets that run side by side: the Original Medicare Safety Net (OMSN) and the Extended Medicare Safety Net (EMSN). The thresholds below are the official 2026 figures published by the Department of Health, Disability and Ageing.
Safety net | 2026 threshold | Who it applies to | What counts toward it | What you get once you reach it |
Original Medicare Safety Net | $594.40 | Everyone | Your gap amount for the calendar year | Medicare pays 100% of the scheduled fee (instead of 85%) for out-of-hospital services |
Extended Medicare Safety Net, general | $2,699.10 | Everyone not in the concessional group | Your out-of-pocket costs for the calendar year | Medicare pays up to 80% of further out-of-pocket costs, up to a cap on each item |
Extended Medicare Safety Net, concessional | $861.20 | Commonwealth concession cardholders and families receiving Family Tax Benefit Part A | Your out-of-pocket costs for the calendar year | Same 80% benefit, reached much sooner |
Thresholds are indexed each 1 January and reset to zero at the start of every calendar year. Expect new figures from 1 January 2027, and check Services Australia for the current amounts.
Understanding Medicare Fees and Costs
Start with three terms, because most confusion comes from mixing them up. Understanding how Medicare fees and rebates work can help you estimate what you may need to pay for medical appointments and specialist consultations.
Knowing the difference between the schedule fee, the Medicare benefit, the gap, and your out-of-pocket costs can make medical expenses easier to understand. It can also help you plan and avoid unexpected costs.
1. Schedule Fee
The schedule fee is the amount the Australian Government sets for a specific Medicare service. It is a benchmark for calculating Medicare benefits, not necessarily the amount your clinician charges.
2. Medicare Gap Amount
The gap amount is the difference between the schedule fee and the Medicare benefit. Under the standard arrangement, this is the 15% of the schedule fee that Medicare does not cover. It counts towards the Original Medicare Safety Net.
3. Out-of-Pocket Cost
Your out-of-pocket cost is the difference between the fee your clinician actually charges and the Medicare benefit you receive. This may be higher than the Medicare gap and counts towards the Extended Medicare Safety Net.
Here is how the two safety nets then play out.
How the Medicare Safety Nets Work
Step 1: Before You Reach a Safety Net Threshold
Medicare generally pays 85% of the Medicare Benefits Schedule (MBS) fee for eligible out-of-hospital specialist services. You pay the remaining amount of the scheduled fee, plus any difference between the scheduled fee and the fee your clinician charges.
Step 2: After Reaching the Original Medicare Safety Net
Once your eligible gap expenses reach the Original Medicare Safety Net (OMSN) threshold, Medicare generally covers 100% of the scheduled fee for eligible out-of-hospital services for the remainder of the calendar year. If your clinician charges more than the schedule fee, you are still responsible for the additional amount.
Step 3: After Reaching the Extended Medicare Safety Net
Once your eligible out-of-pocket expenses reach the Extended Medicare Safety Net (EMSN) threshold, Medicare may cover up to 80% of further eligible out-of-pocket costs for the rest of the calendar year. However, EMSN benefit caps apply to individual services.
For consultation items, the cap is generally the lower of 300% of the schedule fee or $500, although the exact cap depends on the item. For example, psychiatrist item 296 has an EMSN cap of $500.
You receive whichever is lower: 80% of your out-of-pocket cost or the item’s cap.
What Counts Toward Your Safety Net, and What Does Not
Medicare tracks eligible costs automatically, but not everything counts.
What counts
- Out-of-hospital services listed on the Medicare Benefits Schedule, including GP and specialist attendances, psychiatrist and psychologist sessions, and many pathology and imaging services
- Telehealth sessions that attract an MBS rebate
- Gap and out-of-pocket costs on those services for you and, if registered, your family members
What does not count
- Hospital services, and services not listed on the MBS
- Fees for things that are not MBS services, such as cancellation fees or administrative charges
- Bulk-billed services, because there is no gap or out-of-pocket cost to add up
- Unverified costs. Only verified costs count, meaning you paid the clinician’s fee before claiming from Medicare. If you claim an unpaid account, that gap does not count toward your threshold until it is paid
- Private health insurance payments and PBS medication costs, which follow separate rules (the PBS has its own safety net)
Worked Examples: Psychiatry and Psychology
These examples use official 2026 Medicare schedule fees and rebates. The clinician fees are illustrative, since each practice sets its own.
Example 1: Clinical psychologist (item 80010)
Schedule fee: $175.30. Medicare benefit at 85%: $149.05. Say the psychologist charges $240.
Stage | Medicare pays | You Pay |
Before any threshold | $149.05 | $90.95 |
After the Original Medicare Safety Net | $175.30 | $64.70 |
After both safety nets are reached | $227.06 (the $175.30 plus 80% of the remaining $64.70) | $64.70 |
Example 2: New psychiatrist appointment (item 296)
Schedule fee: $316.30. Medicare benefit at 85%: $268.90. Say the psychiatrist charges $500.
Stage | Medicare pays | You pay |
Before any threshold | $268.90 | $231.10 |
After the Original Medicare Safety Net | $316.30 | $183.70 |
After both safety nets are reached | $463.26 (the $316.30 plus 80% of the remaining $183.70) | $36.74 |
The final stage assumes both thresholds have been reached. Depending on your fees and which services you use, you may reach one before the other, and your numbers will differ slightly.
What the examples show
- The safety net pays off most for psychiatry, because the gaps are larger and reach the thresholds faster. If each appointment left you about $230 out of pocket, a general patient would reach the EMSN threshold after roughly a dozen appointments, and a concession cardholder after about four.
- For psychology, the 10-session annual limit matters. Under Better Access, Medicare rebates cover up to 10 individual sessions per calendar year. The safety net only lifts benefits on sessions that already attract a rebate, so it will not make extra sessions rebateable. At around $65 to $90 out of pocket per session, 10 sessions on their own rarely get a general patient to the $2,699.10 threshold. The safety net becomes powerful when psychology costs combine with other medical costs, particularly for registered families.
Safety Net for Psychiatrist vs Safety Net for Psychology
Psychiatrist | Psychologist | |
Referral | From a GP, nurse practitioner or another specialist, depending on the item | From a GP, psychiatrist or paediatrician (GP referrals under a Mental Health Treatment Plan) |
Annual rebated sessions | Not capped at 10 like Better Access, though high volumes of attendances move to different items | Up to 10 individual sessions per calendar year |
Typical gap | Larger, so thresholds are reached sooner | Smaller per session |
Example schedule fee and rebate | Item 296: $316.30 fee, $268.90 rebate | Item 80010: $175.30 fee, $149.05 rebate. Item 80110: $119.45 fee, $101.55 rebate |
EMSN cap | Item 296: $500 | Check each item on MBS Online, since consultation items are generally capped at the lower of 300% or $500 |
One recent change is worth knowing. Since 1 November 2025, Better Access Medicare benefits are only payable when the Mental Health Treatment Plan, review and referral are done by a GP at the practice where you are enrolled in MyMedicare, or by your usual medical practitioner. Referrals dated before 1 November 2025 stay valid until their sessions are used.
Concessional Safety Net: Who Qualifies
The lower EMSN threshold of $861.20 applies to people who hold a Commonwealth concession card, such as a Health Care Card, Pensioner Concession Card or Commonwealth Seniors Health Card, and to families who receive Family Tax Benefit Part A. For many people on lower incomes, this threshold is reachable within a year of regular mental health care.
Register Your Family for the Medicare Safety Net
Registering early in the year matters. Costs only combine from the point Medicare knows who is in your family, so leaving it until you are already close to a threshold can be a missed opportunity.
1. Single People
If you are single, you generally do not need to register. Medicare tracks your eligible expenses and applies the relevant higher benefits automatically once you reach a threshold.
2. Couples and Families
Couples and families need to register with Services Australia so that eligible expenses for all registered family members can count towards the same Safety Net threshold. This applies even if everyone is listed on the same Medicare card.
3. When to Update Your Registration
You generally only need to register once, but you should update your details if your family circumstances change. Examples include entering a relationship, having a baby, separating, or a dependent student child no longer studying full-time.
4. How to Register
You can register through your Medicare online account linked to myGov or by calling Medicare on 132 011.
5. Confirming Your Family Details
As your family approaches a Safety Net threshold, Medicare may ask the nominated contact person to confirm the registered family members. This request may arrive through the myGov inbox or by post.
How to Check Your myGov Safety Net Balance
- Log in to myGov and open your linked Medicare account, or use the Medicare app.
- Look for your safety net or claims information. Menu labels change between versions, so if you cannot find it, search the Medicare section for “safety net”.
- Check how close you are to your threshold. If you are close, ask your clinic what your next appointments are likely to cost.
- If something looks wrong, call Medicare on 132 011.
Your balance only includes verified costs and claims that have been processed, so it can lag behind your most recent appointments.
Common Medicare Safety Net Mistakes to Avoid
Understanding how the Medicare Safety Net works can help you avoid common mistakes that may delay access to higher Medicare benefits. From registering your family to claiming eligible medical expenses, a few simple steps can help you make the most of the support available.
1. Not Registering as a Couple or Family
Without family registration, each person’s eligible expenses may be tracked separately. Registering as a couple or family allows eligible costs to be combined towards a shared threshold.
2. Leaving Accounts Unclaimed
Unverified medical expenses may not count towards your Safety Net threshold. Make sure eligible services are claimed, and your records are up to date.
3. Assuming Bulk-Billed Services Count Towards the Threshold
Bulk billing means you generally have no out-of-pocket gap for the service, but it also means there is no gap expense to contribute to the relevant threshold.
4. Expecting the Safety Net to Cover Non-Medicare Fees
Cancellation fees and administrative charges are generally not eligible for Medicare rebates and do not count towards the Safety Net thresholds.
5. Assuming the Safety Net Reduces Your Clinician’s Fee
The Safety Net increases eligible Medicare benefits; it does not require clinicians to lower their fees. Before booking, ask the practice about its consultation fee, the expected out-of-pocket cost, and the Medicare item that will be billed.
6. Forgetting the Calendar-Year Reset
Medicare Safety Net thresholds reset on 1 January each year. If you have significant medical expenses late in December, your costs may be split across two calendar years, meaning you may need to reach the threshold again in the new year.
Questions to Ask Your Clinic About Out-of-Pocket Costs
- What is the full fee for each appointment, and which Medicare item will be billed?
- What will my Medicare rebate and my gap be?
- Do you bulk bill, and if so, which services?
- Are there additional fees, such as cancellation, report writing, or administration?
- Are your telehealth sessions billed under the same Medicare items as in-person sessions?
FAQs
Can medical expenses from different clinics contribute to the same Medicare Safety Net threshold?
Yes. Eligible expenses from different providers can contribute to your Medicare Safety Net total within the same calendar year. You do not need to receive all your medical care from one GP, specialist or clinic.
Can one expensive specialist appointment help me reach the Medicare Safety Net threshold?
Yes, an expensive appointment may bring you closer to the threshold if the service and associated expenses are eligible. Whether you reach it depends on your accumulated eligible costs and the applicable threshold.
Does reaching the Medicare Safety Net mean my next appointment will be free?
Not necessarily. The Medicare Safety Net increases benefits for eligible out-of-hospital services, but it does not require every provider to reduce their fees. You may still have out-of-pocket expenses, depending on the clinician’s charges and the applicable Medicare benefits.
Do diagnostic tests and medical scans count towards the Medicare Safety Net?
Eligible out-of-hospital diagnostic services may contribute to your Medicare Safety Net total. However, not every test, scan or medical service automatically qualifies, so check whether the specific service is eligible for a Medicare benefit.
Can I benefit from the Medicare Safety Net if I see a private specialist?
Yes. Seeing a private specialist does not automatically exclude you from the Medicare Safety Net. Eligible out-of-hospital specialist services may count towards your threshold, although you may still need to pay part of the consultation fee yourself.
Does the Medicare Safety Net apply to telehealth appointments?
Eligible telehealth consultations may count towards the Medicare Safety Net when they meet the relevant Medicare Benefits Schedule requirements. Eligibility depends on the type of consultation, the provider and the applicable Medicare item.
What should I do if my Medicare Safety Net total seems incorrect?
Check your Medicare claims and the expenses recorded in your Medicare online account through myGov. If an eligible service or expense appears to be missing, contact Medicare or your provider to clarify whether the claim was processed correctly.
Can I still receive Medicare Safety Net benefits if I have private health insurance?
Having private health insurance does not automatically prevent you from receiving Medicare Safety Net benefits for eligible services. However, private insurance payments, premiums and excesses are not themselves Medicare Safety Net expenses.
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For Mental Health Emergencies in Australia, contact:
- Lifeline: 13 11 14
- Beyond Blue: 1300 224 636
- MensLine Australia: 1300 789 978
- Suicide Call Back Service: 1300 659 467
- Veterans and Veterans Families Counselling Service: 1800 011 046
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