Two different yearly spending caps in Australia, one for medicines and one for doctor and test costs, and what changes once you reach them.
A safety net is a yearly limit. Once the amount you have paid in a calendar year reaches a set figure (the threshold), the government covers more of your later costs for the rest of that year. Everything starts again on 1 January.
There are two separate safety nets. The PBS Safety Net is for prescription medicines. The Medicare Safety Net is for doctor, specialist and test costs outside hospital. They are counted separately.
What counts: what you pay for PBS prescriptions at a pharmacy. Brand premiums and some early-supply fees do not count.
2026 thresholds:
General patients: $1,748.20
Concession card holders: $277.20
After you reach it: general patients pay $7.70 per PBS script for the rest of the year. Concession card holders pay nothing per script. Any brand premium is still charged.
You need to act: it is not automatic. Keep a record of what you pay (a prescription record form, or ask your pharmacy) and apply for a Safety Net card.
What counts: out-of-hospital services on the Medicare Benefits Schedule (MBS). Hospital stays and services not on the MBS do not count.
2026 thresholds:
Original (gap costs): $594.40
Extended, most people: $2,699.10
Extended, concession card holders and Family Tax Benefit Part A families: $861.20
After you reach them: after the original threshold Medicare pays 100% of the schedule fee instead of 85%. After the extended threshold Medicare pays up to 80% of your further out-of-pocket costs, with caps on some services.
Couples and families: individuals reach it automatically. Families need to register with Services Australia so costs can be added together.
PBS: you keep paying the normal price per script until your total reaches the threshold. After you reach it and have your Safety Net card, the price per script drops for the rest of the calendar year.
Medicare: you keep paying the usual gap until your total reaches the threshold. After that, Medicare adds extra money to its payment on later out-of-hospital MBS services that year. What you pay can still be more than zero if a practitioner charges above the schedule fee.
Yes, for the Medicare Safety Net couples and families register once with Services Australia so their costs are added together; sharing a Medicare card does not do this for you. Dependants are children under 16 and full-time students aged 16 to 25. For the PBS Safety Net, your partner, children under 16 and dependent full-time students under 25 count together, so keep one record of everyone's PBS costs.
PBS: no. You apply for a Safety Net card and show it at the pharmacy. Medicare: for an individual the higher payment applies automatically once you reach a threshold. Couples and families need to register with Services Australia so their costs are counted together.
Brand premiums do not count toward the PBS Safety Net threshold. Hospital stays and services that are not on the MBS do not count toward the Medicare Safety Net.
Both safety nets count costs within a calendar year (1 January to 31 December). The tally starts again each 1 January, and thresholds are normally updated each January.
No. Safety nets are part of Medicare and the PBS. Private health insurance is separate, and the Extended Medicare Safety Net does not change what your insurer pays.