Safety Nets

This page provides general educational information about how the Medicare Safety Net and the Pharmaceutical Benefits Scheme (PBS) Safety Net operate within the Australian health system.

 

In Australia, many medical services and prescribed medicines receive government subsidies. Even so, people who use a high number of services or medicines in a calendar year may still have out-of-pocket costs. Over time, these costs can add up.

 

Why these safety nets exist

The Medicare Safety Net and the PBS Safety Net are designed to attempt to provide additional financial protection once a person or family’s eligible out-of-pocket spending reaches a set annual threshold.

 

In general, they exist to attempt to:

• Reduce the financial impact of ongoing or complex health needs

• Provide increased government support after a defined level of spending has been reached

• Attempt to limit the risk that frequent healthcare use becomes financially overwhelming

 

How they fit into the system

The PBS Safety Net relates to eligible prescription medicines supplied under the national Pharmaceutical Benefits Scheme. Once the relevant annual threshold is reached, the amount a person pays for eligible medicines is reduced for the remainder of that calendar year.

 

The Medicare Safety Net relates to certain eligible out-of-hospital medical services. After the relevant annual threshold is reached, Medicare may pay a higher benefit for additional eligible services for the rest of the calendar year.

 

Both safety nets operate within the broader Medicare and PBS frameworks, which are funded by the Australian Government. Thresholds, rules, and arrangements are set by legislation and policy, and may change over time.

 

Access and the amount of support available can vary depending on individual circumstances, including concession status and family registration arrangements.

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