Cancer health insurance in Australia
Public or private: What cancer treatment costs are covered and which is the right option for you?
Private hospital cover of Bronze or above allows you to get treatment for cancer, choose your own doctor and stay in your own private room.
This guide will tell you how Medicare and private health insurance can work together to get you the help you need and also how to minimise your out-of-pocket expenses.
What you'll find in this guide
How much does cancer treatment cost in Australia?
Your costs can vary based on the type of cancer you have. A study published by the Medical Journal of Australia in 2018 uncovered the average out-of-pocket costs for five major cancers: breast, prostate, lung, colorectal and melanoma.
They found that breast cancer patients have the highest out-of-pocket costs, ranging from $1,165 to $7,495 with a median of $4,192.Lung cancer patients have the lowest, ranging from $367 to $3,196 with a median of $1,078.
Of course every patient is different and so is every cancer. A rare bone marrow cancer could potentially cost more than those cancers studied.
Another 2018 report from the Consumers Health Forum of Australia (CHFA) shows that nearly half of Australian cancer patients paid more than $5,000 in out-of-pocket expenses for their treatment over a two-year span and a quarter spent more than $10,000.
Needless to say, you will experience some out-of-pocket expenses whether you go public or private, but luckily there are ways to reduce them.
How does private health insurance cover cancer treatment in Australia?
Private health insurance can work alongside Medicare, giving you the benefit of having more control over your treatment and where it occurs. It covers you in four major ways:
- In-hospital cancer treatments. Private health insurance will contribute to your in-hospital treatments at a private clinic, including doctor's fees, accommodation, prescriptions and the treatment itself.
- In-hospital psychology. The only level of cover where you'll get this for sure is a Gold level policy, although some policies as low as Bronze Plus will offer it. The good news is, you can upgrade your policy to one that covers psychiatry and skip the waiting period if you find you need this cover at the last minute.
- Prescriptions. Some extras policies cover medication that is not on the Pharmaceutical Benefits Schedule (PBS). Some rare forms of cancer require obscure medications meaning there's a chance you could be prescribed an expensive drug that Medicare doesn't cover.
- Rehab. Some extras policies will cover a host of treatments that help you recover, like physio, exercise physiology, speech therapy and even acupuncture.
- Ambulance. Many policies offer emergency ambulance cover. You can find this on both hospital and extras policies. This is unnecessary in states like QLD and TAS, which provide ambulance cover for residents.
You'll experience more out-of-pocket expenses with private health insurance, but the trade-off is that you get treated sooner by your choice of doctor. .
Plus you will still be able to claim Medicare benefits.
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What is the best health insurance for cancer patients?
If you're looking for the best insurance policy, here's a few things to consider::
- Get a Bronze policy or higher. All Bronze policies and above are required to offer treatment for cancer and you're unlikely to find private cover at levels below that.
- Consider your transportation costs. If you have to travel more than a certain distance for your treatment (around 200-250km), some private policies will cover some of your transportation and accommodation costs. This can be a great way to save on some of those costs that often fly under the radar but still add up.
- Don't forget your extras. An extras policy can offer a host of important treatments that can help you cope and recover like physical therapy, speech therapy and psychological counselling. It can even cover medications that Medicare doesn't.
- Look for a large network of agreement hospitals. Most private insurers have a network of private doctors and hospitals that have agreed to lower their out of pocket costs for their customers. Look for an insurer that has a wide network with lots of providers near you.
- Think about other services you might need. You might want to consider a policy with in-hospital psychiatry since cancer can take a toll on you mental health. Or you may have a family history of cancer and want to have children before any possible diagnosis. In that case you may want to consider a policy that covers pregnancy.
Are there any waiting periods for cancer treatment?
Here are the typical waiting periods you can expect as a cancer patient:
- If you already have cancer. 12 months since it's a pre-existing condition. It could still worth considering cover since you may have to wait for public treatment.
- If you don't have cancer. 2 months. If you haven't been diagnosed and haven't developed any symptoms, you can get treatment sooner.
Is cancer treatment covered by Medicare in Australia?
Yes. Whether or not you use private health insurance, you'll still rely on Medicare for a large portion of the costs. According to the Sydney Morning Herald, Medicare will cover an average of 63% of the total costs, which ranges from 51% for prostate cancer to 89% for lung cancer.
Medicare provides rebates for some outpatient services, many of which aren't covered by private health insurance. These outpatient services include:
- GP visits
- Specialist visits
- Blood tests
- CT scans
Medicare can also pay for all of your in-hospital treatments if you choose to be treated as a public patient.
Cancer treatment in Australia and your out-of-pocket costs
Why do out-of-pocket expenses vary so much from patient to patient?
Cancer treatment is not as straightforward as something like fixing a broken nose, where the diagnosis is straightforward and you book into see a single surgeon who fixes you up and sends you on your way.
Here are some of the things that make cancer treatment different:
- Every cancer is different. A rare form of blood cancer will probably require more testing and more specialist visits than a malignant mole clearly visible on the skin.
- Diagnosis can take a while. Depending on what type of cancer is suspected, you could be running around from your GPs to the testing clinics, back to the GP, over to a specialist who sends you for some more tests, then back to the specialist and so on.
- Treatment can vary widely from case to case. If you need treatment, you might need anything from surgery to remove a tumor to chemotherapy to hormone therapy to rehab to all of the above.
- You won't always be checked into a hospital. Sometimes you'll be a patient in a hospital other times you'll be treated as an outpatient.
- You can't always choose where you have certain procedures. Sometimes you'll have no choice but to visit a private clinic for procedures like an MRI or radiation therapy. Other times you'll be able to locate a public clinic that will do certain things cheaper..
How can I work out my out-of-pocket costs for cancer treatment?
Look at all of the various treatments, procedures or consultations that you could encounter as a cancer patient.
Your ability to get public and/or private assistance is slightly different in each case. By looking at the options you have and the financial roadblocks you can encounter in each case, you can develop strategies that will help you minimise your out-of-pocket expenses as a whole.
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