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Cancer health insurance in Australia
Both Medicare and private health insurance can play a role in meeting the cost of cancer treatment. Private health plans start from around $88 a month and you'll need to serve a minimum 2-month waiting period before you can claim.
Receiving a cancer diagnosis can be overwhelming for you and your loved ones. The right health insurance help to ease some of the financial burdens while you focus your energy on your recovery. Private insurance can cover some treatments as well as the option to choose your own doctor and stay in your own private room at the hospital.
Is cancer treatment covered by Medicare in Australia?
Yes, Medicare can pay for all of your in-hospital treatments if you choose to be treated as a public patient. Whether or not you use private health insurance, you'll still rely on Medicare for a large portion of the costs linked to your cancer - generally speaking, Medicare tends to cover anything from around 60% to 90% of the overall cost.
Medicare provides rebates for some outpatient services too, including:
GP visits
Specialist visits
Blood tests
CT scans
MRIs
Biopsies.
Be sure to check with your health provider about any costs you'll face ahead of time. Similarly, it's good to check in with your health fund before you receive any treatment so that you know exactly what's covered, along with any restrictions or exclusions.
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 for:
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 still have out-of-pocket costs with private health insurance, it's important to note.
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What should I keep in mind when comparing health insurance for cancer?
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.
Waiting periods to be aware of for cancer treatment
Here are the typical waiting periods you can expect as a cancer patient:
Hospital treatments
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.
How can I work out my out-of-pocket costs for cancer treatment?
Start by working out 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.
How is it covered by Medicare? It's free if the GP bulk bills Medicare but if they don't they'll probably charge an amount above the Medicare rebate. You will be responsible for that portion, known as your gap.
How is it covered by private health insurance? It's not. Private health insurance doesn't apply to GP visits.
Implication: You could end up having dozens of GP visits, but it's relatively easy to avoid large out-of-pocket costs by finding a GP that bulk bills Medicare.
How can you reduce your costs? There are plenty of GPs all around Australia who bulk bill. Locate a couple in your area and stick with one you feel comfortable with.
Can you use private health insurance? Health insurance covers MRIs and other scans only if they're part of your in-hospital treatment.
How is it covered by Medicare? For outpatient tests, certain tests and scans are 100% covered by Medicare if done in a public facility. However, more and more facilities are being privatised meaning you'll get a Medicare rebate and likely pay an out-of-pocket fee. In addition, some scans aren't covered at all, especially those looking for rarer forms of cancer.
How is it covered by private health insurance? Outpatient tests and scans aren't covered by private health insurance and you'll have to rely on the Medicare rebate.
If you're a private patient in a hospital, you will receive a Medicare rebate on tests as long as they are on the Medicare Benefits Schedule (MBS), which is Medicare's list of covered treatments. You will be responsible for any difference in cost and for the full costs of tests and scans that aren't on the MBS.
Implication: These costs can be difficult to predict for a number of reasons:
Diagnosis isn't always straightforward
Not all scans are covered
Private facilities can be hard to avoid
How can you reduce your costs? Keep open communication with your GP about wanting to minimise your out-of-pocket expenses. Research all the public testing facilities in your area and request that your GP refer you to them if possible. If your doctor or someone on the facility tells you something isn't covered, ask them for the item number and search the MBS just to be sure. Make sure you have your bank account information updated in the Medicare system so you can get your refund in a timely fashion.
How is it covered by Medicare? It's free if it meets all of the following conditions:
A GP refers you
The specialist bulk bills
It's a service listed on the Medicare Benefits Schedule (MBS).
If the specialist doesn't bulk bill, you will receive a rebate (and probably pay some out of pocket costs) as long as the consultation is on the MBS.
How is it covered by private health insurance? It is not. Private health insurance doesn't apply to specialist visits.
Implication: Finding a specialist near you who bulk bills can be challenging since they aren't as common as GPs. However, it shouldn't take much legwork to do the research.
How can you reduce your costs? Ask your GP to refer you to a specialist who bulk bills. If they don't know any, do your own research and suggest some names. If you can't find a specialist that bulk bills, email a few others and ask them for a schedule of fees so you can compare prices.
How is it covered by Medicare? This is free if it's done as a public patient in a public hospital, but you will be on a waiting list if the treatment isn't urgent. Your accommodation and anesthesia will also be covered free of charge.
How is it covered by private health insurance? If you have a private hospital policy that covers cancer, you can choose to be treated privately instead. Medicare and private insurance will cover the MBS fee for the surgery and the anesthesia. You will pay your insurance excess and any gap the doctor an anesthetist charge above the MBS fee. You may also have some out-of-pocket costs for your accommodation. This is called your co-pay.
Implication: There are usually more out-of-pocket expenses related to surgery in a public hospital. However, the benefits are that you get to choose who treats you, you can avoid the long wait times associated with the public system and you're pretty much guaranteed a private room.
How can you reduce your costs? There are ways to reduce your out-of-pocket costs if you decide to go the private route. Your private health insurer may have special arrangements in place with certain private hospitals, known as agreement hospitals, that have agreed to reduce your out-of-pocket expenses.
You can also ask your private doctor to treat you in a public hospital, where you can save on some of the associated fees like accommodation.
How is it covered by Medicare? Intravenous chemo and radiotherapy is free in a public hospital. However more and more radiotherapy services are run by private clinics so depending on where you live, you may have no choice but to use their services. If that's the case, you'll get a rebate from Medicare but most likely also pay some out-of-pocket fees.
For chemo and hormone medication taken out of the hospital, Medicare will pay for most of it as long as it's part of the Pharmaceutical Benefits Scheme.
If your medication is not on the PBS (eg, it's for a rare form of cancer or it's a new cutting edge drug), you could end up shouldering the entire cost.
How is it covered by private health insurance? If it's done in-hospital, private insurance will cover your intravenous chemo and radiotherapy, but you may have to pay a gap fee. If it's done as an outpatient, private insurance won't cover you. However, you'll still be eligible for a Medicare rebate.
Private health insurance doesn't cover an oral chemo treatment or hormone therapy taken out-of-hospital, so you'll have to rely on the PBS as mentioned above. Some private extras policies will help out with the cost of non-PBS medications.
Implication: You can expect some out-of-pocket costs for chemo, radiotherapy and hormone treatments since much of this involves pharmaceuticals you'll be taking as an outpatient.
How can you reduce your costs? For all outpatient service, research public clinics in your area and ask your GP to refer you to one of them. If there are only private clinics, call them and ask. them for a schedule of fees so you can compare costs. In regard to outpatient medication, the only thing you can really do is take out a private extras policy that covers non-PBS medications in case you happen to be prescribed one.
How is it covered by Medicare? In-hospital medication that's on the PBS will be fully covered in a public hospital. For prescription medications you take as an outpatient, you'll be covered for most of the cost as long as the medications are on the PBS.
How is it covered by private health insurance? Whether you're an inpatient or an outpatient, you'll be covered for most of the cost as long as the prescription is on the PBS. You'll have some out-of-pocket costs.
If it's not on the PBS, you'll be responsible for the entire cost although some private extras policies will help toward some non-PBS pharmaceuticals.
Implication: You'll most likely have some out-of-pocket costs for prescriptions no matter where you are treated. Since many of these aren't directly related to your treatment, there's a good chance you can find most of them on the PBS.
How can you reduce your costs? If you're prescribed supplementary medication like pain medication or anti-nausea medication, ask the prescribing doctor to make sure it's on the PBS. You can also take out a private extras policy to help out with non-PBS medications if you're prescribed one. Just keep in mind there is usually a waiting period of around two months. Shop around at various chemists for the best price and choose generic versions of the medication if possible.
How is it covered by Medicare? In-hospital psychology and rehab (like physio and exercise physiology) will be fully covered in the public system. Some public hospitals with a lot of resources may offer some of these services like speech therapy and exercise physiology.
You can get a Medicare rebate for out-of-hospital rehab, psychiatry and psychology but this probably won't cover the full cost and you will be responsible for the rest.
How is it covered by private health insurance? Your private health insurance will also cover in-hospital rehab but it may or may not cover in-hospital psychology depending on your policy.
A private extras policy may also contribute to some of these services as an outpatient, but these will not cover the full cost and you'll have to come up with the rest.
Private surgeons may offer certain free classes like classes like nutrition, group counselling or yoga.
Implication: Most people will experience out-of-pocket costs related to allied health services unless they are lucky enough to live near a major public hospital that provide all of these services.
How can you reduce your costs? Take out a private extras policy that covers a range of services like physiotherapy, speech therapy and psychology.
Maximise your Medicare rebates by asking your GP to enroll you in the Chronic Disease Management plan, which can help patients with chronic or terminal diseases become eligible for additional rebates for services like physiotherapy and speech therapy.
You can also ask your GP to enroll you in a Mental Health Treatment plan, which will make you eligible for rebates on psychological counselling.
How much does health insurance cost?
We ask hundreds of Australians what they're paying for health insurance every month. Here's what they told us in April 2024.
Basic: $116
Bronze: $143
Silver: $168
Gold: $209
Price based on 1,000+ responses for single hospital insurance.
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Frequently asked questions
Private health cover will help with a portion, or all, of the costs of being a private patient who receives treatment in either a private or public hospital. The amount you're covered for varies depending on the level of cover you hold.
Your insurance can also help you pay for some out-of-hospital services. What you're covered for depends on the level of extras cover you hold. This could include some of the complementary services that are often used to treat cancer patients. For example, occupational therapy, home nursing, assisted living programmes and psychology.
By paying more for a comprehensive Gold policy, you can help to reduce some of the costs that aren't fully met by your hospital stay and post-hospital care.
Figures from Consumers Health Forum of Australia (CHFA) showed 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; a quarter spent more than $10,000. The 2018 report, which was the most recent data we could find, can be read here.
Costs can vary quite a bit based on where you live, your individual illness, the treatment needed and recovery time.
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. Because these are out-of-hospital treatments, you'd likely need to cover the MRI costs yourself, as insurance can only cover hospital treatments. Other times you'll be able to locate a public clinic that will do certain things cheaper.
Richard Laycock is Finder’s insights editor after spending the last five years writing and editing articles about insurance. His musings can be found across the web including on MoneyMag, Yahoo Finance and Travel Weekly. Richard studied Media at Macquarie University and The Missouri School of Journalism and has a Tier 1 Certification in General Advice for Life Insurance.
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