What is covered by health insurance and what is covered by Medicare?
Cancer affects the lives of far too many Australians, with more than 130,000 new cancer cases diagnosed around the country in 2016.
If you’re diagnosed with cancer and need treatment, your medical costs are covered in a range of ways both by Medicare and private health funds. Let’s take a closer look at the cover available and how it can benefit you.
Private health insurance allows you to choose and pay for a specific level of cover for medical services. The premium you pay, the type of services covered and to what level varies depending on the health insurance policy you choose.
With private health insurance cover in place, you can be treated in a private hospital or as a private patient in a public hospital. You also have the freedom to choose your own doctor and if you choose a top hospital policy, you’ll receive cover for all services for which Medicare pays a benefit.
Medicare allows Australian citizens and eligible permanent residents to access free treatment as an inpatient in a public hospital. However, waiting lists apply to some services and you are unable to choose your own doctor.
Medicare also provides cover for some outpatient services including visits to your GP. In addition, under the government’s Pharmaceutical Benefits Scheme, you can access thousands of subsidised prescription medicines, regardless of whether you are treated in the public or private hospital system. However, many other outpatient costs, for example ambulance transportation and treatment, or home nursing services, are not covered by Medicare.
How much will treatment cost?
The treatment costs for cancer vary for each patient and depend on the cancer type, stage and treatment required. However, every patient has the right to know the full cost before agreeing to treatment, which is known as informed financial consent.
Before you decide whether to undergo treatment in the public or private health care sector, ask your doctor and hospital for a rundown on how much your cancer treatment and consultations will cost. The Medicare Benefits Schedule (MBS) outlines the benefits Medicare pays for different services, but some doctors will charge more than the MBS fee, resulting in a “gap”.
This is why it’s vital to check how much your upfront and out-of-pocket expenses will be, and whether there are flexible repayment plans available so you can pay those bills at a rate that suits your budget. Ensure that you are aware of all the costs that may apply to your treatment. For example, even if you have private health insurance cover, you may still have to pay for the anaesthetist.
If you have private cover, ask your fund about its gap cover scheme. If your treating doctor or specialist participates in the scheme, this may cover all of your out-of-pocket expenses. Check the type and level of health insurance cover you have and ask your health fund to explain what costs it will cover and what costs you will have to pay.
If you will struggle to meet the cost of treatment, speak to your doctor about your options. For example, your doctor may be able to keep seeing you as a public patient, or you may be eligible to access your superannuation to help pay your medical bills.
It’s important to point out that a lot of cancer care is delivered outside of hospitals, including oncologist and surgeon consultations, as well as blood tests, X-rays and other diagnostic services. Some doctors and specialists bulk-bill so you will not have any out-of-pocket expenses, while others charge a fee which you will have to pay and then claim the benefit from Medicare.
What types of financial assistance are available?
There are several things you can do to help manage the financial burden of cancer treatment, including:
- Get financial assistance from Centrelink. If you need to stop work because of your treatment, you may be eligible to receive financial support payments from Centrelink. Your partner or parents can also access financial assistance if they have to take time off work to care for you, and you can receive benefits to help you pay rent, transport costs to and from hospital and accommodation during treatment. Some of the payments which can provide the support you need include:
- Sickness Allowance
- Disability Support Pension
- Newstart Allowance
- Carer Payment and Carer Allowance
- Bereavement Payment and Bereavement Allowance
- Talk to your doctor. Ask your doctor and your hospital whether there is anything you can do to help cover the cost of treatment, such as setting up a flexible repayment plan.
- Get help from the Medicare Safety Net. The safety net ensures that you receive a higher benefit for many medical services once you reach a set threshold of out-of-pocket expenses. Individuals don’t need to register for the Medicare Safety Net, but you will need to register if you are part of a couple or family. A PBS Safety Net is also available to provide higher benefits once you have spent a certain amount on prescription medicines.
- Chronic Disease Management. If you have a chronic health condition (that is, a condition you have had for more than six months or that is terminal) you can receive Medicare cover for allied health services such as physio and counselling. You’ll need to be referred by your doctor under the Chronic Disease Management plan.
- Use your concession card. Some PBS medicines are cheaper if you have one of the following cards:
- Pensioner Concession Card
- Commonwealth Seniors Health Card
- Health Care Card
- Department of Veterans’ Affairs health card
- Make a transport claim. State and territory governments around Australia run schemes to offer financial assistance to people who have to travel long distances to access specialist medical treatment.
- Speak to a financial counsellor. Speak to a financial counsellor to receive help and advice on how to manage your budget and finances so that you can more easily cover the cost of treatment.
- Apply for hardship programs. Most providers of essential services such as gas, water and electricity, provide hardship programs to offer flexible payment options to people who are having trouble paying their bills. This can help you manage your finances while you pay off your medical bills. You can also talk to loan and credit card providers about making temporary repayment arrangements due to financial hardship.
- Take out private health insurance. Even if you’ve previously been diagnosed with cancer, you can still qualify for private health insurance. Australian law prevents health funds from refusing your membership application or charging higher premiums based on your health status or claim history. They can impose waiting periods on all pre-existing conditions, but once you’ve served the relevant waiting period you will be eligible to claim benefits.
There are many different approaches to treating cancer, sometimes involving a combination of the following therapies:
- Chemotherapy. Used in conjunction with other treatments, chemotherapy involves the use of drugs that suppress certain hormones that help cancer grow.
- Radiotherapy. Also called radiation therapy, this treatment option uses radiation to kill cancer cells or slow their growth. It can be delivered externally or internally, and can also be used as a curative approach or to relieve pain.
- Surgery. Surgery can be used to remove cancer cells and to relieve discomfort from tumours.
- Hormone therapy. This option involves the surgical removal of hormone-producing glands in order to control the growth of the cancer.
- Alternative therapies. A wide range of complementary therapies can be used alongside conventional medicine to help improve health and enhance quality of life.