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What you need to know
Palliative care helps you live comfortably with a terminal illness.
Insurance coverage for private palliative care is available from around $90 a month.
Is palliative care covered by Medicare?
Palliative care is usually free with Medicare in the public system. MBS-subsidised palliative medicine specialist services cost an average of $417 per patient through Medicare, according to 2019-20 Medicare Benefits Schedule data.
However, not all palliative care is covered by Medicare. In fact, from 2018-19 to 2019-20, the total number of MBS-subsidised palliative care services decreased by 0.9%, so you might have some out of pocket expenses. For example, you might have to pay for:
Medicines
Equipment for use at home
Nursing staff if you choose to stay at home
Private allied health professionals, such as psychologists and physiotherapists
Therapies such as acupuncture and chiro
Who pays for palliative care?
Medicare
Medicare pays for all MBS palliative care services which can include care in a public hospital. You'll have to pay for services that aren't fully covered by Medicare yourself, such as psychology and 24-hour assistance at home.
Private health
All basic private health insurance policies are required to provide restricted cover for palliative care. This means you'll still have some out of pocket expenses. However, many will fully cover you for the MBS fee — we've put together a list of providers for you below.
Compare health insurance coverage for palliative care
Here are some policies from Finder partners that cover palliative care. All have a 2-month wait period and a $500 excess. All prices are based on a single individual with less than $90,000 income and living in Sydney.
We update our data regularly, but information can change between updates. Confirm details with the provider you're interested in before making a decision.
Compare prices from 30+ Aussie funds in under 30 seconds.
What is palliative care?
Palliative care is a type of personalised care that helps you live as comfortably as possible when you have a life-threatening or terminal illness. Treatment can include a broad range of services that provide physical, emotional and mental health support for you. Some examples of palliative care include:
Radiation therapy to reduce pain (for example, if you have cancer)
Medicines to control symptoms and relieve discomfort
Psychology, physiotherapy and other alternative therapies
Care and treatment in a hospice
Hospital care at home
Where can I receive palliative care?
Depending on your insurance and your condition, you can receive palliative care in different locations.
In a hospital
Generally, palliative care you receive in a public hospital will be covered by Medicare, although complementary therapies, additional medications and extra equipment costs may have to come out of your pocket or a private health fund.
At home
If medically recommended, you may also claim some Medicare benefits for palliative care received at home. However, you may still need to contribute to costs such as specialised equipment, medications and at-home nursing or care staff.
In a residential facility
This includes aged-care facilities and hospices. The cost of palliative care at certain approved private residential facilities may be covered by private health insurance, as well as Medicare, but only to a limited extent. There will be costs for accommodation and other related services when receiving palliative care in such a facility, which may be covered by different parts of your private health insurance policy.
Palliative care in the private system
If you receive palliative care as a private health patient, 75% of the MBS fee is covered by Medicare and your insurance covers the remaining 25%. Here's what else you need to know about palliative care and private health insurance.
You get restricted cover. All health insurers are required to provide restricted cover for palliative care. This means that even if you get a basic policy, your insurer will cover at least some of the costs.
It can cover the gap. Doctors and health professionals don't need to adhere to the MBS fee, so they may charge more. The gap refers to the price difference between the MBS and what is actually charged by the doctor or the hospital. Many private health insurance providers can cover the gap.
You can receive care at home. Some private health insurers can cover you to receive care and treatment at home.
It's often more extensive than Medicare. In many cases, Medicare won't cover alternative therapies like physiotherapy and certain medications, but private health cover can.
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Palliative care: Frequently asked questions
Palliative care is a type of care that helps you live as comfortably as possible when you have a terminal illness. It can include a broad range of treatments from radiation therapy to hospital care at home.
Palliative care is covered by Medicare in Australia, but you might still have some out of pocket costs for certain services. Private health insurance can also cover palliative care for around $90 per month.
If you want to receive care through the private healthcare system, it can be covered on basic and bronze level policies from around $90 per month. In some cases, this can include treatment at home. For example, Medicare currently offers palliative care at home which includes cover for doctors, nurses, social workers, counsellors, pastoral care workers and trained volunteers. It's important to remember that even with private health insurance, palliative care in the private healthcare system may still come with out of pocket expenses.
Yes, Medicare can pay for some palliative care services through the public healthcare system but not everything.
If you receive palliative care through your private health insurance, 75% of the MBS fee is covered by Medicare and your insurer pays the remaining 25%.
Gary Ross Hunter is an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, news.com.au, The Telegraph, Explore Travel and Escape. Gary holds a Kaplan Tier 1 General Insurance (General Advice) certification and a Kaplan Tier 1 Generic Knowledge certification which meets the requirements of ASIC Regulatory Guide 146 (RG146).
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