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Palliative Care - Doctor and Patient at home

Health insurance and palliative care

Is palliative care covered by private health insurance?

Palliative care is the practice of easing the pain of a patient with a terminal illness and making them as comfortable as possible before death. It is provided to patients when cure is no longer the aim of treatment and maintaining the best possible quality of life is the priority.

Both Medicare and private health insurance offer palliative care options for public and private hospitals. In addition to this, the Australian government has launched a national palliative care program which pays 75% of the Medicare Benefits Schedule (MBS) fee for private hospital palliative care patients. The remaining 25%, as well as any gap, will need to be paid by yourself or your health insurance.

Compare health insurance for palliative care

What benefits do health funds pay for palliative care?

All private health insurance hospital policies cover palliative care to a certain extent, as per the Private Health Insurance Act of 2007. Less comprehensive policies generally only pay the minimum benefits they are legally required to, which is dependent on your condition and the treatment needed. More comprehensive hospital policies generally offer cover beyond this.

The standard waiting period for palliative care is two months. This means you must hold your policy for at least two months before being able to claim any palliative care benefits.

FundWhat’s covered?Link
AHM health insurancePalliative care, 2 month waiting period

More info

Australian UnityPalliative care, 2 month waiting periodMore info
GMHBA health fundPalliative care, 2 month waiting periodMore info
HCF health insurancePalliative care, 2 month waiting periodMore info
health.com.au health insurancePalliative care, 2 month waiting periodMore info
HIF health insurancePalliative care, 2 month waiting periodMore info
nib health insurancePalliative care, 2 month waiting periodMore info
Transport Health insurancePalliative care, 2 month waiting periodMore info

Where can I receive palliative care?

Depending on your insurance and your condition, you can receive palliative care in different locations.

  • At the 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 a hospice

A hospice is a home dedicated to providing end-of-life treatment for the sick and terminally ill, most of whom receive palliative care.

Just like hospitals, people receiving palliative care here are eligible for certain Medicare benefits. 75% of the MBS fee will be paid by Medicare, while any gap needs to be covered by private health insurance.

  • The Medicare Benefits Schedule (MBS). The MBS for a particular treatment, such as administering painkillers in palliative care, is essentially a very rough “recommended price” for that treatment.
  • The gap. The gap refers to the price difference between the MBS and what is actually charged by the doctor or the hospital. Health insurance is often used to cover the gap.
  • Private vs public facilities. Public facilities tend to charge the MBS fee for the cost of a procedure, while private facilities tend to charge more.

Hospices are generally private facilities. This means undergoing palliative care in a hospice will typically incur additional expenses beyond what you might expect in a public hospital. However, the advantages may include nicer facilities, more staff and tailored assistance.

How can palliative care help?

Palliative care is more than simply alleviating pain. It is a holistic approach to making sure someone can live life to the fullest in a way that’s meaningful to them right up until the end. This could mean spending time with their family, speaking with therapists, going on excursions and getting their affairs in order. It is intended to ease not only physical pain but also mental and emotional anguish, as well as assist with more mundane issues of convenience. Palliative care can involve:

  • Visiting you in hospital, in a hospice or at home to reduce feelings of isolation and keep you in the loop.
  • Communicating treatment plans to you and coordinating with other doctors and specialists to provide the best care.
  • Making adjustments to your home to help you live independently, or to assist caregivers.

The role of private health insurance in palliative care

As previously mentioned, legislation forces private health funds to be somewhat involved with palliative care programs. This is because of concerns raised about the impact of health insurance on a patient’s journey through the healthcare system. It’s been found that patients who can’t access palliative care instead must opt for more aggressive and expensive treatments, even if they are not the best course of action.

Palliative care, meanwhile, can help people with chronic and terminal health issues live long fulfilling lives. In many cases this is a better treatment than undergoing risky surgery that has a small chance of curing the condition and a good chance of making things worse.

In the coming years it is expected that both public and private health insurance systems will become more closely involved with palliative care, and that options like home care or private hospices will be more readily available for more patients.

Palliative care glossary

You might encounter some of these terms when learning about palliative care or comparing your options.

  • Additional diagnosis

This refers to other conditions that arise during the care period. For example, if a cancer patient is diagnosed with a related heart condition, this would be an additional diagnosis. Comorbidities are when multiple conditions occur at the same time. In this case, the heart condition would be a comorbidity.

  • Elapsed days

The number of days since one began their palliative care regime.

  • Palliative medicine specialist

This is a doctor who is eligible to be paid by Medicare for providing palliative care services. In Australia they are required to be either a Fellow of the Royal Australasian College of Physicians who has completed the palliative medicine college training program, a Fellow of the Australasian Chapter of Palliative Medicine or both.

  • Permanent admission

This is when a patient is admitted with the expectation of long-term care, such as to a residential aged-care facility.

  • Principal diagnosis

This is the condition deemed to be primarily responsible for a patient requiring palliative care.

  • Separation

This refers to any hospital or care facility discharge for any reason at all. When a patient runs away, dies, checks out, gets cured, is transferred to another facility or otherwise leaves, separation has occurred.

Do a side-by-side comparison of policies that cover palliative care

Picture: Shutterstock

Richard Laycock

Richard is the insurance editor at finder.com.au. He is on a mission to make insurance easier to understand.

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