Cancer health insurance in Australia

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?

Medicare will cover cancer treatment in Australia, though there may be some extra costs to pay. If you're a public patient in a public hospital you'll have all your in-hospital treatments covered.

However, it's very likely you'll receive some level of care outside of a hospital. These services can include treatments such as:

Medicare will likely subsidise some of the cost of these treatments, but it will rarely cover the entire cost. Be sure to check with your health provider about any costs you'll face ahead of time.

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 hospital insurance will contribute to your in-hospital treatments at a private hospital. This can including doctor's fees, accommodation, prescriptions and the treatment itself. That said, there may be some out-of-pocket costs to pay.
• 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, if you were to need it. You can find this on both hospital and extras policies.

Remember that there is still the chance of additional out-of-pocket costs with private health insurance, on top of your premiums.

Private health insurance that covers 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. Some Basic Plus policies will cover it, but you'll typically get much better value if you go with at least a Bronze tier policy.
• 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

When you take out private health insurance, there will be a waiting period before you can make a claim for treatment. These are standard across the industry:

• 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.

Out-of-pocket costs for cancer treatment

Even with private health insurance, there's a chance you'll pay an out-of-pocket cost for some of your private hospital treatment. This is because private health funds won't always cover the entire cost of your care. This varies a lot between health funds, hospitals, surgeons and the specific treatment you're having done.

Here are a couple of tips to work out how much you're likely to pay out of pocket.

Medical Costs Finder

Start by checkin your treatment on Medical Costs Finder. This is a database of the average out-of-pocket costs that private hospital patients have paid. For example, it finds that people getting a axilla lymph node biopsy, common in breast cancer treatment, typically pay around $620 out of pocket. This gives you a place to start.

Speak to your doctor

Your doctor, surgeon or other medical practitioner will have the best information on how much they'll charge you, because they'll be doing it! Speak to them about a detailed quote, and find out if they have a partnership with your health fund. Be sure to make sure they include details of any follow up treatment.

Speak to your health fund

Your health fund should be able to give you a firm commitment ahead of any treatment if you ask for it. This will include how much they will cover of a particular surgeon/hospital's fees, and how much out-of-pocket costs you'll have to pay. You should get this in writing before you go in for treatment. If you wait until after the treatment you open yourself up to nasty surprise emdical bills.

Frequently asked questions

• What cancer-related services are covered by private health insurance?

  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.

• How much does cancer treatment cost in Australia?

  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.

• 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. 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.

Written by

Tim Bennett

Insurance expert

A seasoned journalist with over 10 years of experience in news, politics and finance reporting, Tim has previously held roles at the ABC, SBS and Fairfax Media. Tim’s expert insights have been quoted in The Australian, The Daily Telegraph, The Courier Mail and more. He regularly appears on TV and radio, and has been interviewed on 7 News, Sunrise, SBS News, ABC Local, 3AW and 5AA. Tim is passionate about simplifying complex insurance topics for Australian consumers. He holds a Bachelor of Arts (Politics) from Macquarie University and a Tier 1 General Insurance (General Advice) certification, which meets the requirements of ASIC Regulatory Guide 146 (RG146). If you’re interested in a media interview with Tim, please reach out to our PR team at aupr@finder.com. See full bio

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