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Last Updated on 19 February 2019

Health Insurance and Cancer

Cancer is a big killer in Australia. It’s estimated that as many as one in two Australian men and one in three Australian women will be diagnosed with cancer before they reach 85. This is a scary thought and you may be wondering if Medicare and health insurance can help.

Medicare and Diagnostic Tests

Medicare covers the following screening programs.

The National Bowel Cancer Screening Program. This program is aimed at Australians reaching their 50th, 55th and 65th birthdays before December 31st 2014. An average of a million Australians will be invited for screening each year.

The National Cervical Screening Program. This program offers routine pap smears every two years for women aged 18-69.

BreastScreen Australia. This program offers free mammograms for eligible women. Primary targets are women aged 50-69. Women aged 40-49 and 70+ are also able to be screened.

Diagnostic tests are also covered. For example, there are Medicare rebates for MRI breast scans. These are for women aged below 50 who have high risk of cancer. These are available even with no symptoms. Medicare rebates are also available for MRI rectal scans.

Medicare and Cancer Treatment

Cancer treatment can be extremely expensive so you’ll be pleased to know that Medicare does offer support with this. Your doctor should discuss treatment costs with you before you go to hospital. This will let you know whether there will be a gap to pay. He or she can also advise on how to find out about other treatment fees such as for the anaesthetist and hospital accommodation.

Medicare includes free public hospital treatment as a public patient. There are some downsides to this. You do not have a say in who treats you and you may have to wait for treatment. It will also cover 75 per cent of the schedule fee for in-patient hospital services. This does not include accommodation fees, theatre fees or medicines.

Not all cancer treatment will take place in-hospital and Medicare does cover some of this. Consultations with GPs are covered for full schedule fee. For other eligible out-of-hospital services, 85 per cent of the schedule fee is covered. This may include consultations with specialists, x-rays and pathology tests. Be aware that doctors can charge more than the schedule fee, which will result in out-of-pocket costs. If your out-of-pocket costs reach a certain amount, you can take advantage of the Medicare Safety Net.

Many cancer drugs are subsidised on the Pharmaceutical Benefits Scheme. This is designed to make prescription medicines more affordable. Chemotherapy drugs are often free of charge. For example, trastuzumab (Herceptin®) is free for treating late stage metastatic breast cancer. The PBS Safety Net can help if your costs reach a certain threshold.

Allied health services are available through the Chronic Disease Management program. You may be able to receive these if you meet the eligibility criteria. Firstly, cancer (or another chronic condition) must have been present for at least six months. Secondly, you need to be treated by two or more healthcare professionals as well as your GP. Thirdly, your GP needs to have drawn up a GP Health Management or Team Care Arrangement plan. If eligible, you can get up to 5 allied health services per calendar year.

Palliative care is covered by Medicare. This allows you to be treated in a public hospital. Health insurance will be needed for private treatment.

Health Insurance and Cancer Treatment

Medicare support is quite extensive but there are still some good reasons to compare health insurance options. Want to be treated as a private patient? You have much more control over who treats you and can be treated more quickly than as a public patient. Medicare will cover 75 per cent of the schedule fee for this. This still leaves some out-of-pocket costs to meet. Health insurance can cover some or all of this gap. This is also the case for theatre and accommodation costs and medicines.

If you need further diagnostic investigations, health insurance may cover these. Some health insurance options include colonoscopies, for example. This tends to be featured on the broader hospital packages so it’s wise to do a health insurance comparison to look at your options in depth.

Health insurance also covers out-of-hospital services that are not available through Medicare. Examples include physiotherapy and complementary therapies which may be recommended alongside your treatment. Psychology is another popular extra that may help with the stress of a cancer diagnosis. Sometimes, you may be prescribed medicine that is not on the PBS. This can be covered partly or fully by pharmacy extras cover.

Medicare is involved in several screening programs and also covers some or all of the cost of hospital treatments for cancer. How extensive this is depends on whether you want to be treated as a public or private patient and whether your doctor charges above the schedule fee. Many cancer drugs are included on the PBS and some are available for free. You can choose to compare health insurance options for broader support beyond Medicare.

Disclaimer: The above information is correct and current at the time of publication

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