Cancer and health insurance: What you need to know

by Jane Dickenson
Health Geek

When you receive a cancer diagnosis, it can be overwhelming – for you, and your family. Having the right health insurance can help to reduce some of the financial pressures so you can focus on your health and recovery.

If you’re in need of cancer treatment, it’s important you know what’s covered by private health insurance. Every policy is different and every treatment plan is unique; this is one case where the fine print really does matter.

Covering cancer treatment costs – what are the options?

Treating cancer can be more expensive than you might expect. To help cover the costs, some people use the Medicare Benefits Schedule (MBS) alone, and others use a combination of Medicare and their private health insurance.

Here’s what each one offers:

Medicare and the Pharmaceutical Benefits Scheme – what’s covered?

Medicare can cover hospital care, diagnostic testing and imaging, GP visits and some of the cost of specialist visits. If chemotherapy, radiotherapy and drugs such as antinauseants and immunostimulants are being used as part of your treatment, the Pharmaceutical Benefits Scheme (PBS) might reduce or cover the cost of prescribed medications.

With certain medications provided outside of hospitals, there may be a ‘gap’ or an amount you have to cover yourself. Always ask your health provider about these costs ahead of time so that you’re prepared for the bill.

Private health insurance – what’s covered?

Private health insurance generally covers you for part, or all, of the costs of being a private patient receiving treatment in a private or a public hospital, depending on your level of cover. It doesn’t mean your private hospital stays are free, but you can choose your doctor and the hospital you’ll be treated at, and your policy may cover the cost of a single room.

Depending on your level of cover, private health insurance may also cover you for out-of-hospital services. This is called extras or ancillary insurance. For most people, that means physio, optical and the annual dentist visit, but it can also include some of the complementary treatments sometimes used in cancer treatment. This could include things like, home nursing, assistance with travel and accommodation, psychology, occupational therapy, dietician advice, post-operative medical/health aids, assisted living programs.

As a private patient, you may need to pay extra fees including doctors’ charges, hospital accommodation, pharmaceuticals, theatre fees, prostheses and so on. Generally, the higher the premium you pay, the fewer additional costs you’ll have to deal with.

Limiting your health insurance expenses – what should you consider?

Here are some practical things you can do to keep on top of your expenses if you’re using private health insurance:

Contact your health fund before you receive treatment to find out exactly what they cover and what you’ll have to pay for yourself, and if there are any associated waiting periods you need to serve.
Understand what it means if your insurance policy has restrictions or exclusions. It may mean you’re not covered for things you think are included.
Find out if your hospital or specialist has an arrangement with your health insurer so you don’t face avoidable out-of-pocket expenses. You might even decide to change where you go for treatment based on this information.
Ask your doctor for a written estimate of costs and find out how long you’ll have to pay the bills.
Read any letters or brochures from your health insurer; they can make changes to your policy, so it’s a good idea to stay informed
Make any claims with your insurer as soon as possible so there’s no delay on your payments.

Choosing the right level of private health insurance may increase your comfort during treatment and help to lighten your financial load in the long run. It’s important to research your policy options carefully to choose the policy that best suits you.