If you require cancer treatment, it’s important you know what’s covered by Private Health Insurance, and what isn’t. Every policy is different, and every cancer treatment plan is unique, so this is one case where the fine print really does matter.
Treating cancer can be more expensive than you might expect. Some people will rely on Medicare and the public system alone, while others, use a combination of Medicare and the private health system through their Private Health Insurance.
Here’s what each one offers:
When it comes to cancer treatment, Medicare can cover in-hospital care, diagnostic testing and imaging, and some of the costs of GP and specialist visits.1
Private Health Insurance generally covers you for part, or all, of the costs of being a private patient receiving cancer 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 it does mean you can choose your preferred cancer specialist and the hospital you’ll be treated at, and your policy may also cover the cost of a single room.2
Depending on your needs, you may or may not need more than one type of treatment.
While Medicare can cover hospital care, diagnostic testing and imaging, some of the costs of GP and specialist visits,3 there are limits to what Medicare covers in regard to cancer treatment.
If chemotherapy, radiotherapy and drugs such as antinauseants and immunostimulants are being used as part of your cancer treatment, the Pharmaceutical Benefits Scheme (PBS) might reduce or cover the cost of prescribed medications.4
With certain medications or services provided outside of hospitals, there may be a ‘gap’ or an amount you have to cover yourself.5 Always ask your health provider about these costs ahead of time so that you’re prepared for the bill.
Depending on your level of cover, private Health Insurance may also cover you for out-of-hospital services, which is also known as Extras or Ancillary Insurance.
For most people, that means physio, optical and the annual dentist visit, but for cancer patients, it can also include services like home nursing, assistance with travel and accommodation, psychology, occupational therapy, dietician advice, post-operative medical/health aids, and assisted living programs. The services that you may be able to claim will vary depending on your Health Insurance provider and the level of cover you hold.
As a private patient, you may need to pay extra fees including doctors’ charges, hospital accommodation, pharmaceuticals, theatre fees, prostheses and so on.6
Generally, the higher the premium you pay, the fewer additional costs you’ll be likely to deal with.
Hospital treatments are typically categorised into Basic, Bronze, Silver and Gold policies.
As a cancer patient, you may require treatments such as chemotherapy, radiotherapy and immunotherapy, all of which are typically included in Bronze, Silver and Gold Health Insurance policies.7
However, out-of-pocket costs for specialist’s fees may also be payable if your specialist charges more than the Medicare Benefits Schedule fee and your insurer only covers a part of the remaining payment.8
You may be considering complementary therapies as part of your cancer treatment. These types of therapies include mind-body practices, body-based practices, energy therapies, and herbal remedies.9
These types of therapies are not covered by Medicare or the PBS, nor are they typically covered by Private Health Insurance,10 so you’ll need to consider the costs of these therapies if you’re considering using them.
While Private Health Insurance generally won’t cover the costs of remedies and supplements in complementary therapies, some health funds may offer a rebate on a consultation with a complementary therapist.11
Complementary therapies are not part of standard medical care, but they may help you manage the effects of cancer and its treatment alongside standard medical care.12
This type of therapy may help you cope with the emotional consequences of cancer diagnosis and treatment, but it shouldn’t replace standard medical treatment by your doctors and specialists.
If you decide to engage with a complementary therapy for cancer treatment, it’s recommended that you tell your doctors as it may affect how your medical treatment works.13
Waiting periods typically apply for all Health Insurance policies. Generally, a waiting period of 2 months applies to any new conditions that commence after you take out your cover.14
However, if you’ve already noticed signs or symptoms or have visited a doctor in relation to a possible cancer diagnosis, you may need to wait 12 months before you could make any cancer related claims. This is because your condition would be regarded as pre-existing.15
There is usually no waiting period if you need hospital treatment because of an accident that happens after you start your policy.16 An accident is defined as an injury that occurred unintentionally or unexpectedly.17 While cancer is of course unintentional and unexpected, it doesn’t classify as an accident and therefore waiting periods will apply.
If you’re transferring from one health fund to another, or between policies that are the same or a lower level of cover, the waiting periods you’ve already served will usually transfer across with you. Therefore, if you already served the waiting period for cancer treatment on your existing policy and you move to a new policy, you usually won’t need to re-serve the waiting period.18
Under the Private Health Insurance Act 2007, health insurers may impose a 12-month waiting period on benefits for hospital treatment for pre-existing conditions.19
This means that if you had any signs or symptoms of any ailment, illness or condition within six months before the day on which your Health Insurance policy begins, then you would be required to wait up to a maximum of 12 months for hospital treatment.20 This applies to new policyholders and policyholders who upgrade their policy to a higher level of cover.21
Exceptions to the pre-existing condition rule include psychiatric care, rehabilitation and palliative care, which have a two-month waiting period, regardless of whether they are pre-existing or new conditions.22
Medical expenses can quickly add up following a cancer diagnosis. Here are some practical things you can do to keep on top of your expenses if you’re using private Health Insurance for cancer treatment:
Choosing a suitable level of private Health Insurance may increase your comfort during your cancer 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.
Compare Health Insurance* policies from our range of providers today with iSelect.
1 Australian Government Department of Health and Aged Care - What Medicare covers
2 Victoria State Government Department of Health, Better Health Channel - Hospital costs and payments
3 Australian Government Department of Health and Aged Care - What Medicare covers
4 Australian Government Department of Health and Aged Care, The Pharmaceutical Benefits Scheme - Efficient Funding of Chemotherapy Program
5 Australian Government Department of Health and Aged Care - Out of pocket costs
6 As above
7 Australian Government Department of Health and Aged Care - Private health insurance reforms, Gold, Silver, Bronze, Basic product tiers, page 2.
8 As above.
9 Cancer Council - Understanding Complementary Therapies, page 8-9.
10 As above, page 28.
11 As above.
12 Australian Government, Cancer Australia - Complementary therapies
13 As above.
14 Privatehealth.gov.au - Waiting Periods
15 As Above
16 As Above
17 Privatehealth.gov.au - Glossary
18 Commonwealth Ombudsman - Private Health Insurance, The Right to Change (page 4).
19 Commonwealth Ombudsman - The Pre-Existing Conditions Rule
20 As above.
21 As above.
22 Commonwealth Ombudsman - The Pre-Existing Conditions Rule