What is chemotherapy?
Chemotherapy is the use of anti-cancer drugs to destroy or slow the growth of cancer cells. As Cancer Council Australia explains, there are many types of drugs used and you may be treated with a single chemotherapy drug or a combination.
Chemotherapy may be used before or after surgery or radiation therapy, or together with radiation therapy. It is typically given intravenously (through a needle in a vein), but can be administered as tablets or even a cream.
Generally, chemotherapy is given in multiple cycles, with periods in between to allow healthy cells to recover.
How much does chemotherapy cost?
Chemotherapy drugs can be very costly, but fortunately for Australians, the Pharmaceutical Benefits Scheme (PBS) covers all or part of the cost of many chemotherapy drugs for Medicare card-holders.
Cancer Council NSW says that you may have to contribute to some of the cost of oral chemotherapy drugs you take home, with this cost being known as a co-payment.
You may also have to contribute to the cost of some IV chemotherapy drugs, depending on which state or territory you live in, whether you are treated as an inpatient or outpatient, and whether you are treated in a public or private hospital.
Does private health insurance cover chemotherapy costs?
Private health insurance may help to cover part of the chemotherapy costs, depending on the policy. All Bronze, Silver and Gold hospital policies must cover chemotherapy, radiotherapy and immunotherapy for cancer or benign tumours.
If you have private health insurance and opt to be treated as a private patient, the Cancer Council says you may have to pay out-of-pocket expenses and contribute to the cost of chemotherapy drugs.
What are the related costs of chemotherapy?
While chemo treatments are subsidised by Medicare, you may need face certain additional costs as you undergo the process, such as:
- Tests: These may be requested by your doctor, and will not necessarily be covered by Medicare. Breast Cancer Network Australia notes that one such test, the Oncotpye DX test, costs an average of $5,000.
- Medications: This could include anti-nausea drugs, to combat the side effects of chemo. The PBS subsidises some anti-nausea treatment. Currently, you pay up to $31.60 for most PBS medicines or $7.70 with a concession card.
- Travel and accommodation: If you need to travel a long distance and potentially even book overnight stays for chemotherapy, then you will need to consider these costs. You and your loved ones will also need to consider other potential costs like hospital parking.
How to compare health insurance policies if you need chemotherapy
When comparing health insurance options for cancer treatment or chemotherapy support:
- Compare your options carefully: focusing not just on premiums but on how each policy covers inpatient and outpatient cancer treatments. Some policies fully cover chemotherapy in hospital, while others may have restricted benefits.
- Review your policy regularly: your treatment needs, medications, and preferred hospital or specialist may change over time. Ensuring your policy still supports your care plan is essential.
- Choose an appropriate level of hospital coverage: lower-tier policies may not cover chemotherapy or oncology services adequately.
- Check the out-of-pocket costs: gap fees for specialists, pharmacy costs for chemotherapy drugs, and whether your fund has agreements with your chosen oncology providers.
- Understand waiting periods: especially if you are taking out insurance for the first time. Pre-existing conditions generally have a 12-month waiting period, and this is crucial to consider if you require to start or continue treatment soon.
Assess the value of extras cover, which can help with supportive therapies like psychology, physiotherapy, dietetics, or complementary therapies often used alongside cancer treatment.
What are your finance options for chemotherapy?
If you are experiencing financial difficulty paying for treatment, consider whether you are eligible for any of the following options.
Centrelink benefits
You or your carer may be able to receive Centrelink benefits, including:
- Jobseeker payment: when you’re sick or injured and can’t do your usual work or study for a short time.
- Disability Support Pension: if you have a permanent physical, intellectual or psychiatric condition that stops you from working.
- Carer Payment: if you are unable to work because you provide full time daily care for someone with a medical condition.
- Carer Allowance: an income supplement if you provide extra daily care for someone with a medical condition. This can be paid in addition to your wages if you are still able to work.
If you receive a payment from Centrelink, you may also be eligible to receive a Health Care Card. This entitles you to cheaper prescription medicines under the PBS and may also give you access to concessions for costs such as energy, electricity and healthcare, depending on your state and territory government.
Contact Centrelink for more information and assistance. Keep in mind that a waiting period may apply before you can claim.
Withdrawing superannuation early
You normally can’t access your superannuation until you reach your ‘preservation age’ (between 55 and 60 years old depending on when you were born). But as the Australian Taxation Office (ATO) explains, you may be able to withdraw your super early in limited circumstances. This includes on compassionate grounds to pay for medical treatment or if you have a terminal medical condition that is likely to result in death within two years.
Insurance
If you have any insurance (for example, life insurance, trauma insurance or income protection insurance) check to see if your policy or policies cover your current circumstances. Be aware time limits may apply to making a claim.
In addition to any standalone policies, it could also be worth checking whether you have insurance within your superannuation. If you are unsure what you are covered for, contact your insurer or super fund.
If you are struggling financially, consider speaking with your doctor to discuss your options. You can also contact the Cancer Council’s Pro Bono Program to access free financial planning services. These financial planners may be able to help you access your super and insurance, apply for and access Centrelink payments, and provide other financial advice.
What are the potential benefits of private health insurance for chemotherapy?
1. Reduced out-of-pocket costs for treatment
Private hospital cover that includes chemotherapy can help pay for hospital fees, ward charges, and specialist fees. Depending on your policy, this can significantly reduce the out-of-pocket expenses compared with paying fully privately. However, even with cover, you may still incur gap payments if specialists charge above what the insurer or Medicare reimburses.
2. Access to a wider choice of hospitals and specialists
With chemotherapy cover, you can often choose your preferred private hospital and oncologist, rather than being limited to public hospital schedules. This flexibility can be important for scheduling treatment that fits your needs. Check whether your hospital or oncologist has known-gap or no-gap arrangements with your insurer to minimise unexpected bills.
3. Day-hospital and outpatient support
Many policies cover day-hospital admissions, which are often how chemotherapy is administered. Having this cover may help avoid large bills for each infusion, especially if your treatment involves multiple cycles.
4. Coverage (partial) for chemotherapy medicines
Some chemotherapy drugs are subsidised under the PBS or the Section 100 Efficient Funding of Chemotherapy program. However, not all drugs are subsidised. If a drug is not covered, patients may face higher out-of-pocket costs, including for oral chemotherapy.
5. Potential coverage for additional services
Some policies include limited benefits for allied health, rehabilitation, or home nursing related to chemotherapy. While these benefits vary, they can help with follow-up care or managing side effects at home.
6. Shorter waiting periods for urgent treatment (depending on your policy)
Once waiting periods are served, chemotherapy cover ensures you can claim immediately for covered treatments. Be aware that pre-existing condition exclusions or waiting periods may apply for cancer-related treatment.
7. Streamlined claims and administration
Having a policy with chemotherapy cover often means claims are processed under a single clinical category. This reduces administrative complexity when dealing with multiple providers, hospitals, and invoices.
8. Improved financial predictability
Knowing that your policy covers major components of chemotherapy (hospital admission, specialist fees, and some medications) allows you to better manage your finances during treatment. Nonetheless, patients should proactively request written cost estimates from hospitals and oncologists before starting each treatment cycle to avoid unexpected bills.
9. Access to travel and accommodation support
Some insurers provide limited reimbursements for travel, accommodation, or parking when treatment is far from home.
Do I need private health insurance for chemotherapy?
It comes down to choice as to whether you choose private health insurance for chemotherapy in Australia, as you can be treated as a public patient and the PBS covers all or a large part of the cost of treatments for Medicare card-holders. That said, private health insurance can help cover some of the associated costs of chemotherapy, and can allow you to be treated as a private patient with access to a wider choice of hospitals and specialists.
Is chemotherapy free in Australia?
You can receive treatment for free as a patient in Australia’s public hospital system, and the PBS heavily subsidises the costs of chemotherapy drugs. That said, there may still be some costs associated with chemotherapy, such as co-payments for take-home oral chemotherapy treatments, and the costs of any drugs not covered by the PBS. You’ll also need to factor in other associated costs like tests, medications and transport and accommodation.
