Time to read : 4 Minutes
Experiencing the shock of a breast cancer diagnosis is stressful.
Wondering if you can access the best possible treatment and medical care to deal with it shouldn’t be.
When it comes to being told you have breast cancer, you can still access a range of potentially positive treatments in the private health sector, even if you don’t have private health insurance. But your ability to pay for them will be guided by your budget and access to savings. For people suffering temporary or permanent incapacity, or a terminal diagnosis, applying for early access to your super is also possible.
To help you make sustainable financial decisions about your need for medical care, getting the right information is critical. As explained in more detail on the Cancer Council website, “your doctors and other healthcare providers must talk to you about likely out-of-pocket costs before treatment starts”.
This is called ‘informed financial consent’.
It’s also worth noting that, even if you are not covered by private health insurance when you are diagnosed, breast cancer (and sometimes also pre-invasive breast malignancy if a mastectomy is required) is an eligible diagnosis covered under almost all critical illness policies (and this may be covered by existing life insurance or income protection insurance embedded within your superannuation).
The choice is yours
If you need to find a surgeon or specialist oncologist, you can accept the referral from your treating doctor, or you can do your own research to find the right fit for your needs. And given that official estimates of breast cancer statistics show that, in 2022, around 20,000 new cases were diagnosed in Australia (approximately 200+ males and 20,000+ females), using the power of word of mouth from your own network or family and friends may point you in a positive direction.
Private or public?
Having breast cancer doesn’t mean you have to be treated in the private system.
You can make a choice to go public, or you can choose a combination of treatment in both the private and public system (for example, electing to have chemotherapy and surgery privately and radiotherapy publicly).
Each system has potential advantages and disadvantages that you should understand.
Being a public patient
Even if you have private health insurance, you have the right to be treated as a public (Medicare) patient in a public hospital. But letting your treating doctors know upfront is important.
Pros of being a public patient
most of your treatment and care will be free
your care is more likely to be coordinated by a multidisciplinary team (MDT)
you may have greater access to the added care of a specialist breast-care nurse, physiotherapist, social worker, and other allied health professionals
you may find it easier to access a treatment team under one roof.
Cons of being a public patient
you can’t choose your doctors
you may have to deal with a passing parade of health professionals during the course of your treatment
there may be longer waiting periods between appointments and treatments.
Being a private patient
If you want private health sector treatment but don’t have the appropriate private health insurance cover, you can still access private treatment – but it will cost you. The benefits include being able to choose your treating specialists and having greater flexibility around access to appointments.
If you do have the benefit of private health insurance and need to clarify how much your breast cancer treatment will cost and whether your private health insurance covers it, ask your doctor to provide a clear quote and get your private health insurer to explain which treatments are covered.
That way, you’ll understand the gap amounts you need to pay for out of pocket, plus you’ll also have a better understanding of what other relevant services you may be able to claim (such as a wig, a post-surgery bra, or lymphoedema garment).
Pros of being a private patient
you get to choose the doctors and specialists who treat you – and which hospital you can be treated in
timelines between appointments and treatments are (generally) shorter
depending on your cover, you may be able to have a private room in a private hospital.
Cons of being a private patient
depending on your private health insurance cover, you may still face substantial out-of-pocket costs
private health insurance covers inpatient procedures, but outpatient treatments, such as pathology tests, radiotherapy, radiology, and other specialist visits will not be covered (although Medicare rebates do count, but will not cover the whole fee)
access to allied health professionals (social workers, physiotherapists, etc) is less likely.
The bottom line:
Our Australian Medicare system gives everyone access to quality medical treatment, but the reality remains that, with more available funds, additional treatments can be accessed.
For a more detailed look at how much your breast cancer diagnosis (and treatment) may cost you, and how private health insurance may help protect you from some of those expenses, The Financial Impact of Breast Cancer report from the Breast Cancer Network of Australia (BCNA) has plenty of helpful information.
Go deeper: How much does chemotherapy cost with private health insurance?
Financial disclaimer
The information contained on this web page is of general nature only and has been prepared without taking into consideration your objectives, needs and financial situation. You should check with a financial professional before making any decisions. Any opinions expressed within an article are those of the author and do not specifically reflect the views of Compare Club Australia Pty Ltd.
