A Guide To Private Health Cover for Cancer Treatments

There's no denying that a cancer diagnosis can quickly turn your life upside down in an instant, and while Private Health Insurance (PHI) can help ease the burden, in the long run, trying to navigate your way around the complexities of PHI cancer cover can initially add to your worries.

That is why we've put together this comprehensive guide, answering your questions to help you identify what treatments - if any - you may already be covered for, what kind of health insurance plan is most suited to your individual circumstances, and what you might also need to know to alleviate the financial pressure of being diagnosed with cancer.

Cancer statistics in Australia

Cancer continues to be one of the biggest health concerns affecting Australians – and our nation’s healthcare system at large. It’s something we simply can’t escape from, with the latest figures showing more than two in five Aussies (43%) will be given a cancer diagnosis by the age of 85.

In 2024, it’s estimated that approximately 169,500 new cases of cancer will be diagnosed - which is up on the number from last year - and underscores the harsh reality of this killer disease.

Tragically, cancer-related mortality remains a big challenge. It’s projected that around 52,700 Australians will lose their lives to cancer in 2024. These statistics not only highlight the urgent need for ongoing research and improved access to treatments, but they show us that cancer can strike you at any time – so it’s important to be prepared.

Despite these sobering numbers, there is hope to be found in Australia's cancer survival rates. An encouraging 71% of those diagnosed with cancer are likely to survive for five years or more after their diagnosis and this number has remained steady for almost a decade. This gives us hope that there are positives in early detection and plenty of new advancements in cancer treatments.

However, the burden of cancer on the nation remains substantial. In 2024, it’s estimated that cancer will be responsible for nearly three out of every 10 deaths in Australia. This only makes it more critical to take preventive measures in your everyday life, like:

• booking regular screenings.

• making regular skin checks

• making sure you take advantage of early-intervention health advice to reduce the impact of cancer, should you be diagnosed. This is especially important if you have a family history of cancer.

What does cancer treatment involve for patients?

Cancer takes many different forms, and so too does cancer treatment. The type of treatment depends on several factors, including the type and stage of cancer, your overall health and your preferences for specialists and other medical professionals (if you have private health cover).

In general, cancer treatment can involve various types of treatment, all aimed at eliminating cancerous cells and managing the disease effectively for your long-term benefit. Treatments may include any or all of the below: 

Surgery

Surgery is a common approach for many cancer patients, especially when a tumour is localised and hasn't spread to other parts of the body. A surgeon will remove the cancerous tissue, which can be a small lump or an entire organ, depending on the extent of the disease. Surgical options include:

• Minimally invasive procedures: Such as a laparoscopy, which operates on organs inside the abdominal and pelvic areas.

• More complex surgeries: Like a mastectomy for breast cancer or prostatectomy for prostate cancer.

Chemotherapy

Chemotherapy is the use of powerful drugs to target and destroy cancer cells in your body. Many hospitals administer the drugs intravenously, but oral medications are also available.

At its root, chemotherapy is effective against rapidly dividing cancer cells. However, be aware that there are often side effects such as:

• Nausea

• Hair loss

• Fatigue

• Loss of appetite

• Bowel problems

• Mouth sores

• Skin and nail issues

Chemo can be used as a primary treatment for certain cancers, or in combination with other therapies to shrink tumours before surgery or radiation.

Radiation therapy

Radiation therapy uses high-energy rays or particles to damage and kill cancer cells. It’s a highly localised option that targets the specific area in your body where your cancer is located . Radiation can be delivered externally using machines (external beam radiation) or internally through implants (brachytherapy).

In most cases, radiation is used after surgery to eliminate any leftover cancer cells. In some specific instances it can be your primary treatment, especially for cancers like prostate and lung cancer.

Hormone therapy

As the name suggests, hormone therapy is mainly used to combat hormone-driven cancers, such as breast cancer and prostate cancer. It works by blocking hormones or interfering with their effects on cancer cells.

For breast cancer, hormone therapy may involve medications like tamoxifen^, while prostate cancer can be managed with drugs like androgen deprivation therapy^^. Hormone therapy can be a long-term treatment to prevent cancer recurrence.

There are also further treatment options for patients that require supportive care and complementary therapies:

• Supportive care: To overcome physical and emotional challenges, supportive care can include pain management, nutritional support and ongoing management of your treatment-related side effects. Psychological support like counselling or support groups can also help you cope with the emotional impact of having cancer.

• Complementary therapies: Some people may choose to explore complementary therapies like acupuncture, massage and yoga to alleviate stress and improve their overall wellbeing. These can be used alongside conventional treatments but should be discussed with your healthcare team to ensure they are safe and appropriate as part of your ongoing cancer management plan.

The bottom line is that private health insurance for cancer treatment is highly individualised. How you and your healthcare professionals manage it depends on the type and stage of your cancer, as well as your overall health.

Be prepared for surgery, chemotherapy, radiation therapy or hormone therapy – or a combination of these – as well as any additional care and therapies you might prefer to help you manage both your physical and emotional needs throughout your cancer journey.

As a general rule, surgeries, chemotherapy, and radiation are used to kill off your cancerous cells and eliminate cancer from your body entirely.

Depending on your personal circumstances, you may also require additional support such as counselling, physiotherapy, speech therapy and more.

Waiting periods for cancer treatment

A waiting period is set by your health fund. It's the predetermined period before which you can make a claim for certain treatments.

Although it can often feel like a long time to wait, health fund waiting periods are often shorter than public hospital waiting lists and private health cover may still mean that you get your treatment sooner, and with more flexibility of choice.

While every health fund is different, a general list of waiting periods might look like?

How much does cancer treatment cost in Australia?

The most recent available data on the costs of cancer treatment in Australia shows that almost 50% of cancer patients in Australia spent over $5,000 in out-of-pocket expenses treatments, while 25% spent in excess of $10,000. 

There's no escaping the fact that cancer treatment can be costly, but thankfully there are a few ways to reduce those costs.

Is cancer treatment covered by Medicare?

The good news is that regardless of whether you have private health insurance for cancer or not, Medicare will take care of a big chunk of your expenses.

Medicare alone covers your GP visits, blood tests, CT scans, MRIs, and some visits with a cancer specialist. 

If you are treated as a public patient, Medicare also covers the cost of treatments like chemotherapy and radiation.

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

Along with all of the above, you can also use the Pharmaceutical Benefits Scheme (PBS), designed to help patients pay for medications.

This means that if your treatment involves drugs like antinauseants or immunostimulants, those medications' costs will either be subsidised or entirely covered by the PBS.

On this subject, it's important to note that some rare forms of cancer may require equally as rare medications which may not be covered. That means you'll be paying for them out of your own pocket.

How does private health insurance cover cancer treatment in Australia?

Appropriate private Health Insurance can be used alongside Medicare to cover all or part of your treatment as a private patient in a public or private hospital and can give you much more control over the type of treatment you receive.

For example, appropriate private health insurance for cancer patients gives you the freedom to choose which hospital you're treated to and which doctor oversees your care. 

Depending on which health insurance company you're with and the level of cover you have, your insurance may cover you for any medications not included on the PBS, as well as additional services such as:

• Physiotherapy and other rehabilitation services

• Home nursing

• Ambulance journeys

• Counselling and psychotherapy.

If your existing policy doesn't offer the kind of cover you need, it might be time to consider switching. You can use our very simple comparison tool* to find a health insurance plan that's right for you within seconds.

Common treatments for cancer

• Chemotherapy: Suppressive treatment that helps stop cancer growth

• Surgery: Surgery to remove tumours or cancer cells

• Hormone Therapy: Surgical removal of glands or drug-induced of hormones that feed cancer cells

• Radiation Therapy: Radiation therapy or Radiotherapy helps kill or halt cancer cells

• Immunotherapy: Assisting or stimulating the immune system to fight and kill cancer cells

Are there any waiting periods for cancer treatment via private health insurance?

If you already have cancer, then you'll be subject to a 12-month waiting period before your insurance can cover your cancer related treatments.

For palliative care, rehabilitation and other treatments, your waiting period is usually two months.

How can I work out my out-of-pocket costs for cancer treatment?

Since every cancer is different, so too is your treatment, which means there's rarely a straightforward answer to the question "how much is this going to cost."

Fortunately, there is a simple way to work out what your out-of-pocket expenses might be and how to minimise them.

The first step is to consider all of the components that are going to make up your treatment. You can get advice from your doctor or specialist about what Medicare will cover you for with each one.

Anything left over will be your out-of-pocket expenses, though these can be reduced even further with adequate private health insurance.

Can I get health insurance after being diagnosed with cancer?

While you can get health insurance after being diagnosed with cancer, it's important to note that it will be classed as a pre-existing condition, and a 12 month waiting period usually applies. 

What's the best health insurance for cancer treatment?

Choosing the right kind of health insurance for your cancer treatment all depends on your personal circumstances, though there are a few things you'll want to keep in mind when selecting a plan:

• Opt for at least a bronze plan as all plans from this level and up are required to offer some cover for cancer treatments and procedures.

• Take your time to carefully compare plans as some may be more cost-effective than others

• Check whether your preferred plan covers you for everything you need, including not just your main treatments but additional services such as therapies or medications not covered by Medicare.

Why might you want to consider trauma insurance (life insurance) for additional peace of mind?

Trauma insurance (often known as critical illness cover) provides a financial safety net if your cancer leaves you too sick to work. 

Combining this with your private health insurance offers you added peace of mind. You'll know that not only are your treatment costs covered, but your day-to-day expenses are taken care of too, ensuring that you can concentrate on your recovery.

Health insurance is also available for screenings to prevent prostate cancer & hysterectomies - you can read more about that here.

Talk to our team today to help you determine whether combining trauma cover with your private health insurance might be a good move, or use our online tool to help you find the right option for you.

Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

• 1

  Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.

• 2

  An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.

• 3

  Family health cover means your children are covered under the same policy as you.

• 4

  Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).