Medicare vs Private Health Cover for Cancer Treatment

Medicare covers most cancer-related treatments up to a point. Private health from Bronze level upwards can help cover gaps and choice of treatment provider.

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by Gary Andrews

Last update 15 Apr 2021


Cancer affects people all over the world, and Australia is no different.

Cancer has likely touched your life in one way or another, whether it's a family member, an acquaintance, or a colleague.

The public healthcare system of Medicare ensures that Australians who need cancer treatment will be able to receive it.

However, there are some gaps, waiting lists, and other considerations that make private health insurance an appealing option for cancer cover.

Ahead, we'll take a look at health insurance that covers cancer treatment so you can get a better idea of what to expect.

Key Points

Medicare covers most cancer-related treatments and therapies up to a point.
Any additional fee your practitioner charges over the Medicare Benefits Schedule fee is called a "gap."
Private health insurance from the Bronze level upwards can help cover these gaps, along with giving you a choice of hospital and treatment provider.

Medicare and Cancer Treatment

Does Medicare cover cancer? Yes, it does.

The Australian Medicare system ensures that no Australian citizens are left holding the bill when it comes to necessary treatment.

This includes cancer treatment.

Those who are on the Medicare system without private insurance are still entitled to treatment.

There are some caveats to receiving treatment through Medicare, though.

You can't choose your doctor and will be treated as a public patient in a public hospital.

Some related treatments and services won't fall under the Medicare umbrella either.

An ambulance ride or a visit from a home nurse may still come directly out of your pocket.

Cancer care that takes place outside of a hospital may incur an additional fee, depending on how the doctor bills for services.

This is known as a 'gap fee,' and we'll talk more about it further on in this guide.

If a doctor bulk-bills, there should be no gap fee.

There are waiting times to consider as well, though these are prioritised by urgency.

Australian Government data indicates that hospital waiting times are typically from nine to fourteen days for malignant cancer surgery.

Even with these limitations and restrictions, cancer treatment is still accessible to those on Medicare.

You may have to pay for some services and won't be able to choose your provider, but Medicare covers necessary surgeries, procedures, and prescriptions.

Private Health Insurance and Cancer Treatment

Private health insurance grants you the ability to choose your doctor and receive treatment as a private patient in a private facility.

The level of cover you choose will determine what benefits you receive.

The recent changes to private health insurance policies break them into tiers.

This change makes it easier to compare policies from different providers to make sure you're getting the best deal.

The tiers are Basic, Bronze, Silver, and Gold.

Cancer-related treatment starts with Bronze coverage, as Basic only offers a limited level of benefits.

Here is a breakdown of the minimum coverage different tiers provide that may relate to cancer diagnosis and treatment.

Aged based discount

Aged based discount

As you can see, the Bronze tier will cover you for almost all cancer-related treatments and therapies.

The silver tier is a slight step up, but the Gold tier doesn't offer any additional cancer-related benefits.

The tier of health coverage you select is up to you, but it's helpful to have Bronze coverage at least if you'd like to receive cancer treatments as a private patient.

If you've had cancer before, you may have to serve a 12-month waiting period for pre-existing conditions when switching to a new policy or upgrading your level of cover.


The Cost of Cancer Treatment

There's no blanket cost that we can give for cancer treatment.

The cost you'll face will depend on the severity of the cancer, what type of cancer you have, and what treatment is required.

You should talk to your doctor about costs before beginning treatment.

They will be able to walk you through costs, what Medicare or your health fund will cover, and what you'll need to pay out of your own pocket.

The Medicare Benefits Schedule (MBS) details how much Medicare will offer in benefits for each related treatment, therapy, and procedure relating to cancer.

Not all practitioners charge the same amount, so you may face some out-of-pocket expenses to cover the difference between what the doctor charges and what Medicare pays for.

This difference is called a "gap."

You should know about any gaps before you begin treatment so you can plan your payments accordingly.

Some health funds offer gap coverage.

In these cases, your fund will pay the gap, and you won't have to pay anything out of your own pocket.

This feature is another reason why purchasing private health coverage is so important.

Check on your health fund's gap coverage policy before starting your treatment.

This will help you avoid any surprise charges down the line.

Paying Out of Pocket

If you don't have health insurance that covers cancer treatment, you might face some out-of-pocket expenses for your treatment if it is not fully covered by Medicare.

Aged based discount

Aged based discount

You can discuss a payment plan, receive financial assistance, or get help from the Medicare safety net.

It's also essential to understand how your practitioner charges for their services.

Some doctors will bill Medicare for treatment, while others charge you directly and require you to submit a benefit request from Medicare.

Choosing Private Health Insurance

Since gaps in coverage between the MBS and what doctors charge can be high, people may choose to purchase private health insurance.

Private health insurance may cover these gaps and make sure you receive adequate treatment without paying out of your own pocket.

However, due to the 12-month waiting period on pre-existing conditions, it's wise to have cover in place early, especially if you have a family history of cancer.

If you take out cover after a diagnosis, you will still have to complete the waiting period before claiming for treatment.

To compare prices on policies today, use our comparison tool---it's an easy way to shop around, because you can compare policies side-by-side.

Get started today to find a great price on the cover you want.


This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.