Private Health Insurance For Chemotherapy

Whether you’ve been diagnosed with cancer, a loved one has received the bad news, or you’re predisposed to the diagnosis down the track, understanding the costs of chemotherapy in Australia is important. This guide covers what you can expect from the public system, and where private health insurance adds value.

To help wrap your head around all the details, here’s what you need to know about the costs of chemo in Australia.

What is chemotherapy?

Chemotherapy – commonly referred to as ‘chemo’ – is a type of treatment used to destroy cancer cells, either on its own or in tandem with other approved therapies. There are a number of ways chemo can be deployed. 

Your doctor may use chemotherapy to shrink a tumour to a smaller size prior to surgery, it may be able to destroy the cancer cells entirely, or it may be used to prolong your quality of life where a cure for your cancer isn’t possible.

There are a number of different types of chemotherapy treatments, from oral (taking pills or capsules) to intravenous (inserting a needle into the vein), intramuscular, subcutaneous and more. The type of chemotherapy applied will depend on the  cancer type and the recommendations of your specialists.

How much does chemo cost on average?

In general, chemotherapy costs between $240-$380 per session^, though this depends a great deal on the type of cancer you have and in what part of your body it occurs.

Some cancers are more aggressive than others and require more severe, invasive and prolonged treatments, which can end up costing you more. Some of the most common cancers, such as breast cancer and prostate cancer, end up costing the most in out-of-pocket expenses, according to a Queensland study.

The good news is that private health insurance can help cover a portion of your chemo costs. In fact, the latest changes to the Private Health Insurance (Reforms) Amendment Rules 2018 state that Gold Tier, Silver Tier and Bronze Tier private health policies must all include chemotherapy, radiotherapy and immunotherapy cover, to help combat cancer.

How much does breast cancer treatment cost?

Like all cancer treatments, the financial cost of breast cancer varies depending on the type of cancer, the point at which it’s identified, and which procedures and treatments are being used to fight it.

According to the Breast Cancer Network Australia, the average treatment cost for women with early-stage breast cancer was approximately $5,000 over a five-year period, with the majority of those costs incurred during the initial two years from diagnosis.

Why is chemo so expensive?

Despite cancer affecting one in two Australian men and women by the time they turn 85, chemotherapy is still an expensive treatment that can cause financial distress at a time that is already very challenging for you and your family.

The reason chemo is so expensive is because cancer medicine is costly, cancer specialists command high fees, and because cancer is not just a single disease – it’s simply a name for about 100 different diseases. The many different variants require different types of treatment to fight them – and therefore different studies and funding to find those medicines are required, adding to the cost of cancer treatments.

Is chemotherapy covered by the PBS?

When it comes to whether chemotherapy is covered by Medicare, you need to focus on the Pharmaceutical Benefits Scheme (PBS). Chemotherapy usually involves medicines rather than being a surgical procedure or medical consultation, though it is possible for cancer treatment to involve both.

According to the PBS’s latest update on efficient funding of the chemotherapy program: “Patients will pay one PBS co-payment for each original prescription. Repeat prescriptions are dispensed at no cost to the patient. The current PBS patient co-payment is on the PBS website. The PBS patient co-payment for chemotherapy infusions and injections counts towards the patient’s PBS Safety Net.”

What are the waiting periods to use private health insurance for chemo?

If you or a loved one are diagnosed with cancer, treatment may need to begin immediately depending on how far the cancer has progressed. If you don’t currently have private health insurance, finding the right health fund can help reduce the overall costs of chemo.

Waiting periods may be applicable, depending on the provider you choose. It’s smart to speak to your health fund before receiving treatment, to find out:

• what’s covered under your policy for chemotherapy and cancer treatments;

• how much you’ll have to pay yourself (gap fees); and

• any associated waiting periods you’ll need to serve before your treatment is covered under your current policy.

Can life insurance (trauma cover) help with the costs of cancer treatment?

A cancer diagnosis doesn’t just impact your health – it may also mean you’re unable to work and take care of mortgage repayments and other household bills.

Because cancer is a common health issue that can appear quickly and without warning, taking out a form of life insurance like trauma cover offers peace of mind around how your family - and you - will cope financially if you suffer a serious injury or are diagnosed with an illness like cancer. Trauma cover provides a lump-sum payout that can be used during the time you’re unwell, covering any out-of-pocket costs from your cancer treatments as well as your regular household bills.

You can find out more about life insurance and cancer diagnoses in our guide here.

With the right private health insurance policy you can reduce the financial strain on yourself and your family, should you require chemo. On average, we help people save $300** when they compare and switch funds# with us, and you can get started right now.

Sources

^Chemotherapy costs

**Average savings based on 111,658 policies sold Jan - Dec 2022. 

Cancer treatment How much does it cost to have cancer? Cancer treatment legislation The financial impact of breast cancer Cancer facts and figures Health Direct on cancer Chemo and the PBS

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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).