Find cutting edge cancer clinical trials near you using the new Victorian Cancer Trials Link.

Search now

Cancer care and your rights


Navigating the health care system

Health care systems are complex and sometimes challenging to understand, particularly when you are dealing with the physical, emotional and financial impacts of cancer.

Australia’s health system has two parts: the public health system and the private health system. People can be treated publicly or choose to use their private health insurance to be treated privately. Most people treated for cancer use a mix of public and private services.

Australia's health care system
Public hospitals
  • Funded by governments.
  • If you are admitted as a public patient, medical care is free (although there may be a cost for some medicines).
  • Often have a wider range of services than private hospitals.
  • May also have some private services, such as imaging and pathology.
  • You will not be able to choose your doctor and there may be a wait for some services.
  • If admitted as a private patient, some costs may be covered by your private health insurance, but there are likely to be out-of-pocket costs.
Private hospitals
  • Run by private organisations.
  • Treatment may be partly covered by Medicare and private health insurance.
  • You will have to pay part of the cost for medical services (gap payment).
  • May be additional costs for accommodation, operating theatres and medicines.
  • You will be able to choose your doctor.
  • Waiting times for some health services may be shorter than in a public hospital.
Non-hospital care
  • Mostly private, though some public services.
  • If you visit a doctor outside a hospital, Medicare will pay 100% of the schedule fee for general practitioner (GP) visits and 85% for specialist visits, and approved imaging scans and blood tests.
  • Many health providers charge more than the schedule fee and you will have to pay the difference. Ask how much you will have to pay when making an appointment.
  • Private health insurance does not cover out-of hospital medical service costs, which are covered by Medicare.
Medicare
  • Funded by Australian taxpayers.
  • Covers the cost of treatment in public hospitals, and partly covers doctors’ fees for some services in private hospitals.
  • Helps to cover part of the cost of visits to GPs and specialists.
  • Once you have spent a certain amount on medical services, your benefits may increase (Medicare Safety Nets).
  • Sometimes, health professionals accept the Medicare benefit as full payment for a service (bulk-billing).
Private health insurance
  • You may choose to pay for private health insurance.
  • If you have hospital cover, it will cover part of the cost of your care as a private patient.
  • You will usually also have costs you have to pay yourself.
  • If you have extras cover, it may help with the cost of allied health care such as physiotherapy.
Gap payments
  • Medical costs are often higher than the amounts covered by Medicare and private health insurance.
  • The difference between these amounts is called a gap payment or out-of-pocket cost and you will have to pay this. Check with your health care team what your gap payments will be.
PBS
  • Funded by the Australian Government, the Pharmaceutical Benefits Scheme (PBS) covers part of the cost of medicines.
  • Once you have spent a certain amount of money on medicines, your medicines are free or the cost is further reduced (the PBS Safety Net).

Public health care

The Australian Government provides free or subsidised medical care and hospital services through Medicare. This is known as a “universal health care system”. If you have a current Medicare number, you have the right to receive free treatment as a public patient in a public hospital (even if you have private health insurance).

Public hospitals often provide a wider range of services than private hospitals, including:

  • emergency departments
  • specialist surgical and medical units
  • allied health services.

For an overview of what to expect during all stages of your cancer care, visit cancer.org.au/cancercareguides

If you are being treated as a public patient in a public hospital:

  • you can’t choose your doctor or any other member of your health care team at the hospital
  • you might have to wait longer for treatment than a private patient.

Cancer care delivered publicly includes:

  • consultations with your oncologist or surgeon
  • cancer treatments (e.g. surgery, chemotherapy, radiation therapy)
  • tests such as blood tests, x-rays and imaging scans
  • some allied health services (usually in outpatient clinics).

It’s important to remember that both public and private patients have the same access to public hospital services.

The cost of cancer

General practitioner (GP)

When you first notice the signs and symptoms of cancer, the first health professional you are likely to see is your GP. Your GP will arrange initial tests and scans and, if cancer is suspected, will refer you to a specialist for further tests. GP consultations are subsidised by Medicare, but private health insurance does not cover GP consultations.

Diagnostic tests and scans

To confirm a cancer diagnosis, you may have a range of tests and imaging scans. These tests may be done in a public or private hospital or health service. Medicare will cover some or all of the cost of tests and scans. Check with your health care provider what you may have to pay for these tests (out-of-pocket costs).

Treatment

Cancer treatments may be offered in both public health services and private health services. It’s very important to understand the costs that you may have to pay yourself (out-of-pocket costs) before making treatment decisions. This is called informed financial consent.

You may be able to have some of your treatments in the public system and some in the private system. Keep in mind that there may be a period of waiting if you choose to switch from private to public care.

Follow-up care

After completing your treatment, your continuing care may be organised by your GP or your cancer specialist. Medicare may cover the cost of some or all of your medical follow-up services. You may also need to see allied health professionals, such as exercise physiologists and dietitians.

Some of these services may be covered by Medicare; talk to your GP to see if you are eligible for a Chronic Disease Management Plan. If you have private health insurance for extras, you may be able to claim for part of the cost of some allied health services.

Private health care

Some people prefer to be treated as a private patient so they can choose their own doctor, and may not have to wait as long for treatment. You can be treated as a private patient in both public and private hospitals and health services.

Fees

Doctors, service providers and hospitals in the private sector can set their own fees. Some people pay for private health insurance to help cover the extra cost of treatment as a private patient in hospital. If a health service provided in a private hospital is on the Medicare Benefits Schedule, Medicare covers 75% of the schedule fee for some services and private health insurance may cover at least 25%. Many doctors charge more than the schedule fee. Your health insurer may cover some or all of this cost; you will have to pay any costs not covered (gap payment). You will also be charged for hospital accommodation, operating theatre fees and medicines. Private health insurance may cover some or all of these costs, depending on your policy.

Discuss costs

Before being admitted to hospital as a private patient, it’s helpful to ask:

  • your doctor for a written estimate of their fees (and if there will be a gap), who else will care for you (e.g. an anaesthetist or surgical assistant), and how you can find out what their fees will be
  • your private health fund (if you belong to one) what costs they will cover and what you’ll have to pay – some funds only pay benefits for services at certain hospitals
  • the hospital if there are any extra treatment and medicine costs.

Health funds may make arrangements with some doctors about gap payments. Using the doctors and hospitals that take part in your health insurer’s medical gap scheme can help reduce out-of-pocket costs.

Public hospitals

If you choose to be treated as a private patient in a public hospital, it is usually arranged on admission. However, if you have been admitted to hospital through the emergency department, an administration officer may come to your bedside to ask if you want to be treated as a private or a public patient.

You don’t have to decide straightaway. You may like to first talk to your health fund or a patient liaison officer at the hospital.

Many people treated privately are surprised that they have to pay additional costs not covered by Medicare or their private health fund. It is important to ask about out-of-pocket costs before treatment.

Medicare

The Australian Government provides free or subsidised medical and hospital services through Medicare to Australian citizens and permanent residents, and people who meet certain requirements (e.g. visitors from some other countries). The government sets fees for the medical services it subsidises, which are listed on the Medicare Benefits Schedule (MBS). The fees are known as schedule fees and the Medicare benefit for out-of-hospital services is usually 85–100% of that schedule fee.

Bulk-billing

Some GPs and specialists accept the Medicare benefit as full payment for a service, and you will not have to pay anything. This is called bulk-billing. Many doctors do not bulk-bill, so you will have to pay the difference between the Medicare benefit and the consultation fee. You may be able to find doctors who bulk-bill their services by visiting healthdirect.gov.au/australian-health-services.

What Medicare does and doesn't cover

  • It covers hospital care when admitted as a public patient to a public hospital, and visits to GPs, specialists and optometrists. Medicare may cover the cost of certain medical supplies (e.g. breast prostheses, stoma supplies). There are also programs to help with the cost of other services, such as visits to a psychologist or allied health professionals. Talk to your GP to see if you are eligible.
  • It doesn’t cover ambulance services (funding and costs vary according to the state or territory in which you live and may be covered by your private health insurance), dental care (with exceptions), private home nursing services, and other services.

Medicare Safety Nets

This program can help reduce how much you have to pay for some out-of-hospital services. Once your out-of-pocket costs add up to a certain amount (called the threshold) during a calendar year, Medicare will pay you a higher benefit for some services until the end of that year.

Individuals with no dependants do not need to register for Medicare Safety Nets as Medicare automatically keeps a total of your expenses. Couples and families, however, must register for Medicare Safety Nets, even if you are all listed on the same Medicare card. For details, call Medicare on 132 011 or visit servicesaustralia.gov.au.

Private health insurance

Some people choose to take out private health insurance to help cover their future health care expenses. The amount you pay (the premium) and the health services covered vary depending on the company and the type of policy you select.

As a privately insured patient, you can choose your own doctor, and you can choose to be treated in a private hospital or as a private patient in a public hospital. It is likely that you will have some out-of-pocket costs.

You can get hospital cover as well as cover for extras such as dental, optical and physiotherapy treatments. After you take out a policy, there will usually be a waiting period before you can claim benefits. For a general list of what Medicare and private health insurance covers in Australia, visit privatehealth.gov.au/health_insurance/what_is_covered.

Informed financial consent

You have a right to know if you have to pay for treatment and medicines and, if so, what the costs will be. Before treatment starts, your doctors and other health care providers must talk to you about the likely fees that you will have to pay (called out-of-pocket costs). This is called informed financial consent. You can ask for this information to be put in writing, so you can refer to it during your treatment.

There may be costs associated with your treatment that you hadn’t considered. For example, if you have surgery as a private patient, there will be fees for your stay in hospital and for the anaesthetist, as well as the fees for the surgical procedure.

In some instances, such as in the case of an emergency, it is not possible to give informed financial consent before medical care. In such cases, your consent should be obtained as soon as possible afterwards.

Exploring medical costs

Understanding all treatment costs may play a role in your decision to use public or private services. It may be helpful to visit the Australian Government’s online tool Medical Costs Finder, which is a general guide to the typical fees, private health insurance contributions and out-of-pocket costs for medical services in your area.

Also see privatehealth.gov.au/health_insurance/what_is_covered for a general list of what Medicare and private health insurance cover. If you have private health insurance, you will need to contact your health fund to find out what costs are covered in your policy.

Ways to manage health care costs

  • Ask your health care provider for a written quote outlining their fees. If you receive a much higher bill, show them the quote and ask why the bill is higher.
  • Ask your GP to refer you to a doctor in the public health system.
  • Consider switching to a doctor who charges lower fees (if you are a private patient).
  • Ask to be treated as a public patient in a public hospital, even if you have private health insurance.
  • Talk to your doctor about treatment options, and if other treatments might be as effective but cost less.
  • Find out if you can pay in instalments or have more time to pay your bill. If your health care provider agrees, check if you will be charged interest.
  • Ask your doctor if they would consider reducing their fees if you can’t afford treatment.
  • Ask your GP if they can give you a long-term referral to your specialist at the end of your treatment. This is known as an “indefinite referral”. Note, an indefinite referral is not valid for new or unrelated conditions, and it’s important to visit your GP if you have any health concerns and for regular check-ups.
  • For more information on the financial impacts of cancer, see Insurance, financial and workplace issues.

Medicines and the PBS

Many drugs used to treat cancer are expensive. The Pharmaceutical Benefits Scheme (PBS) covers all or part of the cost of many prescription medicines for people with a current Medicare card.

Concession cards and allowances

Some PBS medicines are cheaper for people with a Pensioner Concession Card, Commonwealth Seniors Veteran Card, Health Care Card or Department of Veterans’ Affairs Health Card. You will need to show your card to the pharmacist when you get your prescription filled. People who receive some Centrelink payments may be eligible for a Pharmaceutical Allowance, which can help to cover the costs of prescription medicines. For details, visit servicesaustralia.gov.au.

PBS Safety Net

The PBS Safety Net further reduces the cost of PBS medicines once you or your family have spent a certain amount on medicines each year (the threshold). When you reach the threshold, your pharmacist can give you a PBS Safety Net card, and your prescription medicines for the rest of the year will be discounted (or free if you have an eligible concession card). For details, call 1800 020 613 or visit pbs.gov.au.

Generic medicines

Your pharmacist may ask if you would like a generic brand of your prescribed medicine because it will be cheaper. Generic medicines contain the same active ingredients and meet the same high standards of quality, safety and effectiveness set by the Therapeutic Goods Administration, which regulates medicines sold in Australia. It is your choice whether to buy the generic or original brand.

Non-PBS prescriptions

Doctors may prescribe a medicine that is not on the PBS. This is called a private prescription. You will need to pay the full price for these medicines and it will not count towards the PBS Safety Net. If you have private health insurance, it may cover some or all of the cost of a private prescription. Check with your insurer.

You may also be able to access medicines that are not on the PBS by joining a clinical trial (see Making treatment decisions) or through a compassionate access scheme (see below).

Paying for medicines

  • Public patients in public hospital do not pay for most drugs as the cost is covered by the PBS. Ask your treatment team if you have to contribute to the cost of your drugs (there may be a cost for some oral chemotherapy drugs).
  • If you choose to be treated as a private patient, you may have to contribute to the cost of chemotherapy drugs. Check with your doctor and health fund before starting treatment.
  • Some doctors only prescribe PBS medicines to make treatment affordable. Ask your doctor for every option – including private prescriptions – so you can make an informed decision about your treatment. You may also be able to get some drugs at a reduced cost on compassionate grounds (these are called compassionate access schemes). Ask your doctor if this might be an option for you.
  • You usually have to pay for medicines you take at home. Keep a record of your PBS medicines on a Prescription Record Form, available online or from your pharmacist, so you know when you’ve reached the PBS Safety Net threshold.

Key points

 

  • You can often choose whether to be treated in the public or private health systems. Many people treated for cancer use a mix of health services.

 

  • If you’re a public patient, the public hospital system pays for your care and treatment in a public hospital.
  • Medicare also provides benefits for out-of hospital services, such as doctor visits and imaging scans. These may be bulk-billed or you may have to pay the bill and then claim the Medicare benefit.
  • Once your expenses reach a certain amount (threshold), the Medicare Safety Net further subsidises out-of-hospital costs.

 

  • You may choose to take out private health insurance to help cover certain medical and hospital expenses. Waiting periods may apply before you can claim benefits.
  • Private patients can choose their own doctor and may have a shorter wait for treatment.
  • If you are treated as a private patient in a public or private hospital, your health care providers should talk to you about how much your tests, treatments, medicines and hospital care will cost. This is called informed financial consent.

 

  • The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of many prescription medicines used for cancer.
  • The PBS Safety Net also helps with the cost of medicines. Once you reach a certain threshold, your PBS prescriptions for the rest of the year will be further discounted or free.

 

Cancer Care and Your Rights

Download our Cancer Care and Your Rights booklet to learn more and find support.

Download now  Order for free

Expert content reviewers:

Prof Sarah Lewis, Faculty of Medicine and Health, The University of Sydney, NSW; Kevin Bloom, Senior Social Worker, Haematology and Bone Marrow Transplant, Royal North Shore Hospital, NSW; Danielle Curnoe, Consumer; Alana Fitzgibbon, Clinical Nurse Consultant – Gastro-Intestinal Cancers, Cancer Services, Royal Hobart Hospital, TAS; Hall & Wilcox (law firm); Johanna Jordaan, Consumer; Dr Deme Karikios, Medical Oncologist, Nepean Cancer and Wellness Centre, Nepean Hospital, NSW; Melissa Lawrie, Breast Cancer Clinical Nurse, Cancer Services, Gold Coast Hospital and Health Service, QLD; Jacqueline Lesage, Consumer Reviewer, Cancer Voices NSW; McCabe Centre for Law and Cancer, VIC; Louise Pellerade, 13 11 20 Consultant, Cancer Council WA; Andrew Potter, Consumer; Siân Slade, PhD Candidate, Nossal Institute for Global Health and Non-Executive Director (health, disability sectors), VIC; Paula Watt, Clinical Psychologist, WOMEN Centre, WA.

Page last updated:

The information on this webpage was adapted from Cancer Care and Your Rights (2023 edition). This webpage was last updated in July 2023. 

Talking bubbles icon

Questions about cancer?

Call or email our experienced cancer nurses for information and support.

Contact a cancer nurse