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Does Medicare cover outpatient radio/chemotherapy?

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Hi All,

I have just found out a family member will have to have chemo/radiotherapy. They are having their initial surgery done through St Vincents Private Hospital in Sydney and as we are looking at costs etc (plus its late at night) I'm trying to find out what out of pocket costs would be involved. Does medicare cover it? Does private health insurance cover it? At this point I've been advised that it will be 6wks every day and the hospital apparently has a place nearby that they can stay at (again, there is an out of pocket cost, but not sure how much yet).

 

Anyone able to shed some light? I obviously don't have any clue yet about all this but had assumed it would be covered by medicare. The specialist said the treatment has to be done in Sydney (as opposed to country NSW) so we're just trying to be prepared financially.

 

Thanks!

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toomuchmess

Hi, I had chemo/radiation for breast cancer. Im a bit hazy on the exact details but will tell you roughly what I remember.

For chemo I had to pay for the drugs (like a prescription) but medicare covered the rest. Eg for each round of chemo I had 5-6 drugs and paid around $30 for each drug, so around $150 per 'round'.

For radiation I had to travel each week and spend the week away from home in a purpose built lodge. My local canassist branch picked up the tab for this, from memory it was around $50 per night (possibly a bit cheaper).

The radiation cost is obviously different for everyone depending on where and how long they treat you for. There was the initial mapping and planning session which was possibly around $1800, then each week my bill was about $1250? So that would work out to maybe around $250 per day (for about 2min treatment) and I had 33 days treatment) I think medicare covered most of it and I may have been about $300 out of pocket each week? (im over estimating to be safe).

 

If money is an issue definitely talk to them, or a social worker or see if you can gain assistance from somewhere like canassist or some other specially set up place. They will not want you to stress or have things be difficult for you.

 

My treatment was in rural NSW.

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scarfie

DH starts 6 weeks of Chemo/Radiation next week. We just picked up the chemo drugs today and we got enough for 2 weeks and spent approx $120. Radiation is done through the public system, so I assume Medicare. We had the initial consult with the radiation oncologist and then the mask making and mapping done and just needed to give them medicare details.

 

I think it depends on what type of cancer is being treated as to what chemo drugs are used and how i.e., oral or iv. Luckily we live in Sydney, so he only has the travel costs per day to get to the hospital for treatment. When he finishes the initial 6 weeks he has a month off, then 6 months more of chemo at double the dose, so not sure if the costs will increase for the drugs then.

 

Hope the treatment goes well for your loved one.

 

 

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Thank you so much for this info! I was planning on giving the social worker a call tomorrow to get some more information or at least some direction to where I could find out more. I am still in a bit of shock as to the cost when you go private. This family member is a pensioner, and while they have private health insurance, it really doesn't seem to cover what is needed :( We live in Sydney too, but too far out, so it was good to hear that there are facilities closer to the hospital. What on earth do people do when they can't afford to stay local etc.... I know we get a life for this treatment, but the financial cost is still very high. Makes me want to ensure I have enough money when I'm old and sick to pay for what I need/want medically.

 

Are there any other organisations I should get in contact with? I hadn't heard of Canassist but will google them shortly.

 

Thanks again :)

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scarfie

We have private health insurance, but will still be out of pocket for DH's surgery by about $10,000! Luckily we have transferred to the public system for radiation and chemo! Unfortunately these things hit young people too, so we certainly haven't had an opportunity to put away any extra money to cover any expenses like this!

 

Depends on what type of cancer your loved one has. The Cancer Council is a great resource, and then there are loads of organisations supporting the different types of cancers, so google those too.

 

Check to see if your loved one can have their treatment at a hospital closer to you, i.e. Liverpool, St George, whichever is your closest teritary hospital.

 

 

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KT1978

Dp had chemotherapy at a private facility and it cost about $300 week, fully paid for under phi. $75 of tat was drugs, $220 was the day admission fee (he was there for less than an hour). :rolleyes:

 

It varies wildly between facilities and drug regimes. Ask the oncologist for the item numbers and fees and then talk to Medicare and phi.

 

Don't worry about it though, I haven't heard anyone being out of pocket much for chemo. We paid a few hundred for oncologists check ups and anti nausea meds. I think ake home chemo might be more out of pockets.

 

Like scarfie said, it's surgery that can cost a lot. Ours was about $4,000.

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~~~

Thanks guys, yes, we're looking at probably about 10K for out of pocket costs for the surgery. Cancer is in neck and lymph glands. Just grateful the drs are experienced and positive about the outcome.

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Arthur or Martha

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Edited by ambwrose

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adifferentme

I'm not sure about chemo/radiation costs sorry, but just wanted to ask - Scarfie with PHI how did you still end up $10K out of pocket? I had surgery for bowel cancer in May with no PHI which was around $13,000 - I've now taken out PHI for both kids and I which I can hardly afford (single mum & full time post-grad student) and I'm wondering if there's any point if the out of pocket costs are still huge??? :o

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Lifesgood

I'm sorry your relative has cancer, I wish them and your family all the best.

 

My mum is having cancer treatment for breast cancer and is a pensioner. She has had surgery to remove the lump and test lymph nodes, 6 rounds of chemo and is in the middle of 6 weeks of radiotherapy. She is privately insured.

 

So far her OOP costs have been negligible. The drugs are free as she has already reached her limit of 30 prescriptions a year (pensioners only pay a few dollars per script anyway, regardless of the cost of the drugs, and when they have had 30 scripts for the year they become completely free).

 

The doctors bills have been covered by Medicare so she has only paid the gap between what the safety net covers (80 or 90%) and the total fee.

 

The radiotherapy has had to be paid in full up front and is several thousand dollars, but again she will get most of that back through Medicare.

 

The lodge that she can stay in if she wants to at the hospital is $60/night (Sydney Adventist Hospital).

 

We have been completely amazed at how inconsequential the expenses have been. Even when she had complications from chemo and had to be admitted to hospital for a week or so, we only paid $50! The usual emergency room fee ($300) was waived as she was an existing cancer patient of the hospital. The accommodation costs were completely covered by PHI, apart from the excess.

 

Honestly, sometimes we whinge about our health system but in this case it has been superb.

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**Kylie**

DH had radiation treatments at Premion at Chermside in Brisbane - 15 treatments. Our out of pockets were extremely minimal due to us hitting the safety net with Medicare quickly with all DH'S medical expenses. We were told that if he'd been an inpatient at the hospital then we would have had to pay nothing at all. I wanted him home though not in hospital for another 3 weeks.!

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Just a quick update, we now have an OOP amount for the radiotherapy, which is expected to be less than $500, which is a big relief. Still need to learn more about the safetynet stuff, but just glad that we have one more cost known.

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