Understanding how to find your way in the healthcare system. Learn about Australia’s public and private health systems and the benefits of Medicare.
Learn more about:
- Overview
- Public health care
- Private health care
- Drugs not on the PBS
- Gap payments
- Informed financial consent
Overview
Healthcare systems can feel complex and hard to navigate, particularly when you’re dealing with the physical, emotional and financial concerns of cancer.
In Australia, you can have medical treatment in the public system or in the private system. Some people use a mix of public and private services.
Public health care
 | Public hospitalsPublic hospitals and some community-based services provide free or low-cost care for people with a Medicare card. If you’re being treated as a public patient in a public hospital, you can’t choose your doctor or other members of your healthcare team. Treatment is based on your needs, so you may have to wait longer for care than a private patient, but this isn’t always the case. |
 | MedicareThe Australian Government fully or partly covers the cost of a range of many medical services including cancer care. Medicare may cover some or all the cost of:• visits to GPs and specialists outside the hospital • certain tests and scans used in cancer diagnosis • some medical services provided in private hospitals. Visit Services Australia to find out more about what is covered by Medicare and how to claim. |
 | Medicare Safety NetOnce your gap payments for health care outside the hospital add up to a certain amount, Medicare will pay a higher benefit for the rest of that calendar year. For details, call Medicare on 132 011 or visit Services Australia to learn more about Medicare Safety Nets thresholds. |
 | What if you don’t have a Medicare card?If you’re not a permanent Australian resident and don’t have a Medicare card, you may need to pay the full healthcare costs. Some people can still get public health care, including refugees and eligible asylum seekers, as well as people from countries with reciprocal healthcare agreements (where 2 countries agree to provide visitors with health care). |
 | Bulk-billingSome GPs and specialists accept the Medicare benefit as full payment for a service. This is called bulk-billing, and it means you don’t need to pay anything. To find GPs and specialists who bulk-bill, visit Health Direct. Not all doctors bulk bill, so you’ll need to pay the difference between the Medicare fee and the doctor’s fee. This is called a gap payment. |
 | Pharmaceutical Benefits Scheme (PBS)Many cancer medicines are expensive. The PBS covers all or part of the cost of many prescription medicines for people with a current Medicare card.If you’re treated as a public patient in a public hospital, the PBS pays for most medicines. This means these drugs are free. You might need to pay a small amount (dispensing fee) for some medicines you take home. If you’re a private patient, you may have to pay part of the cost of PBS medicines, but the overall cost will be capped under the PBS Safety Net. Some new cancer drugs are not funded by the PBS, but you still may be able to have them. |
 | PBS Safety NetThe PBS Safety Net further reduces the cost of PBS medicines once you or your family have spent over a certain amount on medicines each year (the threshold). For details, call 1800 020 613 or visit Services Australia to learn more about PBS Safety Net thresholds. |
→ READ MORE: Private health care
Drugs not on the PBS
Doctors may recommend a drug that’s not on the PBS. This is called a private prescription. These drugs are often very expensive, and you may need to pay the full price for them. This cost will not count towards the PBS Safety Net.
Some private health insurance policies may cover part of the cost of a private prescription. Check with your fund.
You also may be able to access non-PBS drugs by joining a clinical trial or through a compassionate access scheme. This is when a drug company is willing to provide a drug to a patient for free or at reduced cost.
Gap payments
Some doctors don’t bulk-bill, so you’ll have to pay the difference between the Medicare benefit and the consultation fee.
It’s often up to the doctor to set their fee, and different doctors set different fees. When you make an appointment with your doctor, ask if there’ll be a gap payment and what it will be. Keep in mind that a doctor with a larger gap payment is not necessarily any better than another doctor with a lower gap payment.
For a guide on what certain cancer tests, scans and treatments might cost in your area, you can use the Australian Government’s Medical Costs Finder.
For more on cancer costs and your finances, see Cancer and your finances and Financial support, or download our fact sheet on Insurance and cancer.
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Prof Lisa Beatty, Professor in Clinical Psychology, Flinders Cancer Research, Flinders University, SA; A/Prof James Lynam, Medical Oncologist and Senior Clinical Advisor, Cancer Institute NSW; Dr Diana Adams, Medical Oncologist, Macarthur Cancer Therapy Centre and GenesisCare, Campbelltown, NSW; Bob Carnaby, Consumer; Dr Maria Ftanou, Director, Psychosocial Oncology Program, Peter MacCallum Cancer Centre, VIC; Mark Godfrey, Consumer; Prof Angela Hong, Radiation Oncologist, Chris O’Brien Lifehouse, Melanoma Institute Australia, GenesisCare, and Clinical Professor, The University of Sydney, NSW; A/Prof Brett Hughes, Senior Staff Specialist, Medical Oncologist, Royal Brisbane and Women’s Hospital, The Prince Charles Hospital and the University of Queensland, QLD; Kimberly Hurley, Consumer; Bronwyn Jennings, Gynaecology Oncology Clinical Nurse Consultant, Mater Health, QLD; Nadine Macbeth, Social Work Team Leader, Cancer and Chronic Care, Westmead Hospital, NSW; A/Prof Geri McDonald, Director Patient Experience and Wellbeing, Peter MacCallum Cancer Centre, VIC; A/Prof Orla McNally, Consultant Gynaecological Oncologist, Director Oncology/Dysplasia, Royal Women’s Hospital, Honorary Clinical Associate Professor, University of Melbourne, Director, Gynaecology Tumour Stream, Victorian Comprehensive Cancer Centre, VIC; Gail O’Brien AO, Consumer and Patient Liaison Advocate; Mariad O’Gorman, Clinical Psychologist, Liverpool Cancer Therapy Centre and Bankstown Cancer Centre, NSW; Deb Roffe, 13 11 20 Consultant, Cancer Council SA; Julie Teraci, Clinical Nurse Consultant – Melanoma, Cancer Network WA; Dr Elysia Thornton-Benko, Specialist GP/Primary Care and Cancer Survivorship Physician, Clinician Researcher, NSW.
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