Medical and pharmaceutical expenses
The Australian Government offers several benefits that can help you access medical treatments, tests, prescription medicines and other medical supplies at a lower cost.
Learn more about how to:
- Register for the Medicare Safety Net
- Receive Medicare benefits for allied health services
- Get a PBS Safety Net Card
- Use your concession card
- Use the Pharmaceutical Allowance
- Receive help with the cost of continence aids
- Be reimbursed for external breast prostheses
- Receive free stoma supplies
A cancer diagnosis usually involves many medical appointments for tests and treatment. Medicare will usually contribute a certain amount towards these expenses, but you may need to pay the difference out of your own pocket.
Through the Medicare Safety Net, once you reach a set threshold of out-of-pocket expenses, Medicare will pay a higher benefit for many services until the end of the calendar year. This may mean you receive more money back from Medicare for your appointments and tests.
- If you are an individual – you do not need to register for the Medicare Safety Net as Medicare automatically keeps a record of your expenses.
- If you are a couple or family – you do need to register even if you are all listed on the same Medicare card. To download the registration form, visit humanservices.gov.au and type “medicare safety net” in the search box, or call Medicare on 132 011.
If you have a chronic health condition (one present for at least six months or that is terminal), you may be able to get Medicare benefits for allied health practitioners, such as physiotherapists, podiatrists, dietitians and psychologists, to help manage your condition.
Under a Chronic Disease Management Plan, your doctor can refer you to at least two allied health practitioners for your condition, and you can claim at least part of their fees on Medicare.
→ Talk to your GP about whether this plan would be helpful for your condition. If so, the GP will prepare a GP Management Plan and Team Care Arrangement, and can then refer you to the allied health practitioners listed in the Team Care Arrangement.
The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of most prescription medicines for all Australian residents with a current Medicare card. The PBS Safety Net further reduces the cost of prescription medicines once you or your family have spent a certain amount on prescription medicines. This amount is known as the Safety Net threshold. It resets at the beginning of each year.
There are two PBS Safety Net thresholds – one for general patients and one for concession card holders. Once you or your family reach the threshold, you can get a PBS Safety Net card from your pharmacist.
With this card, your medicines will be further discounted (or free if you also hold a concession card) for the rest of the year. Some medicines are not listed on the PBS – you will need to pay full price for these.
- To obtain a PBS Safety Net card, keep a record of any PBS medicines you buy. You can use a Prescription Record Form, which you can get from your pharmacy. Your pharmacist might be able to keep a computer record for you, but if you visit different pharmacies, it is best to keep your own paper record.
- If you are part of a couple or family, ask your pharmacist to combine the amounts for your family Safety Net total so you can reach the threshold sooner. For more information, visit pbs.gov.au.
Some medicines will be cheaper through the PBS if you have a:
- Pensioner Concession Card
- Commonwealth Seniors Health Card
- Health Care Card
- Department of Veterans’ Affairs health card.
The concession card may also entitle you to free medicines once you reach the PBS Safety Net threshold, as well as further refunds for medical expenses through the Medicare Safety Net. Some doctors offer bulk-billing to concession card holders, although this is up to the doctor.
→ If you have one of the eligible cards, show it to your pharmacist when you are getting a script filled. You can also ask your doctor if they will bulk-bill your appointments.
The Pharmaceutical Allowance is a small amount that helps some people cover the costs of medicines. People receiving the Sickness Allowance and some other Centrelink payments automatically receive this extra allowance with their main payment each fortnight. For people receiving the Disability Support Pension, Age Pension or Carer Payment, the allowance is included in the Pension Supplement.
→ You do not need to make a claim for the Pharmaceutical Allowance or the Pension Supplement, as Centrelink will automatically assess your eligibility and pay you with your regular fortnightly payments if you qualify. For more information, go to humanservices.gov.au.
If the cancer or its treatment has left you with permanent or severe incontinence (difficulty controlling your bladder or bowel movements), you may be able to get help with the cost of continence products under the Australian Government’s Continence Aids Payment Scheme (CAPS). For most cancers, this payment is available only if you also hold a Pensioner Concession Card. For a small number of neurological conditions, including brain and spinal tumours, you can receive the payment without a Pensioner Concession Card.
→ Check with your doctors if you meet the CAPS criteria, then complete an application form and send it to Medicare. To find out more, call the National Continence Helpline on 1800 33 00 66. Visit bladderbowel.gov.au/caps to download the form and contact the CAPS team on 1800 239 309 for assistance completing it.
Be reimbursed for external breast prostheses
Women who have had a mastectomy because of breast cancer can access the External Breast Prostheses Reimbursement Program if they hold a Medicare card. The program reimburses you for new or replacement external breast prostheses purchased after 1 July 2008. You can usually make only one claim for every two-year period.
→ Call Medicare on 132 011 or visit humanservices.gov.au to check if you’re eligible for reimbursement and to get a claim form. You will need to send the completed form with the receipt to Medicare.
Receive free stoma supplies
In some cases, after surgery for bowel or anal cancer you may need a temporary or permanent stoma, an opening in the abdomen that allows faeces to be collected in a stoma bag. Stoma bags and other supplies are available free under the Stoma Appliance Scheme if you hold a Medicare card and are a member of a stoma association.
→ Your stomal therapy nurse can help you join an approved stoma association and you will then be able to obtain free stoma appliances and products. For more information, go to health.gov.au and type “stoma appliance scheme” into the search box, or visit the Australian Council of Stoma Associations.
Keith Manchester, Senior Legal Counsel, Financial Services Legal, AMP, NSW; Alka Bisen, Financial Counsellor and Project Coordinator – Financial Assistance Services, Cancer Council NSW; Patricia Dunn, Consumer; Emily Gibson, Social Worker, Mater Hospital Brisbane, QLD; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Michelle Ruchin, Social Worker, Cancer Council SA; Robert Simon, Technical Services Manager, Tapln and Technical Strategy, AMP Advice, NSW; Krystyna Wisniewski, Consumer.
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