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Medical and pharmaceutical expenses
The Australian Government offers several benefits that can help you pay for medical treatments, tests, prescription medicines and other medical supplies at a lower cost.
Learn more about:
- Registering for the Medicare Safety Net
- Receiving Medicare benefits for allied health services
- Getting a PBS Safety Net card
- Using your concession card
- Using the Pharmaceutical Allowance
- Receiving help with the cost of continence aids
- Being reimbursed for external breast prostheses
- Receiving free stoma supplies
Register for the Medicare Safety Net
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.
The Medicare Safety Net applies to out-of-hospital costs. Once your out-of-pocket costs go over a certain amount (called the threshold), Medicare will pay you 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 need to register even if you are all listed on the same Medicare card. Download the registration form now or call Medicare on 132 011.
Receive Medicare benefits for allied health services
If you have a chronic health condition, 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, if your GP refers you to one or more allied health professionals, you may be eligible for a Medicare rebate for up to a total of five visits per calendar year.
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. They can then refer you to the allied health practitioners listed in the Team Care Arrangement.
Get a PBS Safety Net card
The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of many prescription medicines for people 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 them each calendar year. This amount is known as the PBS Safety Net threshold.
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, your pharmacist can give you a PBS Safety Net card. With this card, your prescription medicines for the rest of the year will be discounted (or free if you have an eligible concession card). You will need to pay full price for medicines not listed on the PBS.
- To get a PBS Safety Net card, keep a record of any PBS medicines you or your family 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.
- For more information, call 1800 020 613 for the PBS Information Line or visit Services Australia and search for “PBS Safety Net”.
Medicines not on the PBS are usually expensive. You may be able to have them as part of a clinical trial or at a reduced cost through a compassionate access or cost-share program offered by the pharmaceutical company. Talk to your health care team for more information.
Use your concession card
Centrelink issues concession and health care cards to help reduce the cost of medical expenses and medicines for eligible people. These include the Pensioner Concession Card; Commonwealth Seniors Health Card; and Health Care Card (learn about Centrelink). The Department of Veterans’ Affairs Veteran Card also helps with these costs. The benefits you receive with a Veteran Card depend on its colour – visit dva.gov.au for more information.
Some doctors bulk-bill concession card holders, although this is up to the doctor. These cards may also mean you can get:
- cheaper medicines through the PBS
- free medicines once you reach the PBS Safety Net threshold
- refunds for medical expenses through the Medicare Safety Net.
If you have an eligible card, show it to your pharmacist when you are getting your prescription filled. You can also ask your doctor if they will bulk-bill your appointments.
Use the Pharmaceutical Allowance
The Pharmaceutical Allowance is a small amount that helps some people cover the cost of medicines. People receiving some 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 their regular 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 Services Australia and type “Pharmaceutical Allowance” in the search box.
Receive help with the cost of continence aids
The Australian Government’s Continence Aids Payment Scheme (CAPS) helps with the cost of continence products. If cancer or its treatment has left you with permanent or severe incontinence (difficulty controlling your bladder or bowel movements), you may be eligible for 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 you meet the CAPS criteria with your doctors, then complete an application form and send it to Medicare. To find out more, call the National Continence Helpline on 1800 33 00 66. Download the form now. For help completing the form, contact the CAPS team on 1800 239 309.
Be reimbursed for external breast prostheses
Medicare’s External Breast Prostheses Reimbursement Program helps with the cost of new or replacement breast prostheses. Women who have a Medicare card and have had a full or partial mastectomy because of breast cancer can claim up to a set amount for a new prosthesis every two years. If you’ve had a bilateral mastectomy, you are eligible for reimbursement for two breast prostheses. You will need to pay the upfront cost of the prosthesis in full and get reimbursement later. As policies can change, check what assistance is available before you buy a new prosthesis.
Call Medicare on 132 011 or visit Services Australia to check if you’re eligible for the program and to get a claim form. You will need to send the completed form with a copy of the original receipt for the prosthesis to Medicare.
For more on this, see Breast prostheses and reconstruction.
Receive free stoma supplies
In some cases, after surgery for bladder, bowel or anal cancer you may need a temporary or permanent stoma, an opening in the abdomen that allows urine (wee) or faeces (poo) to be collected in a bag. The Australian Government’s Stoma Appliance Scheme (SAS) provides free stoma supplies to people with a temporary or permanent stoma. To apply for the scheme, you must hold a Medicare card and belong to a stoma association.
Your stomal therapy nurse can help you join an approved stoma association. For a small annual membership fee, you will be able to obtain free stoma appliances and products. For more information, visit the Department of Health or the Australian Council of Stoma Associations.
Podcast: Coping with a Cancer Diagnosis
Rania Tannous, Head of Legal, Corporate, Legal and Governance, AMP; Patricia Troll, Senior Legal Counsel, AMP Financial Services Legal, Legal and Governance, AMP; Lynette Brailey, Program Coordinator, Financial Assistance Service, Cancer Council NSW; Stephen Bray, Financial Planner, FM Financial, TAS; Angela Daly, Senior Social Worker, Cancer Services, The Adem Crosby Centre, Sunshine Coast Hospital and Health Service, QLD; Sandra Hodge, Consumer; Sandi Johnson, Consumer; Antony Mitchell, Financial Counsellor, Financial Counselling Program, Cancer Council VIC; Lucy Pollerd, Social Worker, Peter MacCallum Cancer Centre, VIC; Heather Richards, Consumer; Deb Roffe, 13 11 20 Consultant, Cancer Council SA.
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