Claiming chemo at home on health insurance – what you need to know

Cancer survival rates are increasing in Australia, which the government’s Cancer Plan says is thanks to better screening programs, earlier detection and improved treatments. Chemotherapy is one of the key treatments for many types of cancer, where drugs that destroy cancer cells are given orally, through an IV or as a cream, according to the Cancer Council. Depending on your insurer and doctor’s advice, you may be eligible to have chemotherapy in your own home, administered through specialised nursing programs, so that you can be more comfortable and avoid travel while you’re receiving treatment. Here’s what you need to know about claiming chemo at home on health insurance. 

How do I qualify for chemo at home on health insurance? 

Not all insurers allow you to claim for chemo at home. For those that do, the rules can differ between insurers. In most cases, you’ll need to have Hospital Cover that includes the Chemotherapy, Radiotherapy and Immunotherapy for Cancer clinical category, available on all policies Bronze tier and above. According to the healthslips.com.au calculator, there is a small selection of Basic Plus policies that include chemo, but it might be only restricted cover, which means you’ll have hefty out-of-pocket costs.  

You’ll also need: 

• Your doctor’s approval to confirm that chemotherapy at home is appropriate for you. 

• To be living in an area served by a chemo at home service. Australians living in remote or regional areas may not be eligible.  

• A home environment that’s safe to dispose of medical waste (your home will need to be assessed). 

• To have served the relevant waiting period with your insurer. 

Chemo at home often doesn’t show up on your policy documents as it’s an added inclusion, so the best way to know if you’re covered is to contact your insurer and ask.  

Can I switch health insurers to get home-based chemotherapy?  

Yes. If you are covered for chemotherapy treatment but your insurer does not offer access to chemo at home, you can change to a Hospital Cover policy at the same tier of cover with another insurer. You won’t have to serve waiting periods again if you’re staying at the same tier of cover (or lower). However before you buy, healthslips.com.au recommends you contact the new insurer first to confirm your eligibility.  

What are the out-of-pocket costs for chemo at home?   

Usually there are no out-of-pocket costs for at-home treatments under Hospital Cover, as long as you have unrestricted cover for Chemotherapy, Radiotherapy and Immunotherapy for Cancer. Excesses are often waived as well. However it’s best to check with your insurer, and the at-home chemo service your insurer has partnered with, to find out if any costs are involved.   

Sometimes there are out-of-pocket costs for medications used, but the PBS Safety Net means some medications will be cheaper or free once you’ve spent a set limit per year. But if you’re prescribed medicines that aren’t listed on the Pharmaceutical Benefits Scheme (PBS), you’ll have to pay in full and they won’t count towards the PBS Safety Net. If you have Extras Cover that includes Non-PBS Pharmaceuticals, you may be able to claim back a portion of your costs from your health insurer.  

Check the PBS Safety Net limits for this year. 

What medicines can I claim on health insurance? 

healthslips.com.au does not provide general or personalised advice. Your particular circumstances are likely to impact the accuracy, completeness and relevance of the information or results. Take this into account before making a decision and talk to an expert for financial advice.     

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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