Chemotherapy, Radiotherapy and Immunotherapy for cancer

Reviewed and updated 31 March 2024

basic

bronze

silver

gold

RRestricted

OOptional

Covered

What is covered under Chemotherapy, Radiotherapy and Immunotherapy for cancer?

Hospital Cover for Chemotherapy, Radiotherapy and Immunotherapy for cancer includes hospital treatment of cancer or benign tumours.

Treatments include:

an immunomodulating agent that suppresses the immune system
radiotherapy (including treatment with x-rays, radium rays or other radioactive substances)
general anaesthetic for radiotherapy
radiation treatment for tumours using cobalt unit or caesium teletherapy unit.

This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS).

Some treatments you might expect to be in the Chemotherapy, Radiotherapy and Immunotherapy for cancer clinical category are under other clinical categories. Treatments relating to surgery for cancer are included under each body system. For example:

oesophageal cancer is under Digestive System
throat cancer is under Ear, Nose and Throat.

Which Hospital Cover tiers include Chemotherapy, Radiotherapy and Immunotherapy for cancer?

Tier	Clinical category covered?	Can insurers offer restricted cover?
Basic	Optional	Yes
Bronze	Yes	No
Silver	Yes	No
Gold	Yes	No

What does it mean if cover is ‘optional’?

‘Optional’ means that the Australian Government allows insurers to choose whether or not to cover the clinical category under that Hospital Cover tier.

What does ‘restricted cover’ mean?

Restricted cover means the insurer pays only limited benefits.

If insurers offer cover for Chemotherapy, Radiotherapy and Immunotherapy for cancer under a Basic policy, they can do so on a ‘restricted’ basis. If you are admitted as a private patient in a private hospital for treatments under this clinical category, you will face considerable out-of-pocket costs.

Always check with your insurer before agreeing to be treated as a private patient in a private hospital if you have restricted cover for Chemotherapy, Radiotherapy and Immunotherapy for cancer.

Does Medicare cover Chemotherapy, Radiotherapy and Immunotherapy for cancer?

Yes. Medicare includes all treatments under the Chemotherapy, Radiotherapy and Immunotherapy for cancer clinical category.

If there is an MBS item number for the treatment, Medicare covers it.

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