Is palliative care free in Australia?
Medicare will cover palliative care expenses – whether you receive care at home, in a residential aged care facility or hospice – but there can be out of pocket expenses for some specialist care.
If you're treated in a public facility, Medicare should cover all of the costs. However, sometimes you might need to pay part of the cost of care. Don't be afraid to ask about costs in advance of using any service. It can be a really stressful time, so it's better to know about potential bills beforehand. Health insurance can sometimes cover some of the costs too.
Is palliative care covered by Medicare?
Palliative care is usually free with Medicare in the public system. Medicare covered an average of $390 per patient, according to government data.
Sadly, in some cases, palliative care might not covered by Medicare. For example, you might have to pay for:
- Medicines
- Equipment for use at home
- Nursing staff if you choose to stay at home
- Private allied health professionals, such as psychologists and physiotherapists
- Therapies such as acupuncture and chiro
Who pays for palliative care?
Medicare
Medicare pays for all palliative care services in a public hospital. You may have to pay for services that aren't fully covered by Medicare yourself. If you get treated in a private hospital or facility, Medicare will only cover the Medicare Benefits Schedule fee amount. This is often not enough to cover all of the costs.
Private health
All basic private health insurance policies are required to provide restricted cover for palliative care. This means you'll still have some out of pocket expenses.
Palliative care with private health insurance
If you receive palliative care as a private health patient, 75% of the MBS fee is covered by Medicare and your insurance covers the remaining 25%.
However, unlike in the public system, private providers are not obligated to adhere to the MBS fee. They can charge more. This is where you can encounter out of pocket expenses.
Here's what else you need to know about palliative care and private health insurance.
- You get restricted cover. All health insurers are required to provide restricted cover for palliative care. This means that even if you get a basic policy, your insurer will cover at least some of the costs. However, they are not obligated to cover 25% of the MBS fee unless you get gold level cover. In other words, you might have larger out of pocket expenses with a basic, bronze or silver-level policy.
- It can sometimes cover the gap. Doctors and health professionals don't need to adhere to the MBS fee, so they may charge more. The gap refers to the price difference between the MBS and what is actually charged by the doctor or the hospital. Many private health insurance providers can cover the gap.
- You can receive care at home. Some private health insurers can cover you to receive care and treatment at home.
- It's often more extensive than Medicare. In many cases, Medicare won't cover alternative therapies like physiotherapy and certain medications, but private health cover can.
Is it worth getting private health insurance for palliative care?
Our expert says
"It depends on your circumstances. For example, patients typically spend on average longer in private hospitals (12.9 days) compared to public hospitals (9.9 days). Budget is also a big factor. Many policies only provide restricted cover. Gold health insurance is the only level that will fully cover the MBS fee."
Where can I receive palliative care?
Depending on your insurance and your condition, you can receive palliative care in different locations.
In a hospital
Generally, palliative care you receive in a public hospital will be covered by Medicare, although complementary therapies, additional medications and extra equipment costs may have to come out of your pocket or a private health fund.
At home
If medically recommended, you may also claim some Medicare benefits for palliative care received at home. However, you may still need to contribute to costs such as specialised equipment, medications and at-home nursing or care staff.
In a residential facility
This includes aged-care facilities and hospices. The cost of palliative care at certain approved private residential facilities may be covered by private health insurance, as well as Medicare, but only to a limited extent. There will be costs for accommodation and other related services when receiving palliative care in such a facility, which may be covered by different parts of your private health insurance policy.
Palliative care: Frequently asked questions
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