Medical and pharmaceutical expenses

The Australian Government offers several benefits that can help you pay less for medical treatments, tests, prescription medicines and other medical supplies. Here is an overview of available resources to support individuals and families with healthcare costs.

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 often involves many medical appointments for tests and treatment. Medicare will usually cover part of these expenses, but you may need to pay the difference yourself.

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. A couple or family will 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 – one that lasts for at least 6 months – you may be able to get Medicare benefits for allied health practitioners (e.g. physiotherapists, dietitians and psychologists) to help manage your condition.

If your GP refers you to any allied health professionals, you may receive a Medicare rebate for up to a total of 5 visits per calendar year.

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 2 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 still 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.

For more information, call 1800 020 613 for the PBS Information Line or visit Services Australia and search for “PBS Safety Net”.

Use your concession card

Centrelink provides 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.

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).

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 your pharmacist when you get your prescription filled. Some doctors bulk-bill concession card holders, although this is up to the doctor. Talk to your GP about whether they bulk-bill.

Use the Pharmaceutical Allowance

The Pharmaceutical Allowance is a small amount that helps eligible people cover the cost of medicines. It is automatically included if you receive certain Centrelink payments. For people receiving the Disability Support Pension, Age Pension or Carer Payment, the allowance is included as part of their payment each fortnight.

Receive help with the cost of continence aids

The Australian Government’s Continence Aids Payment Scheme (CAPS) helps cover 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.

Be reimbursed for external breast prostheses

Medicare’s External Breast Prostheses Reimbursement Program helps with the cost of new or replacement breast prostheses. If you have a Medicare card and have had a full or partial mastectomy because of breast cancer, you can claim up to a set amount for a new prosthesis every 2 years. If you’ve had a bilateral mastectomy, you can be reimbursed for 2 breast prostheses.

You will need to pay the upfront cost of the prosthesis in full and get reimbursed 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.

Learn more about breast prostheses and reconstruction.

Receive free stoma supplies

After surgery for bladder, bowel or anal cancer, you may need a temporary or permanent stoma. This is 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 for people with a temporary or permanent stoma. To apply for the scheme, you must hold a Medicare card and be a member of a stoma association. These associations usually charge a small annual membership fee that gives access to free stoma appliances and products.

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