Funding medical bills

Review your private health insurance

If you have private health insurance, now is the time to understand exactly what your policy covers. Call your insurer and ask for a specific review of coverage for: hospital admissions, specialist consultations, day oncology or treatment unit visits, radiation therapy, surgery, medical equipment, and ambulance transport.

Ask your insurer specifically about the "no gap" or "known gap" arrangements with your specialists and hospitals. Many insurers have agreements with participating specialists that reduce or eliminate out-of-pocket costs for their members. Ask whether your specialist and hospital are participants.

If you do not have private health insurance and are considering taking it out, be aware that hospital cover has a 12-month waiting period for pre-existing conditions. For someone already diagnosed, private health insurance will not cover costs related to the existing diagnosis during the waiting period.

Medicare and the Extended Medicare Safety Net

Medicare covers a portion of the cost of most medical services in Australia. For services rendered in the public system, Medicare typically covers the full cost. For private services, Medicare covers a percentage (usually 75-85% of the MBS schedule fee), and the gap between the schedule fee and what the specialist charges is your out-of-pocket cost.

The Extended Medicare Safety Net (EMSN) provides additional protection once your out-of-pocket costs for out-of-hospital services pass the threshold for the calendar year. After that, Medicare pays a higher benefit on further services. For most items that is 80% of the out-of-pocket cost, though many items have a cap on the extra benefit, so it is worth checking rather than assuming. The thresholds reset each January and are published on the Services Australia and MBS Online sites. You can track your balance through myGov.

Hospital financial counsellors

Most major Australian hospitals have a patient financial counsellor or social worker who can help with the financial aspects of hospital care. They can review your eligibility for concessions, help navigate hospital billing, and connect you with financial assistance programs.

If you are facing significant hospital bills or are concerned about meeting costs, ask to speak with the hospital's patient accounts or social work department. Do this proactively, not after bills have accumulated. Hospitals generally prefer to resolve financial concerns early and have more options to help before debt becomes significant.

Clinical trials

Participation in a clinical trial can provide access to treatments not yet commercially available, often at no cost to the participant. Some trials also cover or reimburse associated costs such as transport and accommodation.

Not everyone is eligible for a clinical trial, and participation involves its own considerations. Ask your treating specialist whether there are relevant trials for your diagnosis. The Australian Clinical Trials website at australianclinicaltrials.gov.au lists trials currently seeking participants by condition and location.

Disease-specific financial assistance programs

Many disease-specific organisations provide financial assistance to people with serious illnesses. This may include grants for medical expenses, funded counselling, subsidised equipment, or direct financial aid.

Search for the organisation most relevant to the diagnosis and look for financial assistance programs on their website. A hospital social worker can also connect you with relevant programs for your specific situation.

No Interest Loans Scheme (NILS)

The No Interest Loans Scheme provides interest-free loans of up to $2,000 to low-income Australians for essential goods and services, including medical expenses. Loans are repaid in small instalments with no interest and no fees.

To be eligible, you need to hold a Health Care Card or Pension Concession Card, or be on a low income. Apply through Good Shepherd at nils.com.au or call 13 64 57.

Negotiating with specialists

Many specialists will reduce their fees or agree to a payment plan for patients experiencing financial hardship. This is not widely advertised, but it is common. You can ask the specialist directly, or ask their receptionist or billing coordinator whether a reduced fee or payment plan is available given your circumstances.

If you have the option to choose between multiple specialists, ask about their fee structure when booking. A specialist who bulk bills or who has a known gap arrangement with your insurer may cost significantly less for the same level of care.

Keep records of all expenses

There is no longer a general tax offset for medical expenses in Australia, so keeping receipts is not about your tax return. It is worth doing anyway: a clear record of what has actually been spent supports applications for financial assistance, insurance claims, and later estate administration.

Many banks and health funds provide online summaries of medical spending that can help track the overall picture. If you are approaching insurance or financial assistance applications, having a clear summary of actual costs to date strengthens your case.