Private health insurance for breast cancer
Expert tips on choosing the right health insurance
Our health insurance expert, Steven Spicer, has some tips on choosing a health fund and policy that suits your needs.
Steven Spicer
Executive General Manager – Health, Life & Energy
Weigh up the levels of cover
The right level of cover is going to vary from person to person. Consider your healthcare needs, how many people need to be included and what services you’re likely to use when deciding on a policy. Choosing the right level of cover will help you get the cover you need without paying extra for services you won’t use.
Cheaper isn’t always better
While it may be tempting to go with the cheapest policy you can find, you don’t want this to come at the cost of inclusions you need. Instead, think about getting the most value from your money; for example, you could raise your excess instead of cutting inclusions to save on your premiums and help lower costs.
Adapt your policy
Your healthcare needs are going to change over the course of your life. There may be stages where you’ll need a higher level of cover and other times where you can save money by lowering your cover. Regularly comparing your policy gives you the chance to see what’s out there and whether your current cover is still ticking all the boxes. Just keep in mind that you will need to serve any relevant waiting periods when upgrading your cover.
What is breast cancer?
Breast cancer occurs when cells in the breast grow abnormally and result in a tumour.1 While breast cancer can happen to males and females, it’s far more common in females. In fact, after skin cancer, breast cancer is the second most common cancer diagnosed in Australian women. It’s more common in women over 50 but does happen to younger people.
Left untreated, breast cancer can spread to other parts of the body, including the bones, lungs and liver.1 There is usually a three-step process to find the cause of a breast lump:
- Talk to your GP and have a clinical breast examination.
- Imaging tests, including a mammogram and ultrasound.
- A biopsy of the lump is done to see if there are cancer cells.
If cancer is detected, your medical professional will discuss treatment options depending on the specifics of your diagnosis (e.g. what stage the cancer has reached). Not all breast lumps are cancerous, but they should be checked to make sure.
Symptoms of breast cancer
Some of the most common symptoms of breast cancer include:1
- Lumps or thickened areas in the breast (especially if only on one side)
- Change in breast shape or size
- Change in shape or appearance of the nipple (e.g. dimpling, indents, rash, redness or anything unusual)
- Discomfort or swelling in one armpit
- Unusual pain or discomfort in breast(s) not related to your menstrual cycle or after your period.
Any lumps or unusual changes in your breasts should be checked by a doctor.1 Symptoms for men are similar to the above.
While you can reduce your risks of breast cancer by living a healthy lifestyle, unfortunately, there’s no guaranteed way to avoid it.1 Factors such as genetics can play a role in your likelihood of getting breast cancer.
Breast cancer treatment
There are a few treatment options for breast cancer. The right procedure will depend on what stage the cancer is at, how far it has spread and what your healthcare professional thinks will best work.1 The most common treatment options for breast cancer include:
- Surgery: Surgical treatment may be required to remove the tumour and affected areas. The two main surgery types for breast cancer are:1
- Lumpectomy (breast-conserving surgery) removes just the lump and some of the breast tissue around it. The aim is to keep as much of the breast as possible.
- Mastectomy is a procedure that removes the entire breast. Often, lymph nodes in the armpits will also be removed during this surgery.
- Chemotherapy: Treatment that involves medicines designed to destroy or slow the growth of cancer cells.
- Radiotherapy (radiation therapy): This uses radiation to kill or damage cancer cells to prevent spreading.
- Hormone therapy: This requires taking medicine to reduce and block your oestrogen and progesterone levels. The purpose is to slow down or stop hormone receptor-positive cells from returning.
Various health professionals can play a role in your breast cancer diagnosis, treatment and recovery, including a GP, radiologist, an oncologist, surgeon, dietitian and more.1 Depending on your diagnosis, your doctor may recommend other treatments.
Breast cancer treatment costs in Australia
The total medical costs for breast cancer treatment can vary greatly depending on your diagnosis, including the severity of your condition and whether it has spread to other parts of your body.
Below is a general guide to prices for breast cancer treatments, sourced from the Australian Government Medical Cost Finder page for private health system treatment.
| Procedure | MBS item number | Typical specialist fees | Portion of specialist fee covered by Medicare | Median portion of specialist fee covered by insurer | Median out-of-pocket costs (paid by patient) | Typical hospital fees |
|---|---|---|---|---|---|---|
| Breast biopsy | 31506 | $2,400 | $1,000 | $780 | $550 | $2,000 |
| Lumpectomy (cancerous) | 31512 | $3,900 | $1,700 | $1,300 | $540 | $3,200 |
| Lumpectomy (non-cancerous) | 31500, 31503 | $1,400 | $500 | $450 | $360 | $1,500 |
| Total mastectomy | 31519 | $4,000 | $1,800 | $1,400 | $510 | $6,800 |
| Subcutaneous mastectomy with breast reconstruction with prosthesis | 31524 | $6,600 | $2,300 | $1,600 | $2,100 | $8,200 |
| Source: Australian Government Department of Health and Aged Care’s Medical Cost Finder2,3,4,5,6 | ||||||
The prices above should be considered a general guide. Your cancer care may cost more or less than the amounts listed here. These prices don’t account for follow-up appointments, consultations or other medical services you may undertake as part of your recovery process.
Does private health insurance provide cover for breast cancer treatment?
Private hospital insurance can provide cover for various breast cancer treatments. When purchasing health insurance for breast cancer, keep in mind you may need cover for several different treatments. Your policy must include the clinical category ‘Breast surgery (medically necessary)’, which is a minimum requirement for Bronze, Silver and Gold tier hospital cover.
Depending on the treatment required, you may also need cover for ‘Chemotherapy, radiotherapy & immunotherapy for cancer’ which is a minimum requirement for Bronze, Silver and Gold tier hospital cover. Additionally, some breast cancer procedures will require cover for ‘Plastic and reconstructive surgery (medically necessary)’ which is a minimum requirement for Silver and Gold tier hospital cover.
There are several benefits to being treated in a private hospital as a private patient, including:
- Choice of oncology specialist, doctors, healthcare provider and clinic
- Avoid public health system waiting times
- Private room (subject to availability)
- More flexibility in procedure times.
Does Medicare cover breast cancer treatment?
Medicare can cover many of the treatments that are required for breast cancer treatment. It will cover the cost of approved procedures performed in public hospitals and 75% of the MBS fee for private treatment.
There are some disadvantages to being treated in a public hospital as a public patient. Due to high demand, the public healthcare system often has long waiting times for elective surgeries. For breast lump excision or biopsy, the Australian median is 17 days waiting for treatment.7
Are there waiting periods for insurance cover?
If you’re upgrading your health insurance policy or taking out health insurance for the first time, you’ll have to serve a waiting period before you can make a claim. Standard hospital waiting periods are two months for most services.
If you have a pre-existing condition, the waiting period will typically be 12 months. If you’ve changed policies, any waiting period you’ve served before won’t need to be served again.
Meet our health insurance expert, Steven Spicer
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.
Want to learn more about health insurance?
1 Health Direct – Breast Cancer
2 Medical Costs Finder – Breast Biopsy – Accessed February 2025.
3 Medical Costs Finder – Excision of breast tumour/lumpectomy (cancerous). Accessed February 2025.
4 Medical Costs Finder – Excision of breast tumour/lumpectomy (non-cancerous). Accessed February 2025.
5 Medical Costs Finder – Total mastectomy. February 2025
6 Medical Costs Finder – Subcutaneous mastectomy with breast reconstruction with prosthesis. Accessed February 2025.
7 Australian Institute of Health and Welfare – Elective surgery waiting times 2023-24 data tables. Accessed February 2025.