17 April 2025
The financial burden of care for men undergoing diagnosis and treatment of prostate cancer in Australia can be high, with research suggesting one in 10 Australians with cancer spend more than $10,000 on healthcare in the first year following their diagnosis.
This article looks at existing allowances under Medicare and provides options for seeking financial assistance under different publicly funded schemes.
It’s important for all patients to be aware that informed financial consent is a critical component of informed consent for medical treatment. Always ask your clinician about the costs of any tests and treatments that are recommended for you, and contact our Telenursing Team on 1800 22 00 99 for more information and advice if you need it.
Here’s some more information to help you know where you stand.
What is available through Medicare:
You can call Medicare anytime on 132 011 to find out general information regarding cover for many of the costs you may encounter.
Costs for PSA testing:
If you have no previously diagnosed prostate disease, and are not at an increased risk of prostate cancer because of your family history, you have access to a free Medicare funded PSA blood test every 23 months (MBS Item 66655).
If you have an increased risk of prostate cancer, because you have a father or brother who has been diagnosed with the disease, you are eligible for a free Medicare funded PSA test once every every 11 months (MBS Item 66654).
To access these Medicare rebates, your doctor will need to provide you with a pathology referral that applies the correct Medicare Item Number for reimbursement. You can read more about the current Item Numbers in this Medicare Fact Sheet.
If you are being monitored for previously diagnosed prostate cancer, you are eligible to access Medicare funded PSA tests as often as required, under authority from your GP or specialist (MBS Item 66656).
You can read more about it via PCFA’s Toolkit here.
Costs for MRI and PSAM PET/CT scans:
A GP referral to a urologist is required to access a Medicare supported prostate MRI if you are deemed to have elevated PSA requiring further investigations prior to any diagnosis.
PSMA PET/ CT scans in many situations are provided under the Medicare system when you meet the eligible criteria. Your specialist can best advise you about the timing of this.
More information is available here.
With the release of the 2025 Guidelines for the Early Detection of Prostate Cancer scheduled for later this year, changes to eligibility and Medicare reimbursement are expected to align with these best practice evidence-based guidelines.
Treatment costs:
All treatments for prostate cancer can be performed in public or private centers or hospitals in Australia with a current Medicare card. Costs such as travel, parking, accommodation and allied health services often incur additional costs to your primary treatment in both public and private settings.
Have a discussion with your doctor about costs expected as part of your treatment and rehabilitation prior to confirmation of any treatment type. You can also request quotes for these. Outlining your financial situation with your doctor may also enable them to provide suggestions regarding a reduction of your treatment costs.
They can also refer you to the public system for the same or a similar treatment plan at any stage along your prostate cancer journey if your financial circumstances change.
The Medicare Safety Net is accessible when there are significant out of pocket costs for treatment.
Read more about the Medicare Safety Nets thresholds here.
How to seek financial assistance to cover extra costs such as medication and ongoing rehabilitation:
Travel scheme: Each state has a patient assisted travel scheme which may aid in reducing the costs of travel and accommodation for medical appointments and treatments. Download a factsheet on what is covered and eligibility for subsidy here.
Continence Aids Payment Scheme (CAPS): CAPS is an Australian Government scheme available for men that have had prostate cancer with long term incontinence. It is available through Medicare and payments are received once or twice per year to assist with some of the costs of continence products and/or medications prescribed that are related to bladder function. Read more here.
Chronic Disease Management Plan: The Australian Government Department of Health have the Chronic Disease Management Plan accessible via your GP. The two types include a GP Management Plan or Team Care arrangements. From July 1, 2025 this will transition to one type of Chronic Disease management plan. You can discuss eligibility for access to these with your GP. Prostate cancer is termed a chronic medical condition, and you can be eligible for Medicare rebates for up to five visits per year allied health including pelvic floor physiotherapists, exercise physiologist, dietician via this plan. In addition, a Mental Health Care Plan can provide Medicare rebate with an accredited counsellor or psychologist.
How to navigate loss of income not being able to work:
Ask your medical team how much time off work or regular activities you may need, then ask your employer about any leave entitlements or flexible working arrangements to aid your return to work after prostate cancer treatment.
Check out the Medical Costs Finder here for ‘expected’ costs in Australia for specialist treatment to assist in making best financial decisions about health services required. You can search using either a procedure of Medicare Item number (MBS code).
Accessing carer support may also provide short term assistance for a partner or family member required to assist you in your recovery or whilst you have prolonged treatment with prostate cancer. Read more here.
Insurance:
Contact your health insurance company to establish costs covered and those not, with any treatment you are considering. Your doctor can provide you with item numbers, and what can be claimed.
If you have life insurance, contact your life insurer to seek information about accessing any portion of your disability or income protection insurance whilst you are having or recovering from treatments.
You can also check with your workplace and superannuation company to establish if you have access to any cover.
Other support options available:
PCFA: If you have any questions about navigating costs and payments, please feel free to call our team of Telenurses on 1800 22 00 99.
Cancer Council: Cancer Council can assist you to locate any legal and financial planning referral services in your area for more personalised support. Reach out via 13 11 20.
National Debt Helpline: Financial counsellors are free to access on National Debt Helpline via 1800 007 007 or visit ndh.org.au or
If you are linked in with a health service you may wish to ask for a referral to a social worker who may be able to assist with navigating to the appropriate services and supports.
PCFA is a signatory to the Standard for Informed Financial Consent in Cancer Treatment. To learn more, call our Telenursing Team on 1800 22 00 99.
Links to further information:
https://www.prostate.org.au/pcfa-nursing-and-support/financial-and-practical-support-2/
