It is costly to manage an allergic condition. We have put together a list of things for you to consider and some tips for saving money.
GP appointments
When you see a GP they will get money from Medicare. This is called a benefit or rebate. If the GP bulk bills, it means the GP will receive the rebate from Medicare and you will not pay anything. If the GP does not bulk bill, you will have to pay an ‘out-of-pocket’ cost. Ask about bulk billing before you visit to understand if there will be an ‘out-of-pocket’ cost and how much that cost will be. Private health insurance cannot be used for GP appointments
GPs can give you repeat prescriptions for adrenaline devices and update ASCIA Action plans each year. This will usually be cheaper than with a specialist. If you have to visit the GP for any reason, check when your adrenaline device expires and ask for a new prescription if needed.
Bulk billing
- To be bulk billed you need to be enrolled in Medicare.
- Many GPs bulk bill children up to 16 years old.
- People with concession or health care cards may be able to get bulk billed services.
Appointments with an allergy specialist, paediatrician or other specialist
In the public system, Medicare covers the cost of your appointment, and you will not have to pay anything.
In the private system, costs will depend on what type of specialist you see and the Medicare rebate that you receive. Specialists may charge more than the Medicare rebate. The difference between the specialist fee and the Medicare rebate is the out-of-pocket cost. The out-of-pocket cost to see an allergy specialist is around $250 to $500. Sometimes at an appointment you will also need to have testing and this will be included in the total cost of your appointment. Ask about the costs for the appointment and any tests when you call to make the appointment.
Private health insurance cannot be used for specialist appointments.
Costs in private hospitals
You may choose to go to a private hospital if you need to be admitted or to have a procedure related to managing your allergies. For medical services that are on the Medicare Benefits Schedule (MBS), Medicare covers 75% of the MBS fee. Many doctors and specialists charge more than the schedule fee. You will have to pay any costs not covered (this is the ‘out-of-pocket’ cost).
If you have health insurance, they will pay the remaining 25% of the schedule fee and may cover some or all of any additional costs set by private doctors, specialists and hospitals.
Before booking for a procedure in a private hospital, ask for a written estimate of fees and how much of that fee will be paid by Medicare, by private health insurance or by you. Often people have to pay an excess to their private hospital fund when they are admitted to hospital. When people take out their private hospital insurance, they sometimes decide to pay a lower premium by agreeing to pay an amount of money if they are admitted to hospital. This is called an excess. The amount can vary from a few hundred dollars to thousands of dollars.
Some doctors and private health insurance companies have special agreements about what amount patients will be charged. This can mean that patients will pay less of their own money towards the service, and the cost is known to everybody before the service is provided.
Tests
In the public system there is usually no extra cost for tests, or the cost is low.
In the private system, there will be a cost for tests. There is a Medicare rebate for many allergy tests but there will usually be out-of-pocket costs as well. Always ask the healthcare provider what you will have to pay for tests (the ‘out-of-pocket’ cost).
For skin prick tests, the Medicare rebate includes many allergens in one skin prick test.
For a serum specific IgE blood test, the Medicare rebate is for a maximum of 4 allergens in one blood test. Sometimes people think that a panel test is better value for money as a panel is counted as one allergen but panel testing for foods is not recommended. See allergy testing for more information.
Some allergy tests, such as food challenges, are not covered by a Medicare rebate and can be quite costly. The approximate out-of-pocket cost of a food challenge in the private system is around $300 to $400. Sometimes at a food challenge appointment you will also need to see the doctor and have a skin prick test. You may have to pay extra for these services, but you may get a Medicare rebate.
Treatments
Allergy treatments such as immunotherapy may be offered in public and private health services. Always ask your doctor how much treatments will cost and what options are available.
Remember, treatments like immunotherapy can take several years to complete and along with the cost of the medication/treatment there may be costs to see a health professional regularly.
Government subsidies are available for venom immunotherapy to bees and wasps on the Pharmaceutical Benefits Scheme (PBS). Immunotherapy for jack jumper ant allergy is not widely available but may be subsidised by the government in some states.
A private health fund rebate may be obtained for some registered tablet and injected allergen immunotherapy products. This will depend on the level of private health insurance cover. You may need a special receipt or have a letter from your doctor to be able to make a claim.
It is important to ask what the costs may be before making decisions. Ask about costs of appointments, test, treatments, how long you will need the treatments for, and how often you need appointments.
Medications
There are many medications associated with managing allergic conditions, such as antihistamines, moisturising creams, steroid creams, nasal sprays and adrenaline devices.
Prices for the same medicine can vary between different pharmacies, so it is a good idea to look for the best price.
Adrenaline devices:
If you have a Pharmaceutical Benefits Scheme (PBS) authority prescription for an adrenaline device, the cost of two devices is subsidised (partly paid) by the government. The cost you will pay is about $38 for two devices. If you have a health care card, the cost is about $7.70.
See our frequently asked questions about buying adrenaline injectors.
You can buy adrenaline devices over the counter at a pharmacy without a prescription. An adrenaline device will cost $80–$120 depending on the pharmacy. The cost will not be subsidised by the government or health insurance. It is a good idea to ask a few different pharmacies to find the best price.
Some private health insurance funds will cover part of the cost of adrenaline devices bought on a general prescription (not a PBS authority prescription). Check with your private health insurance whether you can claim money back and what you will need to do this. You may need to ask for a signed receipt from your pharmacist or have a letter from your doctor to be able to make a claim.
Ambulance
Medicare does not cover the cost of emergency transport in an ambulance. You can organise to have ambulance cover on your private health insurance in some states and territories.
If you have a healthcare card, concession card, or seniors card then you may be eligible for free ambulance cover in some states or territories. Find out more about ambulance cover in your state here.
If you have a school aged child with allergies, ask the school who is responsible for paying should an ambulance be needed during school hours. In some states, the school is responsible for paying for the ambulance.
Allied health care
There will be some costs for appointments with allied health professionals in the private systems, such as dietitians or psychologists. Some services may be partly covered by Medicare, and you will need to pay the ‘out-of-pocket’ cost.
You may be able to see a dietitian in the public hospital or community health service at no cost. Talk with your specialist or GP and ask if this is possible in your local area.
You can also talk to your GP to see if you are eligible for a Chronic Disease Management (CDM) Plan. With a CDM plan you can get up to five visits with allied health professionals per year with a Medicare rebate. This will make the appointments free or for a reduced fee.
If you have private health insurance and you have cover for extras, such as dietitians or psychologists, you may be able to claim part of the cost of some of these services. You will still need to pay the ‘out-of-pocket’ cost.
Finding out about medical costs
It may be helpful to visit the Australian Government online tool Medical Cost Finder. This online tool gives you some guidance on healthcare costs, including what Medicare covers and what you might pay ‘out-of-pocket’ for medical services in your area. The Medical Costs Finder covers services provided when you are an inpatient in a hospital, or visiting as an outpatient for medical care or services.
A doctor or specialist may refer you to other health services within the same doctors’ surgery or hospital. Although this may be helpful because you do not need to travel anywhere, it might cost you more than other options such as seeing a health professional in a public clinic. Check the wait times and costs and ask questions.
Other costs
| Cost | |
| Travel costs | Depending on where you live, you may be able to get some money to help with travel costs through a Patient Assisted Travel Scheme (PATS). More information can be found here. Some private health funds will contribute to travel costs. You will need to check with your private health fund and find out what your policy covers. |
| Foods | There may be additional costs associated with foods that don’t contain your allergens. Some allergen-free foods may be classified as speciality foods and therefore have a higher price. Some babies and young children with cow’s milk protein allergy need special infant formula. Some non dairy infant formula is available to buy over the counter but others require a prescription. An allergy dietician can help you with suggestions of food options that are cost-effective. |
| Dietary supplements | A dietician or specialist may recommend dietary supplements such as calcium tablets. Not everyone with allergies needs dietary supplements. If these are recommended, it is important to use them as directed. Your health professional or pharmacist may have advice about more cost-effective options. |
| Personal care | You may find it costs more to buy personal care products, such as moisturisers, soaps, laundry detergents, sunscreens and cosmetics that are suitable for people with food allergies and eczema. People with eczema need to use the right amount of moisturiser for their skin condition so will often be buying more product than people without eczema. Talk to your health professional about the most cost-effective moisturisers. |
| Time off work | You may find that you need to take time off work to manage you or your child’s allergy. Things to help with this may be: – Discuss with your specialist about getting any necessary appointments or tests on the same day if possible. – Ask if a telehealth appointment is an option as this reduces travel time. – Talk to your employer about flexible work options |
Understanding allergy care
Learn about allergy care, seeing an allergy specialist, the Australian health system, treatment options and more.
Developed in collaboration with the National Allergy Council through funding from the Australian Government.