Do I Need Private Health Insurance For Pregnancy?

 Find out if you need private health insurance during your pregnancy here with Savvy. 

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, updated on July 10th, 2023       

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Congratulations, you're planning to grow your family! As a potential new parent in Australia, you have a range of choices to make as you embark on this exciting journey. One of the decisions you may need to consider is whether or not to get private health insurance for your pregnancy.  

Private health insurance can provide coverage and benefits beyond what’s offered by the public health system, Medicare. It can offer you greater flexibility and options for your maternity care, but it also comes with additional costs. Explore the choices and options available to you as a pregnant mother here with Savvy to help you make an informed decision about whether you need private health insurance for your pregnancy. 

Do I need private health insurance for my pregnancy?

In Australia, having private health insurance during pregnancy is not medically necessary or compulsory, as all pregnancy-related medical services are covered by Medicare. Therefore, having private health insurance at this important time is purely a matter of personal preference. 

Medicare covers the basic costs of pregnancy and childbirth in public hospitals. Pregnancy and maternity services are government-funded and are available to all Australian citizens and permanent residents.  

Many public hospitals have specialist birthing wards and offer excellent pregnancy, pre-natal and post-natal care. These services are aimed at ensuring that all pregnant women receive appropriate medical care during pregnancy and childbirth, regardless of their financial situation.  

However, private health insurance hospital cover and extras cover can provide additional coverage and luxury treatment as a private patient during pregnancy and childbirth. It's important to note that there’s usually a 12-month waiting period before you can make a claim for pregnancy and childbirth services on most hospital cover policies.  

Many women choose to get private health insurance to cover their pregnancy because it gives them more choice about where, when and how they receive healthcare during their pregnancy. It may also cover additional services and maternity extras which aren’t covered by Medicare, such as antenatal classes, more frequent ultrasounds and postnatal physiotherapy. 

What is covered by Medicare during pregnancy?

Medicare offers a wide range of services and benefits to pregnant women to support their maternal health and well-being, including:  

  • pregnancy-related consultations with medical practitioners such as obstetricians, midwives and general practitioners to monitor the health of mother and baby throughout pregnancy 
  • three pregnancy counselling sessions to assist with emotional changes during pregnancy 
  • free vaccinations before and during pregnancy  
  • three ultrasound scans to assess the growth and development of the baby, as well as to detect any potential health issues 
  • blood tests to monitor the mother's health and screen for conditions such as gestational diabetes and other pregnancy-related complications 
  • hospital services for childbirth, including coverage for public hospital and birthing centre births and deliveries  
  • limited postnatal care, including follow-up consultations with medical practitioners to monitor the health of the mother and baby after childbirth, breastfeeding support, and advice on postpartum recovery 
  • subsidised medications and pharmaceuticals

What is covered by private health insurance during pregnancy?

Private health insurance may offer more options and flexibility in terms of hospital choice, choice of obstetrician or midwife and the availability of private rooms during the hospital stay. In the event a caesarean section is required, you may have more choice about exactly when and where it’s performed and how and where the baby is cared for after birth with private hospital cover.  

Private health insurance will usually provide benefits for the following pregnancy and obstetrics services: 

  • private hospital accommodation, including a private room during your hospital stay, with the potential for your spouse or partner and also your other children to stay with you after you give birth 
  • private intensive neonatal care for your newborn if there are any problems or serious health issues after the birth 
  • your choice of obstetrician or midwife, with continuity of care throughout your pregnancy, so you see the same person you’ve chosen each time you need a check-up (subject to availability) 
  • additional services and maternity extras which may not be covered by Medicare, such as antenatal classes, extra ultrasounds and blood tests and physiotherapy, chiropractic and podiatry care during and after giving birth 
  • access to specialist mother and baby assistance facilities to help with issues such as maternal bonding and breastfeeding 

How do I decide if I need private health insurance for my pregnancy?

Deciding whether or not to get private health insurance during pregnancy is a personal choice which will depend on various factors, including the following: 

  • Coverage: check if your current health insurance covers pregnancy-related services like prenatal care, childbirth, and postnatal care. If you have a basic, bronze or silver hospital cover policy, pregnancy services may not be included. If this is the case, you may have to increase your tier of private hospital insurance to access pregnancy cover. 
  • Cost: think about the out-of-pocket expenses you may encounter during pregnancy, like specialist gap fees and medications. Private health insurance could help with these costs, but you'll need to weigh up the premiums, the excess payment and any required co-payments against potential savings. 
  • Greater choice: with private health insurance, you might have more options for choosing your obstetrician, midwife and birthing facility. If you have specific preferences or want more control over your birth plan, private health insurance may give you more flexibility in choosing your care providers and birth setting. 
  • Waiting periods: keep in mind that private health insurance policies usually have waiting periods for pregnancy-related services. If you're planning to get pregnant, it's important to understand the waiting periods and plan accordingly. 
  • Pre-existing health conditions: if you have pre-existing health conditions which may require specialised care during pregnancy, private health insurance may offer extra coverage for these services 
  • Personal preference: think about your personal preferences and comfort level with the public healthcare system versus private healthcare. Some expectant mothers might prefer the extra options and personalised care which private health insurance can provide, while others might feel more comfortable with the services covered by Medicare. 

Frequently asked questions about if it’s worth having private health insurance

Which tiers of hospital cover have to provide coverage for pregnancy and birth under Australian healthcare regulations?

Under Australian healthcare regulations, only the gold tier of hospital cover is required to provide coverage for pregnancy and birth-related services. However, many health funds do provide coverage for pregnancy and birth under silver policies which offer more than the required minimum cover. These policies are often known as ‘silver plus’ policies. 

Does private health insurance cover fertility treatments or assisted reproductive technologies (ART) for pregnancy?

This will depend on the health cover you decide to buy. Only gold and silver plus hospital cover policies may provide coverage for fertility treatments, such as in-vitro fertilisation (IVF) or other ART procedures. Lower-level policies and cheaper extras cover will have IVF and ART as exceptions which aren’t covered. 

Can I add my newborn baby to my private health insurance policy?

This will also depend on the type of policy you buy. However, most private hospital insurance policies will allow you to add your newborn to your couples, single parent or family policy within a certain timeframe after birth. This can provide immediate coverage for your newborn's health needs, including hospitalisation, vaccinations and other medical expenses following birth.  

Do I need a referral from my doctor to see an obstetrician and get access to healthcare during pregnancy?

In most cases, you’ll need a referral from your GP to see an obstetrician or midwife and get the appropriate healthcare you’ll need during pregnancy. Therefore, your GP should be your first call if you believe you’re pregnant or are planning on growing your family. 

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