Is it worth having private health insurance for pregnancy?
If you are planning on having a baby there is a very important health insurance question you need to answer before getting pregnant.
These products are hand-picked by our team to help make shopping easier. We may receive payments from third parties for sharing this content and when you purchase through links in this article. Product prices and offer details are not assured, and should be confirmed independently with the retailer. Learn more
There’s a lot to consider when planning a baby. Like, “Am I ready for this life change?” and “Can we even afford to have a child?” and “Should we go through the public healthcare system or take advantage of private health insurance?”
Here we look into your options for pregnancy and birth care in Australia by answering eight important questions.
1. Is public or private healthcare best for me?
Australia has a world-class public healthcare system but it does come with some limitations. While you can expect excellent service and care using Medicare during your pregnancy and birthing experience, your choice of health practitioners, appointment times and accommodation may be limited (depending on resources in your local area).
On the other hand, private health insurance cover provides members with more options and access to additional resources that aren’t accessible through Medicare, such as consistency of care under your chosen health practitioner and a private room and facilities in a public or private hospital during birth.
LOOK FOR A BETTER SUITED HEALTH POLICY
2. What’s covered by pregnancy health insurance?
Depending on the insurer and the policy you choose, private health insurance pregnancy cover may provide hospital accommodation (sometimes of your choice), theatre and labour ward fees, hospital-administered pharmaceuticals, access to the special care nursery (if you’re on a family or single parent policy), Medicare Benefit Schedule fees and intensive care services (during and after birth).
RELATED: Why do health insurers have waiting periods?
RELATED: Mum’s pregnancy surprise reveals insurance mistake
3. What isn’t covered by private pregnancy health insurance?
What you’re not covered for depends entirely on your private health insurance policy. In general, the level of health cover will sometimes (but not always) depend on the cost of the policy – so if you go for a budget option, you can expect fewer benefits.
You may have to pay excess costs – or a ‘gap’ – on some services, where healthcare providers charge more than the insurer pays out. These may include specialist consultations and check-ups with an obstetrician, paediatric appointments and some hospital fees (although a portion of these costs could potentially be claimed on Medicare).
4. What are common out of pocket expenses during pregnancy and birth?
While parents using Medicare will have very few, if any, out-of-pocket expenses, parents with private health insurance can certainly expect to pay more. These expenses will vary, depending on your requirements, health insurance policy and insurer, but in general, you can expect to pay the agreed excess for hospital admission as well as costs for care and procedures not covered by your policy.
For example, out-of-hospital care is not always covered in your policy or may be part of ‘extras cover’. Other expenses might include specialist and outpatient consultations, the ‘gap’ on medical services incurred at the hospital, appointments made when not an inpatient, some IVF treatments and hospital prerelease check-ups.
FIND MORE VALUABLE HEALTH COVER
5. What’s the best private health insurance for pregnancy?
There’s an enormous array of health insurance policies on offer covering pregnancy and birth to choose from, all varying in price and cover. And because everyone has different needs, the best policy for one person may not meet the requirements of another.
To help you decide which health insurance policy is best for you, consider your budget and how much you can afford to pay towards your policy each month. Also be realistic about the excess payment you’ll need to pay on hospital admission – while excesses can vary, the less you opt for on sign up, the more you’ll potentially pay in premiums.
6. Is there anything that may affect my eligibility for pregnancy cover?
Insurers consider pregnancy a ‘pre-existing health condition’, so to be eligible for private health cover, you’ll need to have had pregnancy cover in place for a minimum of 12 months to access these benefits. This means that if you want your pregnancies and birth to be covered by private health insurance, you’ll need to think ahead and get your health insurance sorted well in advance of falling pregnant to ensure eligibility.
7. Can I add pregnancy cover to an existing private health insurance policy?
You’ll need to upgrade to a new policy if you don’t already have cover for pregnancy and childbirth. Then you must comply with the 12-month wait time to be covered for pre-existing conditions – such as pregnancy.
While you’re planning ahead, it’s also an ideal time to review your health insurance. Is your existing health insurance policy (singles, couples cover, for example) still relevant to your needs? If not, consider upgrading to family cover along with pregnancy and birth cover, which provides the right level of care throughout pregnancy and childbirth and also ensures your cute new family member will be covered on their arrival.
CLICK TO SWITCH YOUR HEALTH COVER
8. Can I use a combination of private healthcare and public healthcare during my pregnancy and birthing experience?
A proportion of the costs of some pregnancy-related outpatient services can be claimed on Medicare, such as specialist consultations and check-ups with obstetricians and paediatric appointments. (Please check with your service provider.)
But you’ll be required to advise your hospital when you book yourself in for the birth on whether you intend to be a public or private patient. This will determine whether you obtain access to your choice of heath practitioner or if one will be assigned to you; if you share a room with other patients or are put up in a private one; and if you’ll be charged certain out-of-pocket expenses that are waved for public patients.
RELATED: Everything you need to know about extras insurance
Simple way to avoid hospital wait times
If you’re looking to undergo surgery, you may expect to wait over a year for the procedure. But there’s a simple way you can avoid the delay.
Trick to get tax return back faster this year
Tax time is just around the corner, so finding a tax expert now could be the key to getting your tax back quickly and accurately this year.
Must-do task before energy prices rise
Living costs are rising, and energy prices are set to jump too in July. But there are ways you can try to combat it.
New deal to cut costs on internet bills
You might be able to cut costs thanks to a new limited-time offer. Turns out, saving money on internet is easier than you think, and worth the hassle of switching.