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A Comprehensive Guide to Pregnancy Health Insurance 2022

Megan Fraser Updated: 26 April 2022
Types of Health Insurance

pregnancy health insurance

Pregnancy and childbirth are moments filled with wonderful memories. However, these can quickly be dampened when costs for care mount or you’re suddenly faced with unexpected out-of-pocket bills because you or your baby needed additional services or treatments. You may want to consider pregnancy health insurance well in advance of this joyous time to ensure that you’re supported along the way.

Private health insurance offers a means to mitigate financial worry during your pregnancy. It affords parents-to-be peace of mind and the option to choose things like the obstetrician of your choice, shorter waiting times for appointments and even a private room in the hospital.

Key Facts

  • Costs generally depend on the type of maternity care and birth experience you choose.
  • Medicare covers pregnancy and birth-related costs for public services, while private health insurance allows for more choice in your doctor, hospital, etc.
  • Pregnancy is typically considered a pre-existing condition. Therefore, a waiting period applies before private cover starts.
  • It’s best to plan ahead. Choose the cover and policy that meets your needs by comparing policies from leading insurers.

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The cost of having a baby in Australia

If you have a Medicare card and give birth in a public hospital, you’ll have little to no out-of-pocket costs. On the other hand, if you prefer a private hospital’s comfort and consistency, you could pay between $9,000 to $30,000. However, if you have private health insurance with pregnancy cover, your out-of-pocket cost will usually decrease to between $2,500 to $5,000.

Things you’ll typically need to pay for when having a baby include:

Private Health Insurance for Pregnancy

Public vs private care for pregnancy and birth

Benefits Private hospital Public hospital
Out-of-pocket costs without insuranceBetween $9,000 and $30,000$0 to $1,500 with Medicare
Length of hospital stayUsually, up to 5 daysUsually, discharged within 1 to 3 days
Waiting times for check-ups and examinationsGenerally, very short waiting times for appointments Longer waiting times as it’s dependent on the availability of the doctor or midwives
Choice of obstetrician and/or midwife
However, your obstetrician might be on leave when you go into labour

You might also be cared for by junior doctors, who only calls a specialist when needed
Choice of hospital
You’ll have to go to the hospital in the area you reside
Same obstetrician for all your appointments
You typically won’t see the same provider for all of your appointments.
Adhering to your birthing plan
Higher rate of intervention, with private hospitals performing more caesareans

Lower chance of interventions, with a higher number of natural births
Equipped for intensive or specialised care
Not all private hospitals in Australia have emergency departments. If you need a c-section or intensive care, you and your baby may have to transfer to a public hospital
Private room
Typically, you’ll have access to a private room if one is available.

You will typically share a room
A partner can stay over
Generally, your partner will be allowed to spend the night with you.

Very unlikely. Family can usually only stay during visiting hours
Meals in the hospital
Generally, delicious meals available to you and your partner

Depends on the hospital, but might not be as nice as a private hospital
Free lactation consultant
Depends on the hospital
Free nappies/formula and maternity pads
Depends on the hospital
TV to watch
However, you’ll typically need to pay to watch.

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Does Medicare cover pregnancy expenses?

Yes, typically a Medicare card ensures that your pregnancy and birth-related costs are covered. Medicare generally covers antenatal visits, pregnancy counselling, blood tests, routine ultrasound scans and some immunisations. However, the costs that are covered depend on your choice of care and where you give birth. Optional extras such as an ultrasound at a private clinic or a television in your hospital room will incur costs that you will need to pay.

Choosing pregnancy health insurance

When trying to find the right pregnancy health insurance, you’ll generally need to ask yourself a few important questions. These include: who would you like to care for you, where you’d like to give birth, what can you afford and which optional extras you’d like?

You typically have the option to choose between antenatal care and free delivery using Medicare, or you could opt for private health insurance for care and delivery. Although private pregnancy cover does cost a bit more, it generally offers you a wider variety of choices regarding your birthing experience, additional comfort and help towards extra treatments to make the transition into parenthood a little easier.

What is private health insurance cover?

Many of the more basic health insurance policies don’t cover obstetrics, or offer restricted benefits that will only cover you as a private patient in a public hospital. It’s best to confirm what your specific policy covers.

Typically, private health insurance covers:

  • your choice of obstetrician or midwife
  • accommodation as a private patient in a private or public hospital
  • labour ward fees
  • birth-related intensive care
  • medication administered in hospital
  • accommodation for your partner or a family member

Private health insurance pregnancy no waiting period

All private health insurers and health funds have a 12 month waiting period for obstetric services, including pregnancy and birth-related services. It’s also important to check that your baby is covered by the policy you hold as single hospital policies, for example, cover you alone.

Is pregnancy a pre-existing condition for health insurance?

Yes, pregnancy is generally viewed as a pre-existing condition by health funds, and thus, a 12-month waiting period applies. Meaning you’ll generally need to wait 12 months before claiming any pregnancy or birth-related services. Pregnancy is generally still considered “pre-existing” even if you weren’t aware you were pregnant or received confirmation from a doctor within the six months before taking out cover.

How to cut the costs of giving birth?

Going for a public hospital birth ensures little to no cost for pregnancy and birth care unless special services are needed. Private health insurance pregnancy cover typically offers cover for obstetric services with more choice, comfort and added services. You may further be able to save by finding pregnancy cover that better suits your pocket.

You could also try the following to find the best private health insurance for pregnancy:

Frequently asked questions and answers

  • Which health insurance plans cover pregnancy?

    Only Gold level hospital policies must include pregnancy as part of its minimum clinical category. However, a health fund can choose to include these birth-related services, as an optional extra, in their Bronze and Silver hospital tiers, which will generally be indicated by a plus (+) symbol.
  • Can I get cover while already pregnant?

    Unfortunately not. While you can purchase a private health insurance policy during your pregnancy, coverage for pregnancy and birth-related services comes with a 12 month waiting period.
  • Can I change my health insurance late in my pregnancy?

    You may make a change to your health insurance at any time. However, be wary of the waiting periods that apply. If you switch to an equivalent level of cover, typically no waiting periods will apply. It’s best to upgrade your policy well before you’re pregnant.
  • Do you need private health insurance for pregnancy?

    While private health insurance is not necessary, it offers you more choice, consistency, and additional comforts during your pregnancy and birthing experience.
  • How much does having a baby cost without insurance?

    With Medicare, you can give birth in a public hospital with little to no out-of-pocket expenses. Without insurance, a private hospital birth could cost you between $9,000 to $30,000.
  • Are water births covered by insurance?

    Some hospitals and birth centres in Australia have water birthing facilities. Your health plan is more likely to cover a water birth if you’re admitted to one of these facilities.
  • How much is an ultrasound with insurance?

    Ultrasounds are typically not covered by private health insurance. However, Medicare offers a rebate for this treatment.
  • How to get insurance for a newborn?

    Health funds have different rules about covering newborn babies. Typically, insurers require you to upgrade your policy to a ‘family’ level one to three months before your baby is born. Some policies require you to upgrade as early as 12 months before birth.

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