For couples struggling to fall pregnant, fertility treatments like IVF can help them overcome their issues and still realise their family dreams. IVF helps women become pregnant by taking eggs from their ovaries, fertilising them with sperm in a lab, and transferring them back into the uterus, with the hopes of creating a baby. However, as with any fertility treatment, an IVF cycle can cost a significant amount of money, and it is important to thoroughly consider whether it would be the right decision.
Thankfully, there are different ways to manage the financial side of IVF and fertility treatment, including private health insurance. But is getting private health necessary, or worthwhile?
Financial options
Australians have the option of taking out private health insurance if they wish, but it is not a compulsory requirement to access much of the healthcare system. Australia’s universal healthcare scheme, Medicare, ensures that everyone can receive care and treatment they need. This doesn’t extend to every specialty type of treatment though, with some exempt from the system’s coverage.
Many people will opt for private health insurance if they require treatments that fall outside of Medicare’s coverage to help them manage the cost. The cost of IVF treatment is partially covered by both systems.
Is IVF covered by Medicare?
Medicare actually helps to cover quite a lot of the cost associated with IVF and other fertility treatments. While not covering everything, patients eligible for Medicare receive a rebate for a portion of the costs of the IVF procedure and associated consultations. Patients may also access an additional Medicare rebate for IVF if their costs go over an annual threshold, known as the Extended Medicare Safety Net. The EMSN threshold for 2024 is $2544.30. Patients are required to have a referral letter from a GP or specialist gynaecologist/obstetrician to access the Medicare rebates.
Does private health insurance cover IVF?
Most steps in the IVF process are not actually covered by private health insurance, but patients can receive coverage if their procedures are performed in a day hospital. In these cases, health insurance can make it much easier to manage a variety of associated costs that are not covered by Medicare. These include anaesthetist fees, theatre fees or accommodation where necessary.
Private health insurers all offer differing levels of coverage, so if you are exploring IVF, it is important to clarify with them exactly what they cover. In most cases, patients will require a higher tier of hospital coverage. Additionally, most providers will require a waiting period before being able to access the benefits.
What is the best health insurance for IVF?
Any Gold tier hospital policy will cover IVF – it’s a legal requirement. The most important thing is getting Gold, not which brand you choose.
When comparing funds, focus on:
- Waiting periods — usually 2 months if non-pre-existing, 12 months if pre-existing
- Excess amount — this applies per hospital admission
- Fund agreement hospitals — check your Melbourne IVF clinic’s day hospital is covered, as this directly affects your gap fees
How much does IVF cost in Melbourne?
The overall IVF cost will vary for different patients, based on the specific treatments they need and how many cycles they go through. The current out-of-pocket costs of treatment at Create Fertility (excluding the Medicare rebate) are:
- Initial IVF cycle: $3889.70
- Initial IVF cycle with ICSI: $4309.95
- Subsequent IVF cycle: $3209.20
- Subsequent IVF cycle with ICSI: $3629.45
- Frozen Embryo Transfer: $1386
How much does IVF cost with private health insurance?
One round of IVF in Melbourne typically costs $10,000–$12,000 before rebates, but more than half is returned if you’re eligible for Medicare, the Pharmaceutical Benefits Scheme (PBS), and private health insurance.
To give a real example, after the Medicare rebate, a standard IVF cycle at Newlife IVF Melbourne costs $5,469.75 for a first cycle, and $4,747.60 for subsequent cycles in the same calendar year.
Private health insurance for IVF generally helps cover in-patient costs such as day surgery for egg collection and embryo transfer. If you hold a Gold tier policy, your insurer may contribute towards hospital accommodation, theatre fees, and anaesthetist fees – though you may still need to pay a gap fee.
Does bupa cover fertility treatment?
Yes, Bupa covers fertility treatment, on the right tier. Bupa’s Gold tier products include assisted reproductive services cover, which helps pay towards IVF and certain fertility treatments or procedures in hospital.
If you need IVF, a waiting period applies: 12 months if your condition is deemed pre-existing, or 2 months if deemed non-pre-existing.
Critically, private health insurance only covers IVF treatment carried out in hospital – outpatient fertility services are not covered, even if your policy includes assisted reproductive services.
What is the insurance coverage for egg freezing?
It depends on the reason for freezing. Medicare provides a rebate for egg freezing only if there is a medical need – for example, before chemotherapy or other fertility-affecting treatment. Elective (social) egg freezing gets no Medicare rebate.
Private health insurance can reduce costs for egg freezing by covering private hospital admission and anaesthetist fees for egg collection, but only if you have the right level of cover.
Is health insurance for IVF worth it?
Private health insurance for IVF is not a necessity, and many people go through treatment without having cover. However, it can be beneficial to reduce your out-of-pocket costs and make treatment more accessible. If you are seriously considering IVF, we recommend doing research into how much the treatment could cost you, factoring in that it may take you multiple cycles to successfully conceive. With this in mind, you can better evaluate your financial situation and whether you would require the cover of private health insurance.
As we’ve outlined, many patients will go through treatment using just the benefits of Medicare. Other financial supports include accessing part of your super or using a buy-now-pay-later service like ZipMoney. Overall, the decision to get private health or not depends on your unique financial and personal situation, but it is not absolutely necessary.
To learn more about IVF or chat through your options, get in touch with our friendly fertility specialist and we will help you navigate everything to do with your fertility journey.
