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What if I need to have IVF?

We explain how both the public and private systems can support you during IVF.

For many women, advances in assisted reproductive technology have transformed their options for having a baby. In fact, in 2015 there were more than 70,000 assisted reproductive treatment cycles(1) performed in Australia.

There can be many different causes of infertility, and thankfully there are a growing number of options for accessing fertility treatments, including in vitro fertilisation (IVF).

IVF involves the fertilisation of an egg outside the body, the resulting embryos are then transferred to the woman’s uterus. There are a number of steps involved and the type of treatment needed varies from case to case.

While Medicare — the payment system that underpins Australia’s healthcare system — pays benefits towards IVF treatment, the advantage of having hospital cover that includes IVF is that it pays benefits towards some of the in-hospital procedures you might need, assuming you have served your waiting periods.

Who’s eligible for coverage?

Medicare has some eligibility requirements to be aware of ahead of considering IVF. While Medicare can provide a rebate on some of your treatment, you’ll require a GP referral. In some states, people undergoing treatment are also required to undergo a criminal record check and a child protection order check before undertaking IVF.

If you’re looking to claim on IVF as part of your health insurance, ensure you’ve served any waiting periods before you start treatment. The waiting period for IVF is 2 months, or 12 months for those with a pre-existing condition.

What costs are covered by Medicare and health insurance?

IVF involves a series of procedures both occurring in and out of hospital. Some out-of-hospital costs — treatment cycle fees, some blood tests and ultrasounds — will attract a Medicare rebate.

Health insurance cannot pay towards your out-of-hospital treatment, but it will pay benefits towards in-hospital expenses and surgery fees, provided you have the right level of cover and have served any waiting periods.

While Medicare and health insurance can help to reduce the costs of IVF, it’s important to remember there are generally still significant out-of-pocket costs for IVF treatment.

Pregnancy

It’s also worth considering the benefits of health insurance beyond conception. Having choice and control over who you see during your pregnancy and birth — and at which hospital — are just some of the benefits that come with having health insurance. But remember, there is a 12 month waiting period for obstetrics-related services, so you need to have an appropriate level of cover for at least a year before your baby is born.

1 Fitzgerald O, Harris K, Paul RC, Chambers GM 2017. Assisted reproductive technology in Australia and New Zealand 2015. Sydney: National Perinatal Epidemiology and Statistics Unit, the University of New South Wales Sydney, page vi.

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