Last Updated on 19 February 2020

Public or Private? Your Guide to Pregnancy and Birth Healthcare in Australia

Starting a family in Australia raises one very important question: will you go through the public healthcare system or opt for private health insurance? Both systems have their pros and cons, and it can become a very difficult decision, especially if you’re having your first baby.

There is no right or wrong choice overall, only what’s best for you and your family. Still, it can be hard to make up your mind. We’ve put together a comprehensive guide on having a baby in Australia to help you make your decision.

Key Points
  • Public healthcare is a more affordable option for many pregnant women, though it does not offer the same level of choice and care as provided by the private system.
  • Not all private health insurance policies include pregnancy cover, so it’s important to choose one that does if you are planning on starting a family. Secure your policy at least three months before conception as most funds require a 12-month waiting period for pregnancy cover.
  • The levels of pregnancy cover vary between funds and even within funds, so it’s worth comparing policies to find the level of coverage you prefer.

Why Women Choose Public Healthcare When Having a Baby

One of the clearest benefits of using the public healthcare system when having a baby is cost. If you give birth in a public hospital, you usually won’t have to pay any out-of-pocket costs. Scans and antenatal classes may also be covered by Medicare.

Women who choose this option may make some sacrifices in terms of comfort and choice, as you are unable to pick your obstetrician and may not experience continuity of care. Patients in the public system typically give birth in shared rooms. Although you may have less control over your healthcare, choosing to go public is a positive experience for many women.

Why Women Choose Private Health Insurance When Having a Baby

There are many reasons women get private health insurance when having a baby, and many of them centre around the level of care provided. As a private patient, you expand your healthcare options for yourself and your baby. Women gain more freedom of choice over who their treatment provider will be and where they will give birth.

Private patients often have their own room where partners may also be able to spend the night. It can be very comforting to many women to have a private space when giving birth, not to mention having your loved ones nearby.

Pregnancy Caregiver Options

There are several ways to customise your birth experience, and one of them is by choosing your preferred caregiver. Some caregivers are covered by Medicare, while others require private health insurance. Here are three options.

Pregnancy Caregiver Options

Birth Location Options

Not all women give birth in a hospital. You might be surprised at the range of options available to pregnant women, many of which are covered by both public and private healthcare.

Where do women give birth in Australia?

What Does Public Healthcare Cover for Pregnancy and Birth?

Medicare will cover some or all of your expenses throughout your pregnancy, birth, and postnatal care up to six weeks after birth. Services that are not fully covered are usually subsidised. However, the trade-off for many women is a lack of autonomy in choosing your healthcare providers and birthing location.

Medicare covers the following pregnancy and birth services:

  • Care as a public patient in a public hospital, including accommodation while giving birth
  • Subsidised out-of-hospital medical services such as tests and ultrasounds
  • Care for your baby if complications arise

Medicare does not cover:

  • Hospital stay as a private patient in either a public or private hospital
  • Excess fees charged by private healthcare providers such as midwives or obstetricians
  • Full costs for shared care with non-bulk-billing GPs

What Does Private Health Insurance Cover for Pregnancy and Birth?

First, it’s important to be aware that not all private cover includes pregnancy and obstetrics cover. In fact, not all pregnancy policies cover the same services. This gives you flexibility to select a policy that suits your needs and budget, whatever they might be. Be aware of your policy’s level of cover to avoid any unpleasant surprises along the way.

Private health insurance may cover the following:

  • In-patient fertility services such as IVF and other treatments
  • Hospital services and accommodation as a private patient in a private or public hospital during birth
  • Some or all of the fees for your obstetrician or midwife
  • Extras benefits such as physiotherapy or postnatal classes

Private health insurance may not cover:

  • Excess charges for yourself or your baby if he or she needs to be admitted to hospital
  • Out-of-hospital care, including visits to your obstetrician

What's covered in the public and private healthcare system for pregnancy?

Considerations for Parents-to-Be

Preparation is an important part of planning for a pregnancy, and there are some extra considerations to take into account when deciding between public and private healthcare.

Health cover preparation for pregnancy

Which is Best for My Pregnancy: Private or Public?

Unfortunately, there is no magic formula for determining whether you should go through the private or public system for your pregnancy. Each pregnancy is different, and so are each family’s needs. Take some time to weigh up the benefits of each system and decide which one makes you feel the most comfortable.

Whether you choose to go public or private, knowing what you and your baby are covered for is important. It helps you know what you can expect, both in terms of care, comfort, and financial expense, which can mean a better experience overall.

Frequently Asked Questions About Health Insurance

There are three types of health insurance in Australia. They are:

  • Hospital Cover
  • Extras Cover (also known as general or ancillary cover)
  • Ambulance Cover

Hospital cover can ensure any unexpected surgeries, treatments or hospital stays you may require will be covered. With appropriate cover you will have the flexibility to choose your own doctor and the option of receiving treatment in a private hospital.  Most hospital covers allow you to stay in a private room. One other perk is skipping the public hospital systems’ waiting list, which can be lengthy for non emergency treatment.

Extras cover pays benefits for a a range of services, often including treatments and procedures related to the fullowing:

  • Dental/oral health
  • Glasses and contact lenses
  • Podiatry
  • Physiotherapy
  • Psychulogy
  • Acupuncture
  • Remedial massage
  • Chiropractic
  • Hearing aids
  • Travel vaccinations

Ambulance cover, as the name suggests, will cover you should you require emergency ambulance transport. In an emergency, there is enough to worry about. Having the expenses covered for provides security and peace of mind. Many hospital covers include emergency ambulance transport If yours doesn’t, you will need to shop for this separately.

Life is unpredictable. You never know when you might need cover. No matter what life stage you’re in, there’s a policy out there for everyone. You can select as much or as little cover as you want, depending on your health needs and requirements. It’s a small price to pay for the peace of mind health cover provides.

There is no one answer here. Costs vary across providers and policy types. Just because a policy is cheap, that does not mean it is ‘value for money’ and vise versa. Make sure you check what’s included and excluded in a policy before signing up, as you want to purchase a policy that best fits your specific needs.

Premium: A premium is the price you pay for your insurance policy (it may be paid annually or on an ongoing basis).

Policy: An insurance plan. In other words, it is the type of insurance you choose to select.

Policy Holder: The owner, or ‘holder’ of a policy.

Claim: In the event that you require treatment for a service covered by your policy, you can lodge a claim for reimbursement of all or part of the cost of that treatment.. These days, most claims are submitted electronically by the health care provider (dentist, physio etc)

Lifetime Health Cover: Lifetime Health Cover was put in place to encourage young Australians to seek out and maintain ownership of private health insurance early in their lives. If you do not take out a policy before you turn 31, extra charges will be applied should you take out a policy at a later time.

This means you will pay a 2% loading on top of your premium for every year that passes after you turn 30. For example, if you take out a policy for the first time at age 32, you will be charged 4% of your premium as an extra, then at age 40, 20% and so on, up to a maximum loading of 70%.

The loading is payable for 10 consecutive years of cover - after which it is removed and you premiums will be reduced.

Pharmaceutical Benefits Scheme (PBS): Medicare offers assistance for Australians with many of their their prescribed medication costs through the PBS. This assistance is in the form of subsidies towards the cost of many medications. You can check if your prescribed medication is on the list of subsidised items here.

Medicare Levy Surcharge: The Medicare Levy Surcharge is an additional charge (tax) applied to single Australian taxpayers who earn over the income threshold of $90,000 per year, or families/couples who earn over $180,000 per year. This surcharge is only applied to those who choose not to have a private health insurance policy.

The surcharge is designed to reduce pressure on the public health system by encouraging those with higher incomes to invest in private health cover.

Private Health Insurance Rebate: The government’s Private Health Insurance rebate lowers premiums for most Australians with private health insurance Older Australians may enjoy an even higher rebate. Our calculator can help you estimate the Government health insurance rebate you may receive.


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