Best health insurance for IVF treatment

For many Australians, IVF (in vitro fertilization) is the best way to realise their dream of becoming a parent and starting a family. But it’s an expensive procedure and isn’t guaranteed to work the first time, so it can actually become a big financial burden. That’s where having private health insurance can help alleviate some of the costs.

This guide will explore the best health insurance options for IVF in Australia if you want to have a child or grow your existing family. From upfront costs to Medicare support to all the procedures involved, here’s how to make the most of IVF with private health insurance.

IVF is a complex and expensive process. While the total cost will depend on your individual circumstances, according to Monash IVF, the cost of IVF in Australia is can range from $9,000 (for a single IVF cycle) to $14,000 (if you use a frozen embryo and need ICSI treatment for male infertility).

Here’s a very general breakdown of what’s involved with IVF costs:

• Initial consultation
• Stimulation cycle
• Medication
• Egg collection
• Embryo transfer
• Embryo freezing
• Storage fees

The final amount you pay will depend on the clinic you go to, where you are located around Australia, as well as the exact treatments required. You’ll also need to budget for additional expenses like follow-up consultations, blood tests, ultrasounds and more.

Medicare provides some level of support for IVF treatments in Australia. The rebates cover a portion of the costs associated with consultations and some tests and procedures related to IVF. Here’s a quick overview of what Medicare covers:

• Initial specialist consultation (partially covered).
• IVF treatment cycle (partially covered under specific MBS items).
• Egg retrieval (partially covered).
• Embryo transfer (partially covered).
• Hospital admission for procedures (partially covered if performed in a public hospital).

While Medicare helps lower the costs, the out-of-pocket expenses can still be quite high – so you may want to register for the Medicare Safety Net.

IVF involves several steps and multiple procedures for each ‘cycle’, including:

• Initial consultation: Meeting with a fertility specialist to discuss your medical history and treatment options.
• Ovarian stimulation: Using medications to stimulate the ovaries to produce multiple eggs.
• Monitoring: Regular blood tests and ultrasounds to monitor how the ovaries are responding to stimulation.
• Egg retrieval: A minor surgical procedure to collect eggs from the ovaries.
• Sperm collection: Obtaining a sperm sample from the male partner or donor.
• Fertilisation: Combining eggs and sperm in a lab to create embryos.
• Embryo culture: Growing embryos in a lab for several days.
• Embryo transfer: Placing one or more embryos into the uterus.
• Pregnancy test: Doing a blood test to see if pregnancy has occurred.

Yes, many private health insurance policies will cover parts of IVF treatment, which can give you even more financial relief on top of what Medicare covers. Be aware that you’ll need to be on a higher tier to get benefits for IVF treatments, so compare a few policies and providers before settling on a specific level of insurance. You’ll generally get covered for:

• Costs associated with hospital stays for procedures like egg retrieval and embryo transfer.
• Fees for day surgeries conducted as part of the IVF process.
• Some policies cover specialist consultations with fertility specialists.
• Certain medications used during the IVF process might be partially covered.

While coverage for the above might be the norm, you’ll still need to review your own policy details as not all insurance plans cover IVF-related treatments, and out-of-pocket expenses can still be quite large – even if you are covered.

Pretty much all health insurance policies have waiting periods before you can claim benefits for IVF treatment. Here’s what to expect:

• Standard waiting period: There is usually just a two-month waiting period for assisted reproductive services like IVF.
• Pre-existing conditions: If you have a pre-existing fertility condition, the waiting period for IVF cover will jump up to 12 months.
• Switching policies: If you switch to a new health insurance provider, you will probably still have to see out the waiting period – unless the new policy includes a waiver for transferring members.

Pros:

• Private health insurance can greatly reduce your out-of-pocket costs for things like hospital stays, day surgeries and some medications.
• Being able to choose a private hospital means you could have shorter wait times for IVF procedures compared to public hospitals.
• Private insurance means you get to choose your fertility specialist and treatment facility.
• Some policies will cover extra support services like counselling, which can be very helpful during the IVF process.

Cons:

• Premiums can be expensive, and not all policies cover IVF treatments.
• Even with insurance, you will still be on the hook for a few out-of-pocket costs for IVF cycles and associated treatments.
• The mandatory waiting periods can delay your treatment plan if you’re not already covered.

Here are some easy-to-do tips to help you make the most of your cover:

• Review your policy: Understand exactly what is – and isn’t – covered under your current health insurance plan and check for any IVF exclusions.
• See out waiting periods: Plan your treatments around the waiting periods so you can claim the maximum benefits.
• Get referrals: Get all the necessary referrals from your GP or specialist to access covered services.
• Keep the paperwork: Maintain detailed records of all treatments, consultations and receipts so the claims process is as easy as possible.
• Communicate with your insurer: Stay in touch with your provider to clarify any particular details of your cover, as well as confirm the claim processes.
• Use registered providers: Make sure your preferred fertility clinic and specialists are recognised by your health insurer to guarantee cover for their services.

Having the right health insurance can give you an extra dose of financial relief during the IVF process. While Medicare does partially cover some of the costs, private health insurance can help reduce the burden of big out-of-pocket expenses.

With careful planning and the right support from your insurance provider, you can focus on starting or growing your family with the help of IVF.