Private Health Insurance That Covers IVF & Fertility Treatments

Assisted reproductive technology, such as IVF, provides a pathway to parenthood for many Australians. However, the financial burden of these treatments can be significant. With the right private health insurance policy, you can reduce some of the costs associated with fertility treatments while gaining access to additional services not fully covered by Medicare.

This guide answers key questions about IVF and private health insurance, helping you navigate your options and make an informed decision.

What Are Assisted Reproductive Services (ARS)?

Assisted reproductive services (ARS) include a range of medical procedures that assist individuals or couples in conceiving. These treatments cater to diverse situations, such as infertility, same-sex couples, and individuals looking to reduce the risk of genetic disorders.

Common ARS Treatments Include:

In-vitro fertilisation (IVF): Fertilisation of eggs occurs outside the body, with embryos implanted in the uterus.

Intracytoplasmic sperm injection (ICSI): A single sperm is injected directly into an egg for fertilisation.

Intrauterine insemination (IUI): Sperm is placed directly into the uterus to aid fertilisation.

Ovulation induction (OI): Hormonal treatments stimulate ovulation in women with irregular cycles.

Preimplantation genetic testing (PGT): Embryos are tested for genetic conditions before implantation.

What is IVF?

In vitro fertilisation (IVF) is Australia's most well-known and effective assisted reproductive technique. It involves collecting eggs from the ovaries, fertilising them with sperm in a lab, and implanting the resulting embryo in the uterus.

According to the Mayo Clinic, IVF remains the gold standard for fertility treatments. However, it is resource-intensive, and factors such as age and health conditions impact its success.

Does Private Health Insurance Cover IVF?

Private health insurance can help cover IVF-related costs under certain policies. However, having the right level of hospital cover is crucial to avoid unexpected expenses.

What’s Covered?

Private health insurance generally applies to inpatient services, including:

• Hospital accommodation.

• Theatre fees and anaesthetists for procedures like egg retrieval.

• Day surgery for embryo transfer.

• Partial coverage for non-PBS medications under your extras cover (if applicable).

What’s Not Covered?

Outpatient services, such as consultations, ultrasounds, and blood tests, are not usually covered by private insurers. These costs may be partially reimbursed by Medicare, depending on the treatment.

Pro tip: Use the Medicare Safety Net to reduce your out-of-pocket costs for high-expense treatments like IVF.

Is Private Health Insurance Worth It for IVF?

Considering the high costs of IVF, private health insurance can significantly reduce financial stress. Here’s what private insurance can offer:

Coverage for Day Surgery and Hospital Fees: Reduces or eliminates inpatient costs, which Medicare alone won’t fully reimburse.

Medication Benefits: Extras policies may partially reimburse IVF-related medications that aren’t on the PBS.

Access to Specialist Care: Provides flexibility in choosing your doctors, clinics, and private hospital facilities.

How much does IVF Cost?

As of July 2024, here’s a comprehensive breakdown of average costs:

• Initial IVF Cycle: $11,566

• Subsequent IVF Cycle (after Medicare Safety Net): $5,346

• Initial IVF Cycle with ICSI (Intracytoplasmic Sperm Injection): $12,526

• Subsequent IVF Cycle with ICSI (after Medicare Safety Net): $5,789.25

• Intrauterine Insemination (IUI) Cycle: $2,967

• Frozen Embryo Transfer (FET): $4,212

These costs encompass essential components of fertility treatment, including consultations with specialists, ultrasound scans, and egg transfers.

Additional costs to consider:

• Day surgery fees

• Anaesthetic services

• Medications, such as hormone injections

• Appointments with specialists (e.g., fertility doctors or endocrinologists)

• Counselling services, which may be recommended or required

• Genetic screening tests, particularly for inherited conditions

• Donor-related costs if using donor eggs, sperm, or embryos

Before any Medicare rebates or private health insurance benefits, the average cost of a single IVF cycle can range between $9,000 and $14,000, especially if additional services, such as using frozen embryos, are needed.

It’s important to remember that your costs will vary, depending on your clinic, location, and the complexity of your treatment plan. 

Why compare health insurers for IVF?

When undergoing IVF or other fertility treatments, it’s a good idea to compare different health insurers and policies carefully. Not all health funds offer the same level of cover for different fertility treatments, and the costs can vary significantly. Here are a few key reasons why comparing insurers is important for those pursuing IVF:

• Hospital and medication costs: Private health insurance for IVF generally helps cover in-patient costs such as day surgeries for egg collection and embryo transfer. If you hold a Gold tier or select an appropriate Silver Plus hospital policy, your insurer may contribute towards costs like hospital accommodation, theatre fees, and doctor or anaesthetist fees. However, you may still need to pay a gap fee. A gap fee is the difference between what Medicare and your health fund covers (through the Medicare Benefits Schedule or MBS) and what your doctor charges.

• Gap fee differences: Doctors often charge more than the MBS-recommended fee, leading to gap fees. Some insurers have agreements with certain hospitals and doctors to reduce or eliminate these gaps. Choosing an insurer with no-gap or known-gap arrangements can substantially reduce out-of-pocket expenses.

• Extras cover for non-PBS medications: IVF treatments often require medications not covered by the PBS. Some health funds include these drugs in their extras cover, while others don’t. Comparing Extras cover options could save you money on essential medications.

• Access to preferred providers: Some health insurers have partnerships with specific fertility clinics or hospitals, which may influence the level of care and convenience you receive. Researching these partnerships can help you access your preferred treatment providers.

• Waiting periods: IVF and fertility treatments typically have a 12-month waiting period under most private health (hospital) insurance policies. If you’re switching policies or upgrading your cover, it’s essential to compare waiting periods across insurers to avoid delays in starting your treatment.

By thoroughly comparing policies, you can optimise your cover and reduce the financial burden while undergoing IVF, which can involve multiple treatment cycles and significant costs.

Take the Next Step

Fertility treatments like IVF can be emotionally and financially demanding, but the right insurance policy can make a real difference. By comparing private health insurance options, you can minimise out-of-pocket costs while getting access to the best care and services available.

Speak to our Compare Club specialists today to find health insurance# tailored to your fertility journey. We’re here to help.

Frequently Asked Questions

Does Medicare Cover IVF?

Yes, Medicare covers certain IVF-related expenses, including:

• Consultation fees (when referred by a GP or specialist).

• Some blood tests and ultrasounds.

• A portion of egg retrieval surgeries.

Tip: Medicare’s Safety Net provides additional rebates for out-of-pocket costs once you reach your annual threshold.

How Do I Avoid Waiting Periods for IVF?

Unfortunately, a 12-month waiting period applies to most private health funds’ hospital cover for IVF. To avoid delays:

Take out health insurance as early as possible, especially if you’re considering starting a family.

If switching insurers, check if your waiting period transfers.

Can Extras Policies Cover Counselling or Genetic Testing?

Yes, some extras policies may include benefits for fertility-related counselling and genetic screening services. Ask your insurer about inclusions before proceeding.

Sources

Cost and fees: IVF.com.au

IVF success rates: IVF Australia

MBS billing for ARS

Medicare services for conceiving pregnancy and birth

Monash IVF

UNSW ARS

Private Health ARS

IVF Costs

IVF success rates

IVF costs covered by health funds

IVF and Medicare

Health Insurance Product Tiers

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Hospital and Extras Cover Comparison

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Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

• 1

  Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.

• 2

  An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.

• 3

  Family health cover means your children are covered under the same policy as you.

• 4

  Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).