Private Health Insurance That Covers IVF & Fertility Treatments

Around 1 in 20 births in Australia result from assisted reproductive technology. The right private health insurance policy can help cover many costs not fully reimbursed by Medicare. Understanding your treatment options and costs - and what your health cover will pay (or not) - is important for you to know before committing to any procedures.

What are assisted reproductive services?

Assisted reproductive services (ARS) refer to medical treatments designed to help you conceive when natural conception isn't successful. These services cater to a wide range of people, including those facing infertility, people in same-sex relationships, or individuals at risk of passing on genetic conditions. he most common ARS treatments include:

• In-vitro fertilisation (IVF): A process where sperm fertilises eggs outside the body, and successful embryos are implanted in the uterus.

• Intracytoplasmic sperm injection (ICSI): A specialised IVF technique used for male infertility where a single sperm is injected into the egg.

• Intrauterine insemination (IUI): Concentrated sperm is placed directly into the uterus.

• Gamete intrafallopian transfer (GIFT): Collected eggs and sperm are transferred into the fallopian tubes.

• Ovulation induction: Medications are administered to stimulate ovulation in women with irregular cycles.

• Preimplantation genetic testing (PGT): Embryos are screened for genetic abnormalities before implantation.

What is IVF?

In vitro fertilisation (IVF) is one of the most common fertility treatments around – alongside other procedures like intrauterine insemination (IUI). IVF helps with fertility for women of various ages, with the ultimate goal of assisting in the conception of a child. According to the Mayo Clinic, IVF is “the most effective form of assisted reproductive technology”, so it makes sense that so many Australians who are struggling to conceive decide to go down the IVF route.

Couples & individuals decisions around IVF and fertility are not smalls ones. Below we answer some of the important questions around private health can help you with these fertility treatments.

Does private health insurance cover IVF in Australia?

Yes, appropriate private health insurance can help you cover some of the costs associated with ARS, particularly IVF. However, having the right policy is key, and you’ll need to ensure that you serve any applicable waiting periods before you can claim your benefits.

Note: Private Prescription medications associated with assisted reproductive services may be partially covered through your extras cover if they are not listed on the Pharmaceutical Benefits Scheme (PBS). Some drugs might fall under Medicare's PBS, but non-PBS medications could also be reimbursed if your Extras policy allows.

Are outpatient services covered by private health insurance?

Private health insurance does not typically cover outpatient services such as consultations, ultrasounds, and blood tests, though some of these costs may be claimable through Medicare. Depending on your doctor’s referral, the Medicare Safety Net may also help reduce any of your high out-of-pocket expenses.

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.

How much does private IVF treatment cost?

As of 1 July 2021, various fertility procedures cost*:

• IVF cycle: $9,974.

• ICSI cycle: $10,754.

• Frozen embryo transfer (FET): $3,797.

• Intrauterine insemination (IUI): $2,611.

• Ovulation induction (OI): $700.

What waiting periods apply to IVF?

Not all health funds cover IVF treatments, so it’s important that you compare private health insurance to find the right provider for your fertility needs. For health funds that do cover these procedures, you'll generally need to wait out a 12-month period before you can access benefits related to IVF. Our guide to health fund waiting periods is found here.

Frequently Asked Questions

What is the success rate of IVF in Australia? The success rates of IVF treatment in Australia can vary significantly based on several factors, including the patient's age and whether a fresh or frozen embryo is used. 

According to data from IVF Australia for 2022, here’s a breakdown of success rates for fresh embryo transfers using the patients’ own eggs that led to live births:

Fresh Blastocyst Transfer (Day 5)

For frozen embryo transfers, the success rates are also noteworthy, showing higher rates for younger patients:

Frozen Embryo Transfer

How much does it cost for IVF in Australia? The cost of IVF in Australia can vary significantly based on the specific treatments and services required. Several factors can influence total costs, including the number of IVF cycles, additional procedures, and the complexity of individual treatment plans. 

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. 

Does Medicare cover IVF?

Many patients are eligible for Medicare rebates through the Medicare Safety Net, which may reduce your out-of-pocket expenses for subsequent IVF cycles. This rebate system is designed to make fertility treatments more affordable over time. If you have private health cover as well, this reduces your out-of-pocket costs for consults and hospital accommodation.

Is private health insurance worth it for IVF? Having appropriate private health insurance can significantly reduce the financial burden of IVF, especially for inpatient treatments and medications. While Medicare provides some benefits, private insurance offers additional cover, allowing access to a broader range of services, your choice of doctors, and private hospital facilities.

Comparing different insurers helps you discover which policy provides the better value cover for IVF, identifies cost gaps, and outlines waiting periods, ensuring you receive optimal care tailored to your needs.

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

Related Articles

Hospital and Extras Cover Comparison

Private Health Insurance for Pregnancy, Obstetrics & Birth

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).