Both Medicare and private health insurance cover prenatal care, but private offers a few extra perks.
Congratulations! You probably don't need us to tell you there's a whirlwind of adventure ahead. Luckily your prenatal care (also called antenatal care) is pretty straightforward, whether you use Medicare or private health insurance to cover it.
You’ll be in good hands either way, but there are some important differences between how the public and private systems work.
What are the next steps after finding out you’re pregnant?
Your next steps will differ a little depending on whether you're using the public system or the private one. Let's look at each.
Prenatal treatment in the public system
If you don't have private pregnancy cover by this point, your only option is to use the public system, unless you want to be tens of thousands of dollars out of pocket. That's because you have to wait 12 months before you can use private health insurance pregnancy benefits on new cover.
Don't fret, the public system is very good and best of all, you won't pay a cent.
Here's what you'll need to do next if you're going the public route:
- Decide where you want to deliver the baby. As a public patient, you can choose to have your baby in a public hospital, a public birthing centre or at home. A birthing centre is a home-like environment usually connected to a hospital and is best suited for women who don’t expect any delivery complications, though if there are any complications, you can still be referred to the hospital.
- See your GP. Your GP will refer you to the public hospital where you'll give birth. It can be the one closest to you or you if you have a different preference, you can ask your GP to refer you there instead.
- Book an appointment with the hospital or birthing centre. Call your hospital's prenatal clinic to book your first appointment. You might not go in until you're about eight weeks pregnant, but call right away because spots can fill up fast. At this session, a midwife will perform a simple health check on you and the bub and may do an ultrasound if you can't figure out how far along you are.
- You'll attend another 7–10 appointments. You'll keep going back to your hospital or birthing centre throughout your pregnancy. Midwives will continue to check on you and your baby, performing ultrasounds, scans and other tests leading up to your delivery date. You may or may not see the same midwife each time and there won't be one specific obstetrician (OB) who is responsible for your care, although you will have access to the OBs on duty if you need them.
Prenatal treatment in the private system
If you took out a top level of hospital cover private health insurance that includes pregnancy at least three months before getting pregnant, you will be covered to deliver your bub at a private hospital. The prenatal in-hopsital treatment process is very similar to the public version, with a few differences. Here's how the process shakes out in the private system:
- Choose your OB and make your first appointment. Private cover lets you choose your OB, who provides care throughout your pregnancy with the help of their own team of midwives. You can make your first appointment directly with the OB instead of going through your GP, unless you want your GP involved in the birth.
- Choose where you want to give birth. Tell your OB exactly where you want to give birth: in a private hospital, as a private patient in a public hospital, in a birthing centre or at home. You can choose exactly which hospital or centre you want.
- Do your follow-up sessions. You'll have another 8–10 appointments at your OB's offices, where they and the midwives will monitor your progress and perform ultrasounds and any other tests you need.
- Claim your discounts if you have extras cover. For those out of hospital services, the extras side of your insurance can give you some discounts towards a variety of treatments. We'll get onto that inext.
How much does prenatal care cost?
Medicare and private health each cover a large part of your prenatal care. The following table shows how each system covers the costs of various treatments, as well as where you’ll be receiving them.
|How does Medicare treat prenatal care?||How does private health insurance treat prenatal care?|
|Consultations||Medicare will cover the costs of all your consultations with OBs and midwives.||Medicare will cover 75% of what it would have paid if you had gone public. If you have pregnancy cover, your insurer will pay the additional 25% for those services.|
You are responsible for any amount the doctor chooses to charge above that amount, plus any doctor's fees.
|Tests||Medicare will cover the cost of all your tests including blood testing and ultrasounds.||Private insurance doesn’t cover these. Medicare will cover some tests like ultrasounds and blood tests but only if those take place in public clinics.|
|Prescription medication||Most prescriptions will be covered under the pharmaceutical benefits scheme (PBS).||If the PBS does not cover your prescription, private health insurance may cover it if you have the right extras policy (it won’t be covered by your pregnancy cover if it is not in-hospital).|
|Prenatal classes||Medicare does not specifically cover prenatal classes like breastfeeding classes, but your hospital may offer them free of charge.||Extras cover can also offer discounts for prenatal classes, birthing courses and even some garments.|
|Yoga/exercise classes||Medicare does not specifically cover exercise classes, but your hospital may offer them free of charge.||Extras cover can often provide discounts on exercise classes, your private OB may also offer complimentary classes as part of their services.|
|Where you'll get your care||You'll be looked after in a public hospital or birthing centre.||You'll be looked after in your OB's private offices.|
|Who will treat you||You will be treated by the midwives who are on duty at the public hospital or birthing centre where you'll be giving birth.|
You'll have access to any OBs who are on duty if you need them.
|You'll be treated by the doctor you choose and their team of midwives.|
Are prenatal classes covered?
Medicare won't cover prenatal classes per se. However, your hospital or OB might offer classes for free as part of their service. You’ll have to call around to find out which places offer these free services.
Important classes you might want to take include:
- How to breastfeed
- How to pump and store breastmilk
- How to massage your baby
- How to support someone who is pregnant (for support people)
- What to expect during birth
- What to expect as a parent
- What to expect from anaesthesia
- What to expect during a C-section
Private health insurance can often cover some contributions towards pre and postnatal services. You can actually find some discounts in extras only cover. That's also far cheaper than top hospital cover if you're not ready to jump in the deep end (or missed the waiting period) on the hospital side of things.
Extras cover that includes pre and postnatal can be a relatively low-cost way to get discounts on classes including birthing courses - and you don't even need a top level of cover.
For example, we looked at one of the finder.com.au partners - ahm, who include limits and discounts on the following treatments from $12.45* weekly. The prenatal services have no wait period too.
- Consultations and classes
- Birthing course
- Lactation consultant
- Pregnancy compression garments
*price based on a singles policy.
What about other treatments like prenatal massage and prenatal yoga?
This works the same as the other prenatal classes mentioned above: they aren’t specifically covered by Medicare, but some hospitals and OBs will offer free exercise classes like prenatal yoga and Pilates.
Most extras policies cover therapies like massage, acupuncture and physio, making those policies fantastic for helping you work out some of those pregnancy-related aches and pains. Not all extras policies cover exercise classes, so look closely at each policy you are considering.
Checklist for finding the right OB
Having the right OB or team of midwives can set the tone for your entire pregnancy, so you'll want to choose carefully. The process will look a little different based on whether you are using the public system or going private, because you have a little less choice within the public system.
If you're using the public system
If you've decided to use the public system, you have less choice about who treats you. However, there is some wiggle room that will open up a few options:
- Choose the right public hospital. If you live in the city, there may be several public hospitals near you. Check out online reviews and chatter on pregnancy forums to see if any of them stand out more than the others. If you have a preference, ask the GP to send you there.
- Use a birthing centre. Many public hospitals have birthing centres attached to them. These are home-like environments that usually have smaller teams of people looking after you. If having a smaller team is important to you, you should consider this option. However, it's only for people who will be having a straightforward birth that is free from complications. You may get referred back to hospital if your late stages of pregnancy turn out to be a bumpy ride.
If you're using the private system
In the private system, you can choose whatever obstetrician you want, so there are a few more steps you can take to make sure you get the right one.
- Read online reviews. You'll find a treasure-trove of pregnancy advice on the web, with mothering forums offering the richest personal accounts related to pregnancy and delivery. You can find women sharing their experiences with OBs from all over Australia.
- Check which OBs are in-network. Most health insurers have a network of private providers and you may have to pay an additional out-of-pocket fee if you use someone outside of this network.
- See if the OB offers free classes. Some OBs offer complimentary classes, including yoga, Pilates and a host of info workshops.
- Don't feel locked in. If you don't feel comfortable with your OB after your initial consultation, don't feel that you have to stay with them. The longer you wait, the more difficult it will be to change to a new OB, so start looking elsewhere if you feel it's a bad fit.