IVF-min

Health insurance for IVF and fertility treatment

Health insurance and Medicare can help towards the cost of IVF in Australia

Fertility treatment can help people who find it difficult to conceive. The good news is, Medicare and private health insurance can work together to help you save on some of the costs.

Health insurance for IVF and other fertility treatments

We researched finder.com.au partners to compare the hospital policies that offer cover for IVF and reproductive services (for example other treatments such as GIFT.) The options below have a 12 month waiting period. Consultations or services provided outside of a hospital receive Medicare benefits only. Quotes are all based for a single in NSW.

Provider Cost per month Policy Excess Apply
$195.45 Top Hospital $400 if overnight Go to site
$155.29 Premium Hospital $500 Go to site
$160.37 Premium Hospital $500 Go to site
health.com.au logo $187.71 High Hospital $500 More info

What is in vitro fertilisation (IVF)?

The phrase "in vitro" refers to a procedure that happens outside of its natural environment. So in IVF, doctors take eggs from your body and try to fertilise it with sperm from your partner or other donor, and then implant the fertilised eggs (or embryos) into your uterus to develop and grow as normal.

It is one of the most popular forms of assisted reproductive therapy (ART), which is a fancy way of saying fertility treatment.

How does Medicare treat IVF?

As long as you have a referral from your GP, Medicare will cover a portion of your IVF for as many cycles, or rounds of treatment, as you need.

So if you are having trouble conceiving, just see your GP who will refer you to an IVF/fertility clinic. If the clinic thinks you need IVF, then you're as good as covered.

Most IVF centres are privately run and you will have most of your treatment in their private outpatient facilities and, to a lesser extent, their private day hospitals.

Even though it takes place in a private clinic, Medicare will give you a rebate for many aspects of your IVF treatment even if you don't have private health insurance. By the time it's all said and done, your rebates per IVF cycle will be about 50% of the total cost.

How does Medicare determine how much they will pay?

All of the services covered by Medicare are listed in the Medicare Benefits Schedule (MBS). The MBS describes the individual inpatient and outpatient services they cover, along with a dollar amount that equals what Medicare will pay for that service in a public facility. This is called the schedule fee.

But since you’ll be in a private facility, they will only pay a portion of the schedule fee, and even then, only for some services (for example, Medicare will help pay for a doctor to collect your eggs, but they won’t pay anything for you to freeze them).

At the end of the day, you’ll be responsible the entire cost of services Medicare doesn’t cover, a portion of the cost of services that Medicare only partially covers, and any additional fees or premiums the clinic decides to charge.

Where does private health insurance fit in?

Even though Medicare covers a decent chunk of your costs, private health insurance can be an important source of additional cover. Here's where it can help:

  • Your inpatient services. You know those services that Medicare only covers a portion of? Your private hospital cover will take care of that remaining amount, as long as it is Medicare-approved and you’re being treated as an inpatient (plus it covers related costs like anaesthesia, doctor's fees, accommodation fees and prescriptions that aren't part of the pharmaceutical benefits scheme).
  • Other prescriptions. If you need any prescriptions as an outpatient, and these aren't part of the pharmaceutical benefits scheme, your private extras policy will cover a percentage of those.
  • Any inpatient services related to complications. If you come down with a complication due to IVF, such as ovarian hyperstimulation syndrome (OHSS) and you need hospitalised, your insurance will cover you in a private hospital with the doctor you choose.
  • Childbirth. This isn't technically part of your IVF treatment, but if you use private health insurance for IVF, then you'll most likely also have pregnancy cover. By the time you're ready to give birth, this lets you to choose your own obstetrician and hospital, and gives you your own private room.

What is involved in a cycle of IVF?

A standard IVF cycle involves a series of steps over several weeks including:

  • Ovary stimulation to produce eggs for collection
  • Blood tests and ultrasounds to collect eggs at the correct time
  • Fertilising embryos in a lab
  • Transferring and implanting fertilised embryos
  • Pregnancy tests
  • Psychological counselling
  • Specialist consultations
  • Specialist nursing care

How much does IVF cost?

A standard IVF cycle can cost anywhere from $9,000 for a normal IVF cycle to $14,000 if you need to have your ovulation induced and you're using a frozen egg (that’s before any refunds or private cover). These rates include consultations, treatments, medications and fees.

The following tables estimate your out-of-pocket costs for one IVF cycle using data from provider IVF Australia.

Cost of IVF before hitting the Medicare Safety Net Threshold

Treatment Total Cost Medicare rebate Estimated out-of-pocket costs
Normal IVF cycle $9,495 $4,788 $4,707
Frozen embryo transfer (FET) $3,650 $1,391 $2,259
Ovulation Induction (OI) $700 $0 $700

Cost of IVF after hitting the Medicare Safety Net Threshold

Since IVF isn't always successful the first time around, you may end up going through multiple cycles and that will push your costs even higher. If you end up having multiple cycles in the same calendar year, Medicare may increase your rebate for the rest of the year if your total out-of-pocket expenses have reach a point called the Medicare Safety Net Threshold (MSNT).

Treatment Total Cost Medicare rebate Estimated out-of-pocket costs
Normal IVF cycle $9,495 $5,344 $4,151
Frozen embryo transfer (FET) $3,650 $1,498 $2,152
Ovulation Induction (OI) $700 $0 $700

Source: IVF Australia. Based on prices from 17 Aug 2018

Is IVF bulk-billed?

Until recently, there were no IVF centres that offered bulk-billing, since all IVF centres are private and private practices are free to charge whatever they want.

However, in recent years, some private IVF centres have started to offer bulk-billing services as a way to attract customers who are put off by the high price tag.

These clinics have decided not to charge anything extra for any of the procedures that Medicare covers - only what Medicare has agreed to pay. That means you won’t owe anything for those particular procedures, although you will have to pay for procedures Medicare doesn’t cover.

Private health insurance can still step in to help in the same way it would at any other IVF clinic.

Using a bulk-billing IVF centre can bring your costs way down, but they are usually only found in large cities and you may not see the same doctor every time you visit.

According to provider Primary IVF, your total out-of-pocket costs would be anywhere from $600-$1,000 per cycle.

What inpatient IVF procedures does private insurance cover?

The table below lists the three most common IVF procedures that you could have as an inpatient (usually at your private IVF clinic's day hospital). Private health insurance will pay the amount in the right-most column plus a percentage of any anaesthesia and doctor's fees, per IVF cycle, up to your benefit limit.

Some women have had up to 8+ cycles before falling pregnant, so these contributions from private health insurance can really add up, especially when you combine them with any of the other forms of cover private health offers.

IVF service Medicare Item Number Description Medicare Schedule Fee Amount covered by Medicare in a private setting Amount covered by your private insurance
Egg collection 13212 The doctor collects mature eggs during your menstrual cycle, usually when you're sedated. $354.45 $265.85 $88.60
Transferring embryo to uterus 13215 The doctor places the fertilised egg into your uterus. There is usually no pain or sedation required. $111.10 $83.35 $27.75
Preparing frozen embryos 13218 For those using fertilised eggs from a previous menstrual cycle, this is the extra prep work needed to get you ready, including thawing the embryo and manipulating your hormones to mimic a menstrual cycle. $793.55 $595.20 $198.35

Source: Australian Government Department of Health, 17 Aug 2018

What are the other types of fertility treatments?

Although it is the most well-known, IVF isn't the only form of fertility treatment available. Here are some of the others.

  • Intrauterine Insemination (IUI). IUI, sometimes called artificial insemination, is much less invasive than IVF because the fertilisation happens inside your body rather that outside of it. Doctors or nurses collect sperm from your partner or a donor, isolate the strong sperm and then put in your body.
  • Gamete Intra Fallopian Transfer (GIFT). GIFT is similar to IVF, except that after the eggs are removed and combined with the sperm outside of your body, they are implanted into your fallopian tubes to fertilise inside your body. Reaching the fallopian tubes requires surgery and is becoming less and less common as the success rates of IVF continue to increase.
  • Zygote Intra Fallopian Transfer (ZIFT). ZIFT is a combination of IVF and GIFT. As with IVF, the eggs are fertilised outside of the body but unlike IVF and more like GIFT, the fertilised egg (sometimes called a zygote) is placed into the fallopian tube via surgery as opposed to the uterus. As with GIFT, ZIFT is becoming less and less common.
  • Intracytoplasmic Sperm Injection (ICSI). ICSI is a form of IVF that is most commonly used to help overcome male infertility. The difference is that with normal IVF, the egg is combined with hundreds of thousands of sperm and everything is left to fertilise as normal (albeit outside of the body). With ICSI, a single sperm cell is injected with precision into the egg for fertilisation. The fertilised egg is then implanted into the uterus as per normal IVF.

What isn’t covered by Medicare or private health insurance?

Neither Medicare nor private health insurance will cover the following procedures related to IVF:

  • Ovulation induction. This is where you take medication to encourage egg growth in your ovaries. Not all women will need this.
  • Freezing and storing embryos or sperm. You only need to have these done if you plan on having IVF at a later date, but want to preserve viable eggs and/or sperm beforehand.

Questions you should ask before choosing an IVF clinic

If you're considering IVF or other fertility treatment, here are are some questions you should ask any potential clinic:

  • What credentials and training do their staff have?
  • Are they members of any recognised associations or medical bodies?
  • What is their overall success rate?
  • What is their success rate for the procedure you are considering?
  • What are their clinic and lab hours (can be important if you are working)?
  • Can they freeze extra embryos for later use?
  • What does each cycle cost, including drugs?
  • Do you have to pay up-front or can you pay in instalments?
  • Are counselling services available?
  • Do they have patients you can speak with who have completed their program, successfully or otherwise?

Have questions about health insurance? Check out our comprehensive list of frequently asked health insurance questions.

Market overview of funds covering reproductive services

Fund Which policies cover assisted reproductive services? More info
AHM health insurance Assisted reproductive services will be covered under Top Hospital cover, and there is a 12 month wait period. ahm provide cover for reproductive services and cover all agreed hospital charges in a partner private hospital in a shared or private room. In a public hospital we'll pay all accommodation charges for a shared room and benefits towards a private room.

More info

Australian Unity provides cover for pregnancy and related services including fertility treatments such as IVF and GIFT, and private midwifery on its Platinum Hospital policy.

More info

GMHBA health fund IVF and assisted reproductive services are covered under the Bronze Hospital (Public hospital cover as a private patient only), Gold Hospital, Everyday Family Package and Premium Family Package.

More info

HCF logo The Premium policy covers assisted reproductive services such as IVF and GIFT.

More info

health.com.au-logo The High Hospital policy covers pregnancy related and assisted reproductive services. Be aware that there is a 12 month waiting period for pregnancy and assisted reproduction related services.

More info

hif Both the Gold and GoldStar Hospital provide cover for assisted reproductive technology. This includes cover for expenses including accommodation, theatre and ward fees. You may also be able to make claims for your doctors' and anaesthetists' fees. If you have either Super Options or Premium options as your extras package, you will be able to claims for expenses associated with IVF drugs. The are 12 and 36 month waiting periods for assisted reproductive technology and IVF drugs respectively for new members. More info
nib Assisted reproductive services are covered by Top Hospital. This policy provides cover for inpatient services relating to egg retrieval and implantation including IVF and GIFT. There is a 12 month waiting period. Outpatient specialist fees related to reproductive services aren't covered.

More info

Both Top Hospital and Top Hospital with excess provide cover for assisted reproductive services such as IVF and GIFT. Basic Hospital provides restricted cover.

More info

ACA health logo Assisted reproductive services covered under Deluxe Hospital, Private Hospital and Basic Hospital policies. More info
Bupa logo Top hospital and Growing family are the covers that will include IVF in a private hospital. More info
CBHS-LOGO CBHS members may be able to claim most or a part of their IVF expenses, as assisted reproductive services such as IVF can be covered under private hospital cover. ART services are covered on the Prestige StepUp Package, with restricted cover available on the KickStart Package, and the Limited and Basic Hospital policies. These services have a 12 month waiting period. More info
CDH logo There is a Benefit Limitation Period of two years for assisted reproductive services including IVF and GIFT. More info
cua logo Assisted reproductive services are covered on the Private Hospital 100% (nil or $250 excess), Private Hospital 90% and Private Hospital 75% policies. More info
Assisted reproductive services covered under ADF Total Package and Premier Hospital policies. More info
Frank logo IVF and related services are covered by Basic Hospital, Basic Hospital and Best Hospital policies. More info
gmflogo Assisted reproductive services including IVF are covered by the Smart Saver Twin pack, Healthy Saver Hospital, Top Hospital and Ultimate Package. Assistive reproductive services including IVF have a two month waiting period. More info
hbf-logo Assisted reproductive services including IVF are covered by the Smart Saver Twin pack, Healthy Saver Hospital, Top Hospital and Ultimate Package. Assistive reproductive services including IVF have a two month waiting period. More info
Health Care Insurance Cover for assisted reproduction technology such as IVF and GIFT have a 12 month waiting period. More info
logo health partners Assisted reproductive services are covered under Gold Hospital and Silver Hospital. More info
latrobehealthlogo Assisted reproductive services provided in hospital to assist conception such as IVF and GIFT are covered under Top Hospital. More info
Medibank logo Fertility treatment including IVF and GIFT programs are covered by Top Hospital. More info
Mildura logo A waiting period of 12 months for assisted reproductive services including IVF. More info
navy-logo Premium Hospital and Healthy Hospital 200 + 500 cover assisted reproductive services such as IVF. Maternity (or admissions related to the management of) and IVF procedures attract a 12 month waiting period. More info
onemedifundlogo Private Plus Hospital covers assisted reproductive services such as IVF with a 12 month waiting period. More info
Peoplecare health insurance To claim for IVF services in a hospital, you’ll need to have Mid or Premium Hospital cover. All pregnancy and birth related services have a 12 month waiting period. More info
Phoenix Health Fund logo Top Hospital $500 Excess covers fertility treatment such as IVF and GIFT programs. More info
policehealthlogo Assisted reproductive services like IVF are covered by the Top Hospital policy. More info
Queensland Country Health Fund Top Hospital provides cover for assisted reproductive services such as IVF. Intermediate Hospital cover provides restricted cover for assisted reproductive services. More info
rbhslogo Under Gold Hospital cover, you can claim for 90% of the cost of IVF, up to $2,800 (lifetime limit). More info
RT health Under the Step Up Hospital you're only covered when you're treated in a public hospital for assisted reproductive services and treatments such as IVF. More info
St. Lukes Health Logo The in-hospital costs associated with IVF and other assisted reproductive services will be covered by St.LukesHealth less any excess that applies to your policy, providing you have served the 12 month pre-existing waiting period. More info
Teachers Health fund Infertility treatments are covered by Top Hospital, with restricted cover available under Mid and Basic hospital. More info
Cover provided for infertility investigations, assisted reproductive services under Ultimate Choice and Easy Choice policies More info
Platinum and Gold policies include cover for IVF. More info

Compare over 30 Australian health funds in a few clicks

Simply complete the form, hit Search Policies and use the refine search button in the top right-hand corner to sort policies by 'Assisted Pregnancy'. You'll need a hospital or hospital + extras policy.

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Picture: Unsplash

Brad Buzzard

Brad is an insurance writer whose background in analytics makes him the perfect person to research, analyse and interpret the complex world of insurance. When not writing, you can find Brad in the nearest yoga studio.

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