Public Medicare or Private Health Insurance - Where are they different?
When you find out a baby is on the way, one of your biggest choices will be whether to give birth in the public system using Medicare, or to give birth in the private system using private health insurance. Each has its own perks, and no matter what one you choose, your baby will be in good hands.
This guide will give you an overview of how each system is different at each stage of your pregnancy journey. Need a little more detail? We got you covered there too. Follow any of the links within this guide to find pages specific to each of your pregnancy questions.
Public versus private overview
In Australia, you have the luxury to choose between a free delivery using Medicare or a private delivery that may costs a little extra but offers a little more comfort, pampering and consistency.
In terms of the essentials, like how many appointments you go to, what test you need to take and how you choose to deliver, you won’t find much difference between the public and private systems.
The big differences centre on the professionals you’ll be interacting with, where you’ll be staying when you deliver, how long you’ll have to recover and what additional perks are available to you.
We’ll look at each stage of your pregnancy and explain what the major differences are at each stage of the journey.
Cost is also obviously a major difference, but we’ll look at that at the end.
Public versus private for your prenatal care
Your prenatal care starts the day you first see a medical professional to confirm your pregnancy, all the way to the day you give birth. You’ll be in and out of appointments with GPs, obstetricians (OB), midwives, radiologists (for ultrasounds) and other clinicians for blood work and genetic testing.
However, there are a few differences you should be aware of between public and private prenatal care. These are:
- Who you see first. In the public system, you will first see your GP who will refer you to the nearest public hospital or birthing centre. In the private system, you can go straight to your chosen OB.
- Where you go for your regular appointments. In the public system, you’ll go to a public hospital or birthing centre for your appointments. In the private system, you’ll most likely go to your OBs private offices.
- Who you see at these appointments. In the public system, you’ll see a group of midwives with the opportunity to see whatever OB is on duty when necessary. In the private system, you’ll see the same OB at a majority of your appointments, along with their smaller team of midwives.
Other than that, your appointment schedule will be about the same, and you’ll most likely have access to educational and fitness courses through both systems.
Public versus private for your birth
The big day has arrived! Regardless of whether you go public or private, you can deliver naturally, via c-section, with or without pain relief and even via waterbirth if that’s what you choose.
However, this is the stage of the pregnancy where the differences between the public and private systems start to become more clear - mostly because of how much more comfortable the accommodations are when you go private. Here are some of the major differences:
- Your accommodation. Most people in the public system will deliver in a shared public room. The only exception is that if you book early enough and plan to have an uncomplicated birth, you can book yourself into a more comfortable birthing centre. In the private system, you will get your own private room with the opportunity to upgrade to a more plush premium delivery suite.
- Who delivers your baby. In the public system, the OB who is on duty at the time will be delivering your bub. When you go private, your chosen OB will be the one who delivers your baby.
Public versus private for your postnatal care
Your postnatal care refers to your immediate recovery period in the hospital, as well as a period of time post-birth when you’re nursing yourself and your baby into good health. Whether you use public or private, you’ll receive the same number of basic check-ins, where doctors and midwives will make sure everyone is healthy. The big difference is that the private system offers much more in the way of counselling, education and therapeutic services.
Here are the differences you’ll notice:
- The length of your stay in the hospital. For an uncomplicated birth in a public hospital, you could be discharged as early as four hours after your birth. In a private setting, you will get to stay at least three nights. If you have a c-section, you’d be looking at around five nights in a public hospital or seven nights in a private one.
- Consultations. Apart from the two standard consultations everyone gets, your private cover may offer speciality lactation consultation. You may also still have access to private classes run by your OB.
- Natural therapies. Medicare won’t cover you for physio or massage, but a private extras policy will. This can come in handy as you work out some of those post-pregnancy niggles.
- Exercise classes. If your public hospital offers complimentary exercise classes, you may be able to attend for a certain amount of time post-baby. However, private health insurance offers more options. Not only can you ask your OB to attend some exercise classes they offer, but a private extras policy may also include cover for exercise classes of your choice.
The cost of going public versus private
Another major difference between delivering publicly and privately is cost. A Medicare-covered public birth is generally free. With a private birth, your insurer and Medicare will team up to pay a majority of the costs, but you’ll still have some out-of-pocket expenses.
Here’s what you’ll pay for:
- A portion of the essential procedures. For every procedure covered by Medicare and your private cover, there may be an additional amount that you have to pay. That’s because private doctors set their own prices, and these can go above what is covered.
- Tests. Medicare largely won’t cover tests performed in a private clinic, like bloodwork, ultrasounds and genetic testing. Your private insurer may cover some of this, but it will be up to you to pay the remainder. If you’re concerned, you may be able to ask your private OB to refer you to bulk-billing clinics if one is available.
- Fees. Medicare largely won’t cover any additional fees like accommodation fees, theatre fees or your doctor’s admin fees. Again, you private cover will take care of some of this, but there may be a portion you’ll need to pay out-of-pocket.
- Medications. If you need medication that is not part of the Pharmaceutical Benefits Scheme, you will have to pay for it whether you use public or private. However, if you have private health insurance, you may get a percentage of the costs back.
How to choose the best option for you
Deciding whether to have a public birth or a private birth isn’t always easy. On the one hand, you could have it done for free. On the other hand, you could have a much more comfortable birth for not much extra money, relatively speaking. That said, there are a few questions you can ask yourself to make the decision easier:
- Will your pregnancy be complicated? If your doctors think you’ll have an uncomplicated birth, you may be able to get most of the comforts of a private hospital using a public birthing centre. However, spaces are limited, they are only for uncomplicated births and you won’t have access to strong pain relief.
- Is privacy important? Many women in the public system will be giving birth in a shared space. With private, you are almost guaranteed to have a private room. If you don’t mind delivering around other people, then it may be worth saving the money by going public.
- Do you want more time to recover? The public system won’t kick you out before you’re ready, but the private system gives you a chance to kick your feet back with a few extra days to recover.
- Do you like consistency? With a private birth, you will see the same OB and a more intimate team of midwives throughout your pregnancy. In the public system, you will see whoever is on duty when you go in.
- Do you need additional support? Although the public system will give you access to some additional support like motherhood classes, exercise/nutrition classes and lactation consultation, private health insurance can offer much more, including massage and physio.
- Is there a particular hospital or OB you prefer? If the closest hospital is a private one and being close to home is important, you should consider private health insurance. Similarly, if there is a private OB you would feel comfortable with, private health insurance is the most cost-effective way to get consistent care from that same doctor throughout your pregnancy.
- Is it worth the cost to you? You can weigh up the cost of cover to see how much more you would be paying, start a sheet to document your out of pocket costs, separate you buying decision for hospital and extras and see if you might just want one top-level
At the end of the day, it’s a personal choice but if you’re still unsure, it doesn’t hurt to ask around for advice. Reach out to friends and family and find out what their experiences have been like. Hop onto some online forums and FB groups to hear from women there, many of whom will be from your local area offering local advice.
Compare private pregnancy options
Pregnancy cover can be found in a top-tier policy. There is usually a 12 month waiting period. As an example, the following table shows finder.com.au partners. Prices are based on a female living in NSW. , they all have a 12 month waiting period.
| Provider | Excess | Treatments included | Cost per month | Apply |
|---|---|---|---|---|
 Top Hospital |
$400 |
|
$155.47 | Go to Site |
 Premium Hospital |
$500 excess |
|
$155.29 | Go to Site |
 Premium Hospital |
$500 excess |
|
$160.37 | Go to Site |
 Advanced Hospital |
$500 excess |
|
$171.47 | More info |
*Prices based on individual female living in NSW
Different types of birth
According to the Australian Institute of Health and Welfare, in 2014, 307,844 women gave birth in Australia, and 98% of them had their child in hospital. Of those women giving birth, 73% of women gave birth in public hospitals while the remaining 27% gave birth in private hospitals.
In 2014, 205,927 of women (67%) had a vaginal birth and the other 33% (101,896) had a caesarean section. The majority (81%) of vaginal births were non-instrumental, but if instrumental delivery was required, vacuum extraction (11%) was used more commonly than forceps (8%).
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