What's the difference between pregnancy with Public Medicare & Private Health Insurance?
Each has its own perks, and luckily no matter which one you choose, your baby will be in good hands.
Here we'll 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.
Public versus private overview
In Australia, you can choose between a free delivery using Medicare or a private delivery that may cost a little extra but offers a little more choice, comfort and help toward your out of hospital treatments.
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 to see a midwife. In the private system, you can go straight to your chosen OB in either a private clinic or private hospital.
- Where you go for your regular appointments. In the public system, you’ll go to a public hospital for your appointments at a time allocated to you. In the private system, you’ll most likely go to your OBs private offices and have a little more choice over time.
- 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 your appointments.
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. When it's time for you to come into the hospital, you'll be in a public room. However, if you book early enough and there aren't any foreseen complications, you may be able to book yourself into a birthing centre. In the private system, you will get your own private room with the opportunity to upgrade to a premium delivery suite.
- Who delivers your baby. In the public system, the team on duty at the time will be delivering your bub. When you go private, you can consult with an obstetrician of your choice. They'll come to the birth if they're available, If your obstetrician can't be there, they'll arrange another one.
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:
- Is privacy important? 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, a team of midwives will look after you during the birth with the on duty OB.
- 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, private health insurance could be worth it. Similarly, if there is a private OB you would like to see, private health insurance will give you more choice.
- Do you have a specific hospital in mind? With private, you'll have more choice over where you give birth.
- 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 (or gold tier policy. As an example, the following table shows finder.com.au partners. Prices are based on a woman living in NSW earning under $90,000. They all have a 12-month waiting period.
| Provider | Policy | Treatments included | Excess | Price | Apply |
|---|---|---|---|---|---|
 |
Hospital Gold |
|
$500 | $164.05 | Go to Site |
 |
Top Hospital Gold |
|
$750 | $168.90 | Go to Site |
 |
Gold Top Hospital |
|
$500 | $186.98 | Go to Site |
*Prices are based on a single policy for Sydney, 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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