MEDICARE SERVICES AT WHM AND BEYOND

WHAT MEDICARE REBATES ARE AVAILABLE FOR CONCEIVING, PREGNANCY AND BIRTH?

Medicare rebates help cover some of the health care costs of care provided at WHM.

MANAGING GYNAECOLOGY, FERTILITY AND PREGNANCY COSTS

WHM is a private billing clinic. However even in private medicine, you may receive help from Medicare you with your health care costs. This can include rebates towards you doctor or allied health visits (where eligible), pathology tests, and diagnostic imaging.

Private health insurance may also help you to reduce your out-of-pocket costs. You can ask your health insurer what your current policy covers. If you wish to have a private obstetrician care for you during a pregnancy you are planning,  keep in mind, many private health insurance policies have a 12 month waiting time before you can claim IVF and assisted reproduction services, pregnancy and birth costs.

WHAT DOES MEDICARE COVER IF YOU NEED HELP TO CONCEIVE?

If you require fertility treatment or IVF to conceive, significant out of pocket costs can be expected. If you are trying to conceive with a partner, it’s a good idea to register for the Medicare Safety Net. The Medicare Safety Net is designed to help to reduce your out of hospital costs once you meet “the threshold”. If you are single, you don’t need to register. However if you register as a family or a couple, Medicare combines your family’s medical costs to reach a shared threshold. After reaching the Medicare Safety Net, any family member is entitled to higher Medicare rebates.

Medicare can help you cover costs for outpatient specialist and GP appointments and also for fertility treatments including assisted reproductive treatments such as IVF and oocyte cryopreservation when performed for medical reasons.

IVF AND FERTILITY

If your WHM doctor has referred you for  fertility treatments, you can claim some money back from Medicare.

There is currently no limit on the number of assisted reproductive treatment rounds you can have in our WHM private practice.

Medicare rebates do not cover the full cost of treatment in our WHM private care model, where patients are responsible for some private costs.

Your total out of pocket costs will be influenced by which service you require and have elected to undertake and whether you have private health insurance.

WHM will endeavour to provide your with clear fee structure information and can assist you in claiming Medicare rebates to which you are entitled.

WHAT DOES MEDICARE COVER WHILE YOU’RE PREGNANT?

Medicare may help by providing rebates to contribute to or to cover the costs of:

  • Routine pregnancy ultrasounds

  • Pregnancy counselling

  • Blood tests (Please note specialist genetic tests including NIPT (Non Invasive Prenatal Testing) and expanded genetic carrier screening panels do not currently attract a Medicare rebate. Please ask the pathology company you plan to attend for clear cost information for privately billed tests)

  • Some vaccinations

  • Outpatient appointment rebates towards care from a private obstetrician

  • Telehealth/telephone consultation rebates towards care from a private obstetrician

These rebates also apply for our WHM Obstetrician lead share care program, Lead by Dr Tzippora Ben Harim. Shared care at WHM is ideal for patients who desire continuity of care from an experience obstetrician during their pregnancy, but who have not elected to take out private health insurance. Patients in our WHM shared care program attend antenatal visits and WHM and choose to give birth in the Victorian Public Hospital System.    

IS PREGNANCY COUNSELLING COVERED BY MEDICARE?

Being pregnant, especially after a fertility treatment journey, can bring up confusing and difficult emotions. Medicare helps to fund 3 counselling sessions to support you. This service can be arranged for WHM patients.

You can read more about Medicare rebates for pregnancy support counselling on the Australian Department of Health and Aged Care website.

IMMUNISATION AROUND A PREGNANCY

Before you become pregnant, it’s important to check your immunity status and that you are up to date with your immunisations.

Prior to pregnancy, if not immune, vaccination should be offered for Varicella and Rubella.

Pregnant women should have vaccinations for Pertussis and Influenza.

Vaccine medication costs are fully covered by Medicare cover through the Australian National Immunisation Program. You may access this scheme through your GP.

You can read more about immunisation for pregnancy on the Department of Health and Aged Care website.

WHAT DOES MEDICARE COVER WHEN YOU GIVE BIRTH?

Starting a fertility journey, this time point may seem a long way off. However, it is best to consider your options now.

You may choose to give birth is different service models, within the private and public hospital systems. In both scenarios, you are eligible for Medicare contributions for services provided by midwives and obstetricians when you give birth.

If you give birth in a hospital you can choose to be a private or a public patient. Public patients as a general rule will not have any out-of-pocket care charges.

If you choose to give birth at a birthing centre you should enquire about costs when you make your booking.

You’ll find some helpful information about being pregnant and having a baby on following Australian Government resource:  the Pregnancy, Birth and Baby website.

You can also find relevant episodes on our podcast “knocked up”.

WHEN YOUR BABY HAS BEEN BORN

If your baby needs extra care, such as specialist and intensive care unit services, Medicare may assist with costs.

Medicare also contributes rebates to assist with outpatient or in community care from midwives and obstetricians, immunisations for your baby and visits to your GP. This includes lactation and perinatal support services offered at WHM.

HAVE YOU ADDED YOUR BABY TO YOUR MEDICARE CARD?

It’s important to add your new baby to your Medicare card as soon as possible. Once you’ve added your baby, Medicare will issue you with an updated card. If you have the Express Plus Medicare mobile app, your digital Medicare card will show your baby’s name straight away.

When you give birth, your hospital will give you a form as part of the new Parent Pack. You can use this form to add your baby to your Medicare card.

Here is a link with further information about how to add your newborn to your Medicare card.