Medicare during pregnancy
7-minute read
Key facts
- Medicare may cover many of the health care costs of having a baby, including doctor and midwife visits, ultrasounds and blood tests and having your baby in an approved facility.
- Your state or territory government may also help to pay some of the costs of some services after your baby is born.
- If you are not eligible for Medicare, you will usually be charged the full cost of your care, so you may wish to purchase private health cover before you are pregnant.
- Private health insurance doesn’t usually cover all the costs associated with your pregnancy, so you may still have some out-of-pocket expenses.
What is Medicare?
Medicare is a health insurance scheme funded by the Australian Government. It gives eligible people access to many types of medical care and hospital services at a lower or no cost, including many medical expenses related to pregnancy and birth.
Medicare covers:
- free treatment and accommodation for public patients in a public hospital or birth centre
- free or subsidised treatment from health care professionals, including obstetricians, doctors and eligible midwives
- free or subsidised ultrasounds and blood tests
- free or subsidised telehealth consults
- 75% of the Medicare benefit schedule in-hospital services that you receive as a private patient in a public or private hospital (This does not include hospital accommodation, theatre fees or medicines.)
If you need help to conceive, Medicare may also help you to cover the costs of fertility treatments or IVF.
Am I eligible for Medicare?
All Australian residents are eligible for Medicare, as are some visitors to Australia. You can check your eligibility for Medicare at Services Australia.
If you don’t have a Medicare card, you will need to apply for one to access Medicare-funded services. Contact Services Australia to find out how to enrol.
What is covered by Medicare during pregnancy, birth and early parenthood?
If you have a Medicare card, your costs during pregnancy and birth will be subsidised by Medicare. How much Medicare will cover and whether you will have any out-of-pocket costs will depend on your choice of antenatal care provider and where you give birth.
Antenatal care
While you are pregnant, Medicare may help with the costs of:
- midwives and/or obstetricians in the public healthcare system
- routine ultrasound scans
- pregnancy counselling
- blood tests
- some immunisations (for example, whooping cough and influenza vaccination are provided free under the National Immunisation Program.)
- telehealth and telephone consults
You can claim usually Medicare benefits for these services when you are at the doctor’s office. If your doctor bulk bills you, you won’t have to pay any ‘gap’ or ‘out-of-pocket’ cost.
Labour and birth
When you give birth, you can choose to be a public or a private patient.
Medicare may cover:
- care from midwives and/or obstetricians in a public hospital, birth centre, or publicly funded homebirth program
- your stay in a public hospital or birth centre
- some in-hospital medical tests and scans
If you choose to give birth as a private patient in a public or private hospital, you will usually have some out-of-pocket costs that are not covered by Medicare or by your private health fund.
Make sure to ask about the costs involved in your birth when you make your booking.
Postnatal care
After your baby is born, Medicare covers some or all the costs of:
- care from midwives and/or obstetricians in a public hospital, birth centre or publicly funded homebirth program
- immunisations for your baby
- visits to your GP
Medicare may also cover some of your costs if your baby needs special care, such as a specialist or intensive care unit services.
Your state or territory government may also help to pay some of the costs of services after the birth.
Adding my baby to my Medicare card
After your baby is born, it’s important to add them to your Medicare card as soon as possible. Your midwife or hospital will give you a form to do this. You can find more about enrolling your baby in Medicare on the Services Australia website.
What isn’t covered by Medicare during pregnancy and birth?
Some services are not covered by Medicare, for example:
- your hospital stay as a private patient in a private or public hospital
- gap fees for private obstetricians or private midwives caring for you during pregnancy or after the birth
- fees for private midwifery care during labour and/or birth at home
- out-of-pocket private hospital expenses, including medicines
- some antenatal tests, such as non-invasive prenatal testing (NIPT)
If you have private health insurance, you may be covered for some of these services.
What if I am not eligible for Medicare?
If you are not eligible for Medicare, you will have to pay for all the costs involved in your pregnancy, birth and postnatal care, whether you choose to be cared for in the public or private hospital systems.
A private health insurance that includes maternity care may help you cover some of your costs.
If you are planning a pregnancy, it’s good idea to look into your options early. Many private health insurance funds have a waiting period of 12 months before they will cover you for maternity care. If you do not take out private insurance in time, you may need to pay the full costs associated with your care.
If you’re not an Australian resident, you can read more about pregnancy care on a visa in Australia.
Resources and support
Find out more about what Medicare covers during pregnancy from Services Australia.
Read more about Medicare and other benefits
Speak to a maternal child health nurse
Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.