Can health insurance pay for fertility treatment?  

For one in six Aussie couples who have trouble conceiving, the road to parenthood can be full of stress and heartbreak. Making matters worse, fertility treatments can be eye-wateringly expensive, putting many couples under financial stress.  

While the cost of fertility treatment varies wildly between clinics, as an estimate, the first consultation alone can cost up to $350. A single round of in vitro fertilisation (IVF) may be more than $9,000 – and there are no guarantees of success. According to data from the Victorian Assisted Reproductive Treatment Authority, 68% of women aged 36-37 don’t have a baby after the first round, so you could be facing multiple rounds of treatments. 

Whether you’re a couple experiencing infertility, a same-sex couple wanting to start a family or a single woman deciding to do parenthood alone, the cost of fertility treatments will no doubt weigh on your mind.   

Medicare does cover some fertility treatment costs, but there are still significant costs you’ll need to pay. Naturally, you might be wondering whether your Private Health Insurance can help meet those costs. Read on to find out more. 

Does Medicare cover fertility treatment? 

Fortunately, Medicare covers some fertility treatment costs, but there are usually out-of-pocket costs involved, such as fees for hospital procedures, medications and tests. Talk to your fertility specialist or clinic for a full breakdown of costs and what financial support you’re eligible for. 

Does health insurance cover fertility treatment? 

Yes, fertility treatments are covered by health insurance, but it depends on what level of cover you have, and there may be restrictions on what you can claim.  

‘Assisted Reproductive Services’ is one of the 38 Clinical Categories included in the Gold tier of Hospital Cover (in other words, the top level of health insurance). Some insurers offer it as part of Basic, Bronze and Silver cover, but there may be restrictions on what’s covered under Basic policies. 

What are the different tiers of cover, and what do they each include?

When it comes to fertility treatment, the main benefit of Private Health Insurance is for hospital costs. For example, if you need day treatment in hospital for a procedure, such as an embryo transfer, Hospital Cover will cover fees for the hospital, specialist, anaesthetic and medication. There may be a Gap, however, if the clinic or doctor charges a higher fee than what your health insurer will pay. We recommend you check with your insurer about what they’ll cover before you go ahead with private hospital treatments.  

If your current Hospital Cover doesn’t include Assisted Reproductive Services, you’ll need to upgrade to a higher tier, and serve a waiting period of 12 months before you can claim on treatments. Try our Calculator to find a policy that’s right for you.  

Learn more about waiting periods.

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

Read more.