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Health Insurance for Pregnancy
Health Insurance for Pregnancy
Written by
Madeline Pettet
Edited by
Ellie Garran
Reviewed by
Dr Jill GambergHow does health insurance for pregnancy work?
There’s no specific health insurance just for pregnancy, but coverage for pregnancy and birth is included in some hospital cover policies. This means the birth itself, plus obstetrics treatment in the lead-up to it. You can also find coverage for IVF (assisted reproductive services) on some policies.
Do I need health insurance for pregnancy?
It’s not mandatory to have cover for pregnancy; you can give birth in the public health system. Private health insurance can involve out-of-pocket costs, but it will allow you to give birth in a private hospital, and give you more flexibility and choice in your care. About 25% of women who gave birth in Australia in 2023 opted to go private.1Australian Institute of Health and Welfare – Data tables: National Perinatal Data Collection annual update 2023
In 2024, almost 5% of iSelect customers told us their main reason for comparing their health insurance was because they were planning on having a baby. The average age of those planning to have a baby was 31.
Pregnancy cover explained
Learn more about how pregnancy cover works in this short video.
Laura Crowden
ISELECT SPOKESPERSON
What does health insurance for pregnancy cover?
Assisted reproductive services, including IVF
Gold tier hospital policies cover procedures like in-hospital IVF egg collection and embryo transfers as part of the ‘assisted reproductive services’ category. If you’re on a gold tier policy, you’ll likely have these procedures covered too.
Caesareans
As long as you’re covered for pregnancy and birth, you’ll also be covered for a C-section.
Home births
While they might not be as common as you’d like, you might find a policy that includes partial cover for the costs for a homebirth with a private midwife attending.
Miscarriage and termination
If, sadly, this pregnancy isn’t meant to be, a hospital policy that covers pregnancy will most likely also cover these procedures.
Prenatal and antenatal classes, and birthing courses
Some extras policies have coverage for a range of classes related to labour, birth, and being a new parent. Not every extras policy covers classes, and the provider will need to be recognised by your insurer.
Twins and multiple births
If you’re blessed with an extra bundle of joy, any treatments related to being pregnant with and giving birth to twins or multiple babies will generally still be covered, assuming you have pregnancy and birth coverage.
Full costs of a treatment every time
Even if you do have coverage for a procedure or treatment, you may still have a gap payment. This covers the difference between the cost of the treatment, different doctor’s fees (including obstetricians, anaesthetists, and surgical assistants), and what your insurance covers.
Newborn care
Pregnancy cover is about taking care of you. If your baby arrives needing a little extra TLC, they may be formally admitted to the hospital, meaning their care no longer comes under your policy. If you want bub’s costs to be covered by private health insurance, you may want to switch to a family policy. The clincher is, you might need to have done this as early as a year before they’re born.
Services outside of hospital
Unfortunately, hospital policies don’t cover consultations with specialists, like an obstetrician, or related services, like ultrasounds, if you aren’t admitted to hospital for them. Sometimes Medicare may get you some money back, though.
Assisted reproductive services, including IVF
Gold tier hospital policies cover procedures like in-hospital IVF egg collection and embryo transfers as part of the ‘assisted reproductive services’ category. If you’re on a gold tier policy, you’ll likely have these procedures covered too.
Caesareans
As long as you’re covered for pregnancy and birth, you’ll also be covered for a C-section.
Home births
While they might not be as common as you’d like, you might find a policy that includes partial cover for the costs for a homebirth with a private midwife attending.
Miscarriage and termination
If, sadly, this pregnancy isn’t meant to be, a hospital policy that covers pregnancy will most likely also cover these procedures.
Prenatal and antenatal classes, and birthing courses
Some extras policies have coverage for a range of classes related to labour, birth, and being a new parent. Not every extras policy covers classes, and the provider will need to be recognised by your insurer.
Twins and multiple births
If you’re blessed with an extra bundle of joy, any treatments related to being pregnant with and giving birth to twins or multiple babies will generally still be covered, assuming you have pregnancy and birth coverage.
Full costs of a treatment every time
Even if you do have coverage for a procedure or treatment, you may still have a gap payment. This covers the difference between the cost of the treatment, different doctor’s fees (including obstetricians, anaesthetists, and surgical assistants), and what your insurance covers.
Newborn care
Pregnancy cover is about taking care of you. If your baby arrives needing a little extra TLC, they may be formally admitted to the hospital, meaning their care no longer comes under your policy. If you want bub’s costs to be covered by private health insurance, you may want to switch to a family policy. The clincher is, you might need to have done this as early as a year before they’re born.
Services outside of hospital
Unfortunately, hospital policies don’t cover consultations with specialists, like an obstetrician, or related services, like ultrasounds, if you aren’t admitted to hospital for them. Sometimes Medicare may get you some money back, though.
When it comes to health insurance, it’s important to remember to check your policy documents for what you are and aren’t covered for.
What out-of-pocket costs can I expect with health insurance for pregnancy?
Having a baby in a private hospital can be expensive. For this reason, it’s important to understand your coverage before choosing a policy. As well as your chosen excess, you might be expected to pay for all or some of:
- your hospital fees
- check-ups with your obstetrician
- visits with a paediatrician
- ultrasounds.
The good news is that some of these costs may be covered by Medicare. But there’s also potentially a gap between what a treatment costs and the cost it has listed on the Medicare Benefits Schedule. Unless your provider has a gap cover agreement with the hospital you choose, you’ll probably need to pay that too.
We’ve gathered some of the costs you might encounter for common pregnancy-related procedures as a private patient – or at least what they were in 2023–24. Depending on the procedure, sometimes your private health insurance chips in to help cover the cost; sometimes it’s just between you and Medicare. You might also initially pay more and have Medicare refund a portion of it.
| Procedure | Patients typically paid out of pocket | % of patients with out-of-pocket costs |
| Initial obstetrics specialist appointment | $174.00 | 81% |
| Follow-up obstetrics specialist appointment | $99.00 | 69% |
| Pelvic or abdominal ultrasound before 12 weeks | $175.00 | 50% |
| Pelvic or abdominal ultrasound between 12 and 16 weeks | $246.00 | 83% |
| Pelvic or abdominal ultrasound between 17 and 22 weeks | $288.00 | 90% |
| Pelvic or abdominal ultrasound between after 22 weeks | $225.00 | 66% |
| Vaginal delivery (no complications) | $420.00 | 38% |
| Caesarean section (no complications) | $500.00 | 65% |
Sources: Medical Costs Finder – Caesarean section (no complications); Follow-up specialist appointment; Initial specialist appointment; MBS item 55700; MBS item 55704; MBS item 55706; MBS item 55718; Vaginal delivery (no complications),
Note: These are the amounts patients typically paid for these services in 2023–24, rounded to the nearest dollar. They do not include hospital payments such as excesses, co-payments or other payments. These fees may vary depending on your situation. Not all patients had out-of-pocket costs; those who didn’t aren’t included in these figures. Data retrieved May 2025.
Is it worth getting health insurance for pregnancy?
Pros
You can choose your own doctor
In the public system, you often can’t choose which midwife or doctor you see. You also can’t necessarily see the same doctor over the course of your pregnancy. On the other hand, in the private system, you can choose your doctor. They’ll also treat you throughout your pregnancy, birth, and afterwards. If this kind of choice and continuity of care is important to you, you probably want private health insurance.
You could get money back for pre- and post-birth classes
Whether or not this is your first rodeo, you might be grateful for some practical support and advice. Some extras policies will give you a rebate on your class fees, both before and after the baby’s born. These could include topics like preparing for labour, breastfeeding, and bathing your new bub.
You can (potentially) stay in a private, nicer room
In the public system, you might need to share a hospital room with others, which could mean your partner can’t stay overnight with you. As a private patient, you’re more likely to get a private room after you give birth, whether you’ve opted for a private hospital or a public one. In a private hospital, you might also have access to more pleasant facilities. You may also get to stay in hospital a bit longer if you want to. Australians who gave birth in a private hospital in 2023–24 stayed 4.5 days on average. Those who opted for a public hospital only tended to stay for 2.8 days.2Australian Institute of Health and Welfare – Admitted patient care 2023–24 5: What services were provided?
You can access massage and some natural therapies
Pregnancy can be an exciting time, but it can also be tough on your body. This might be a time you need some extra help, whether it’s an acupuncture session to help with nausea or a massage to ease your muscles and joints. Depending on your policy, many extras plans can help you access these treatments and more.
Cons
Waiting periods can be long
If you’re taking out hospital insurance for the first time or upgrading your cover so that it covers pregnancy, waiting periods may apply before you can start claiming. For pregnancy, the waiting period is 12 months. So if you didn’t start planning a few months before you conceived, it might already be too late to get covered.
You may still have out-of-pocket costs
Costs for medical services outside of hospital won’t be covered by your hospital policy, although your extras policy and Medicare may help. Similarly, you may need to pay an excess or co-payment upon admission to hospital. For the costs your health insurance does cover, there may still be gaps left for you to pay, and these can be considerable.
If you want bub covered, you might need to upgrade your policy far in advance
Funds differ on their rules for newborns, but your newest family member may not be automatically covered under your policy. Instead, you may need to switch to a family policy before the big day, sometimes even as far as 12 months in advance. This may not be an issue if all goes well and your baby doesn’t require hospital care, but you might have greater peace of mind knowing they’re covered just in case.
You may not otherwise need such a high level of cover
Gold tier policies have the greatest level of hospital cover. But, aside from pregnancy, you might not want or even need such extensive cover. If you’re young and healthy with no real health concerns, cover for things like weight loss surgery, kidney dialysis, or cataracts may not add that much value for you.
‘While giving birth in a public hospital was such a positive experience for me (our midwives were absolute gems), a few extras would’ve made things even better. Having my own room would’ve been lovely (I shared with another new mum whose baby wasn’t a fan of sleep). Nicer meals wouldn’t have hurt either (my first dinner as a mum wasn’t particularly appetising). Staying a bit longer to ease into things would’ve made a huge difference, not to mention a proper bed for my partner so he could stay overnight with us.
These perks you hear about with private patients would’ve been the icing on the cake for our first salvo into parenthood. Given our first experience, my partner and I are considering maybe becoming a private patient in the same hospital for the next kid.’
Tina Sendin
Digital Writer, iSelect
At what age are people planning to have a baby?
Everyone likely has a different idea of when the right time to start a family is. However, the average age of iSelect customers looking to start a family in 2024 was 31 years old. This lines up pretty closely to national figures, as the average age of new mums in 2023 was 29.9.3Australian Institute of Health and Welfare – Australia’s mothers and babies
When it came to preferred policy types in 2024–25, more of these customers were looking to take out a single female policy, followed by those looking for a couples policy.
Helpful tip
There is generally a 12-month waiting period before you can claim on pregnancy and obstetrics services. If you would like the option of giving birth in a private hospital and choosing your own obstetrician, it is important to take out or upgrade your health insurance policy before you start trying for a baby! Once you are already pregnant, it is too late to opt to have your baby privately – unless you’re prepared to self-fund the full out-of-pocket cost (which is very expensive).
Dr. Jill Gamberg
GP, Coach and Lifestyle Medicine Physician
Frequently asked questions
What type of health insurance should I get for pregnancy?
When it comes to hospital cover, generally only gold policies – or the rare silver plus policy – cover pregnancy. When it comes to extras, you have more freedom to choose your own pregnancy adventure. Prenatal classes? Acupuncture? Remedial massage? It’s up to you.
What are the waiting periods for pregnancy health insurance?
No matter what your plans are, the time to get pregnancy cover could be now. That’s because once you’re already pregnant, it’s too late. There’s a 12-month waiting period before you can claim pregnancy treatments on your private hospital insurance. A good rule of thumb is to get your insurance sorted six months before you conceive, to make sure your bundle of joy is born safely outside the 12-month waiting period.
When should I upgrade to a family policy?
The definition of pregnancy coverage is pretty literal: it insures your pregnancy and birth, but not your child once they’re born. To make sure your baby’s covered, you’ll need to investigate the options under a family health insurance policy.
Timing is also important here. Many providers ask you to upgrade your health insurance to a family policy three months before your baby’s birth. But some expect you to upgrade as much as a year in advance. So it’s worth checking directly with your fund.
If you’re trying for your first baby, it could make financial sense to upgrade just the mum-to-be’s policy to cover pregnancy (single female), rather than paying for a more expensive couples policy. You’ll just need to remember to switch to a family policy ahead of bub’s arrival!
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