Although private health insurance will pay benefits towards the in-hospital services you receive during your pregnancy, you may still have out-of-pocket expenses to pay.
For inpatient medical services, Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee for your obstetrician, anaesthetist and any other doctors, as well as any diagnostics billed with an MBS item number (e.g. x-rays or lab tests) while you’re admitted to hospital. Medibank pays the remaining 25% of the MBS fee (as long as you’ve completed any relevant waiting periods).
Keep in mind that some doctors charge rates that are higher than the MBS fee for a particular service. When this occurs, you’ll have to pay the difference — this is known as the ‘gap’. You can reduce or eliminate these out-of-pocket expenses by choosing doctors who agree to participate in Medibank’s GapCover.
Another consideration is what hospital you attend. Medibank has arrangements with most private hospitals and day surgeries in Australia — these are known as Members’ Choice hospitals. You’ll generally get better value if you go to one of these providers. If you’re treated at a non-Members’ Choice private hospital, we’ll generally pay lower benefits and you may incur significant out-of-pocket expenses. Where you’re treated as a private patient in a public hospital, we’ll pay benefits towards overnight and same day accommodation in a shared room.
You may also have out-of-pocket expenses for any services your baby receives. Generally, a healthy newborn isn’t separately admitted to hospital as an inpatient (this is because the baby comes under the mother’s admission). Because the baby isn’t an inpatient, it’s important to be aware that any treatment, tests or doctor’s visits (e.g. a pre-release check-up by a paediatrician) are outpatient services, for which Medibank doesn’t pay any benefits. This means you’ll only be eligible to claim a Medicare rebate for those services and may have out-of-pocket expenses.
We recommend that you talk to your obstetrician, the hospital and Medibank about what costs you can expect and how you can reduce them.
For more on this topic read our article: Understanding the Costs of Having a Baby