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Do you need health insurance to have a baby?

We compare public vs private care, and reveal the best health insurance policies for pregnancy and birth from both open and restricted health funds.

pregnant woman at doctors insurance
Last updated: 14 October 2019

Not everything in life goes to plan, and the birth of your baby is no exception. But you can have control over what type of care you receive during your pregnancy.

The decision about how and where you want to give birth, and if you want to go private or public is very personal.

Jump straight to our expert picks for the best health insurance for pregnancy and birth (members-only content).

Public vs private care for pregnancy and birth

In Australia, doctors in private and public hospitals alike provide high quality care for pregnancy and birth. The main advantage of going private is that you can choose the obstetrician who cares for you during your pregnancy and attends the birth.

However, this may not be the best option for you if you prefer a 'natural birth'. The statistics are pretty clear on this: there are more natural births (non-instrumental vaginal births with or without pain relief) in public hospitals and more caesareans in private hospitals.

Birth in public vs private hospital – the stats
Public (%) Private (%)
Vaginal birth 56 38
Ceasarean 32 47
Vacuum suction 6 11
Forceps 6 4
Source: AIHW. Labour and birth: Method of birth 2017.

In 2017, about 301,000 women gave birth in Australia; the vast majority – 97% – in a hospital, almost 2.5% in birth centres, and a small number at home, on the way to hospital or in a remote community health centre. Of the mothers who delivered in hospital, 74% did so in a public hospital and 26% in a private hospital.

CHOICE tip: It's important to choose the right obstetrician for the type of care you want. Ask about their rate of interventions, particularly caesareans.

Giving birth in a public hospital as a public patient

Pros

  • Lower rate of interventions and higher rate of natural births.
  • Only very small, if any, out-of-pocket costs.
  • Usually better facilities if you have a high-risk pregnancy or a sick or premature baby.
  • Some hospitals have birth centres or midwife programs, where you can get more personalised care with your own midwife. Book in early, these programs are very popular.

Cons

  • You often don't know the doctor and midwives attending your birth and may see a different doctor/midwife each time.
  • Food and facilities may not be as nice as in a private hospital.
  • You often have to share a room with other mothers and their babies.
  • You may be cared for by junior doctors, who will call in a specialist when needed.

Giving birth in a private hospital as a private patient

Pros 

  • Continuity of care with your own obstetrician and their midwives during your pregnancy. 
  • Food and facilities may be nicer than in a public hospital. 
  • Better chance of getting a private room and your partner may be able to stay with you. 

Cons 

  • Higher rate of interventions and lower rates of natural births. 
  • High out-of-pocket-costs. 
  • Your obstetrician may be on leave or may not make it in time for the birth. 
  • You usually won't know the midwives who attend your birth and provide postnatal care.  
  • If your baby or you need intensive care you may need to be transferred to a public hospital. 
  • Doctors and anaesthetists are often not on site but have to be called in. 
  • While they'd usually get there within 30 minutes this can be a disadvantage in an emergency. 
  • Some public hospitals also have staff available on-call, after hours, rather than on site.

CHOICE tip: Some public hospitals may encourage you to use your private hospital cover as a public patient without any cost to you – while there is no difference in your medical care, you may have a better chance of getting a private room.

How much does it cost to give birth?

Public patient

If you go to a public hospital as a public patient, you'd normally be fully covered by Medicare. But out-of-pocket costs could arise for:

  • shared care with a GP who doesn't bulk bill
  • scans or pathology outside of hospital
  • childbirth classes

Private patient

Even if you have private health insurance, large and sometimes unexpected out-of-pocket costs can arise for private care. Health funds are not allowed to cover out-of-hospital care. Therefore, each time you visit your obstetrician, you may have out-of-pocket costs. The amount depends on if and how much they charge above the Medicare Schedule Fee. The largest cost may be the pregnancy management fee, usually between $3000 and $5000. There are also caps on fees covered by the safety net, so even if you have already met the safety net, you could still be out of pocket. 

According to health insurer BUPA, out-of-pocket costs as a private patient for uncomplicated pregnancy and birth can range from $1725 to $7392 in a private hospital and only slightly less in a public hospital. 

Ways to cut down on the costs

  • Check with your health fund for an obstetrician who uses the fund's gap scheme for the birth and would attend to you in a hospital that has an agreement with your health fund.
  • Use shared care with a GP who bulk bills.
  • Ask your obstetrician to detail all costs beforehand.
  • Consider being a private patient in a public hospital. It's less likely that you'll have unexpected out-of-pocket costs for blood test, x-rays and ultrasounds, anaesthetist and paediatrician.  

Health insurance waiting periods for pregnancy

Health insurance is one of the things you need to think about well ahead of time if you're planning to have a baby. 

If you want your baby to be covered, you need to upgrade your existing policy to a family policy. If you have a normal birth and your baby is healthy, they usually won't get admitted to hospital, so you may not need cover for them right away. 

But if your baby is born early, has any health issues or you have twins, they may need to be admitted to the special care nursery or intensive care. This can cost thousands of dollars.

CHOICE tip: If you are a private patient in a public hospital and your baby needs to be admitted, you can usually choose if you want them to be a private or a public patient. 

Checklist

  • Look for a Gold-level private health insurance policy that does not apply the excess to children.
  • Take out private health insurance well ahead of getting pregnant. There is  a 12-month waiting period that applies to the date you're admitted to hospital for the birth. 
  • You won't be covered if you have a premature birth within the waiting period or even if you give birth only a few days before the end of the waiting period.
  • Check with your health insurer how soon you need to upgrade to family cover so that your baby is covered.
  • Once you're pregnant, check whether you have served the waiting period. If you give birth before the waiting period is up, consider going to a public hospital as a public patient. Don't worry, Australia has a world-class health system and public hospitals have excellent birthing facilities.

Cover for midwives and doulas

A private midwife can provide pregnancy care, sometimes under an agreement with an obstetrician and in some states may be able to attend births in hospitals, birth centres and at home. 

A doula is an extra support person who does not provide medical services but can provide extra support. They can help you and your partner to prepare for the birth process and offer relaxation techniques such as massage to help you during labour. They also usually visit you after the birth and can help with a debrief and referral to other services, for example if you have problems with breastfeeding. 

Both models of care are associated with a lower rate of interventions.

Midwives

  • Care by a midwife could cost between $3000 and $6000. 
  • Depending on the whether the midwife is endorsed by the Nursing and Midwifery Board, under some circumstances Medicare and some private health funds may pay part of the cost. It's important to check with the midwife beforehand.

Doulas

  • Depending on experience and level of service provided, costs usually range from $800 to $2000.
  • Doulas do not qualify for Medicare or health fund rebates. 

Best health insurance for pregnancy and birth

Our insurance experts have compared hospital policies from open and restricted health funds to find the best cover for pregnancy and birth. The below information is for CHOICE members only. 

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