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Thread: What does Medicare cover for pregnancy?

  1. #1

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    Question What does Medicare cover for pregnancy?

    Or maybe the better question would be, what doesn't it cover? I am new to Australia and I will be under Medicare in a couple months. BTW, the assume when everyone speaks of public vs. private they mean Medicare as public and something like Medibank Private for private. Right now I have Medibank Private's overseas student health insurance. If I'm wrong on that, please enlighten me. I find the internet to be no help at all.

    Does Medicare cover midwifes and birth centres or just classic births in a hospital? When a hospital/birth centre says no charges to public patients does that mean Medicare covers everything or just part of all their services or what? Also when a hospital/birth centre says no private patients or no public patients does that exclude those who pay out of pocket? Can you tell I'm really confused? Thanks.


  2. #2

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    Um, I am no help with the birth centres. But if you use the public hosiptal system then yes Medicare covers pretty much all of your preg & birth. Things you will need to pay for are things like Ultrasounds. some places do Bulk bill (medicare) others like the one I use in NSW doesn't but I only pay the gap, which is say the ultrasound costs $150. You pay that at the time of your appointment & then take your recipt to a medicare office & you can claim part of the cost back. So you may get say $80 back. If you use a place that only makes you pay the gap then you pay say $65 and then medicare sends you out a cheque made out to the ultrasound mob, which you then take into them. Does that make sence??

    other things that may be a cost to you are if you use a GP who does not bulk bill.

    I would imagine if the the birth center says no charges to public patients then they probably do use the medicare system, But just phone & check.

    Someone else will probably be able to answer your questions better.

  3. #3

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    Well I'm with a birthing centre within the hospital, and everything is covered by Medicare - which is the public system.
    There is a standard schedule to ensure that you shouldn't be out of pocket for anything along the way. So even for blood tests and everything like that, you just front up with your medicare card, show them that, and they should all be bulk billed.
    The only exception to this would be if you wanted to go through a different supplier than what your local system is - so for example I wanted a 9w scan because of a previous miscarriage, so I had to pay something like $25, Medicare picked up the rest (because I had a clinical reason for requiring the scan). If I wanted a scan at 30w becasue I felt like it - I would have to pay most of it.
    The scan at 19w which is the standard should be completely covered, and there shouldn't be a gap that you pick up - provided you go to the hospital or recommended u/s people, and not someone who you decide to go to.

    If anything happens in the birthing process, and you end up needing a c/s or anaesthetic - this will all be covered under Medicare provided you dont go flashing a private health cover card. But what this means is you get the drs on duty - you dont get to choose, and you will be a public patient in the public hospital - so sharing a room!

    I hope that helps - I'm guessing you could ask the birth centre for more clarification.
    Finally - if you are prepared to pay top dollar, I presume you can have what ever you want. This means you could be a public patient, but have a private OB, and pay from your pocket rather than paying a hefty medical insurance premium, and not getting it all back.

  4. #4

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    I have had all my babies under medicare and have had 4 c/sections,babies in NICU and flown from state to state and have never been out of pocket except for a few u/s and of course up front dr's fees which are reimbursed.. so as far as i have experienced there was no wories at all..and I have had no problems with dr's...

    jan xx

  5. #5

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    I am going to a public hospital for my antenatal care with the midwives and to have my baby and am not/have not payed anything. Medicare also covers ultrasounds if you go to a place that bulk bills.. same as if seeing a local GP.
    As long as its the "Public" system or they say they provide "Bulk Billing" then its all covered under Medicare and you dont have to pay a cent, just show them your Medicare Card.

  6. #6

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    Hi I was an overseas student as well. But was lucky enough to get permanent residence just before baby was born. As I had already servered the one year wait for maternity benifits on my overseas student health cover...I was eligible for private insurance maternity cover frm the same ins provider. Had to switch to a different cover tho.
    That maybe an option for you.....it was def worth going private for me.

  7. #7

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    I have private cover but have decided to go public (after much asking around for everyones opinions and advice).

    As above for public info..

    If you decide to go private, you do get lookd after by one person but you will still be anywhere between $1-2000 out of pocket by the time you have had baby (in my opinion thats alot of money I could spend on my bub)
    My sister in law is a midwife and passed on this info for private, she has worked in both private and public and even though she has private cover, she also opted for a public birth etc. If you are having any difficulties or are perhaps over 35 then the personalised Ob care is great. However the statistics show that there is a huge amount more of interferance or assisted births (forceps, ceasers etc). Most OBs have a schedule whereas midwives will let you giv birth in your own time without hurrying things along, unless you want them to.

    I know alot of people who went private first and then public 2nd time and said both were good experiences and there was no difference except the cost so why waste all that money I say.

  8. #8

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    Thanks for all the help. I definitely have a lot to look into in the next few weeks. I'll still be checking this if anyone else has any advice. Thanks.

  9. #9

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    I have gone public for all my pregnancies, which basically means attending the antenatal clinic at my hospital for all my appointments and being looked after primarily by midwives, although I can see an OB if I have a particular concern. I have not had to pay a cent for any ultrasounds or blood tests or any other tests, as I have had them all done at the hospital and they are covered by medicare. As for the birth, each time I have given birth with a midwife (or two) and an OB present. I don't get to choose who my carers are, but that has never been an issue for me. Afterwards I have shared a room on the maternity ward with two other women, although the beds were not always full, meaning that sometimes I only shared with one other person or I was on my own. Admittedly it can get annoying when the other people have noisy visitors but then I had my fair share of visitors too, so I couldn't complain too much! My after-birth care was good, although the midwives get very busy so you can be left on your own a bit, but if you need help they come fairly quickly, and most are more than happy to help you with feeding, bathing etc., especially if it is your first baby. When I left hospital and came home I was able to use the home midwifery service, where a midwife comes to your home at least twice in the first few weeks to check on things and offer any help/advice. This was free, and it is a great service.

    As I said I have never had to pay a cent for any of my pregnancies and I have been happy with the standard of care I received. I can't comment on the Private system as I have never used it, but I think even if I had private cover I would still go public for my pregnancies. But it really does depend on personal preferences - if you want to choose your doctor and see the same person throughout and you want a private room after giving birth, things like that, then private care would be the way to go. Also if you think you might want an elective caesarian, you will need a private OB as in general public hospitals will only do caesarians if they are medically warranted, as in emergencies.

  10. #10

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    KellsBells, I see you're going to be in Adelaide soon which is where I live. There are a number of public hospitals where you can have public antenatal / postnatal care depending on where you live. The biggest and most central is the Women's and Children's Hospital in North Adelaide. If you are a public patient then all the costs will be covered by medicare. You will be given the choice to have antenatal care by the Obstetricians or the midwives or even shared care with your GP. If your pregnancy is high risk then you will have to be seen by the doctors predominantly rather than the midwives. You get pretty frequent appointments - 4 weekly I think intially, then 2 weekly and weekly towards the end. You won't be able to choose your carer and will probably see someone different each time. The routine 18 - 20 week scan will be done at the hospital and also covered. For the delivery you will be seen by the doctors on duty - usually registrars - ie doctors who are towards the end of obstetric training - this does not mean they are not real doctors - most have done their 6 years of medicine to be doctors and anywhere from 3 - 7 years obstetric training. There will always be a senior obstetrician on call for any problems. If all goes smoothly you will go through the delivery with 1 midwife - 2 if there's a shift change. If there are no problems you will probably go through the delivery without ever seeing a doctor after you are admitted. But the advantage of public hospitals is that there is always a doctor on duty in the hospital including paediatric doctors if bubs gets in trouble rather than waiting for someone to drive in from home. (again training doctors but at least someone there.) The rooms in delivery are single rooms and in post natal ward - double rooms. I have worked in the area and I couldn't recommend it highly enough.

    The advantage of private is that you get to see the same person every appointment and at the delivery but there will be costs involved depending on who it is. You will also need to book quite early to get the person / hospital you want. You can also choose to be a private patient but deliver at a public hospital.

    I must admit that if I lived down south I think the ideal option as a private patient would be at Flinders Private Hospital. Flinders private is a beautiful private hospital but is attached to Flinders public. If anything goes wrong the public doctors are right there as well as a neonatal intensive care unit again in case bubs is in trouble. I think you get the best of both worlds there.

    Hope this helps with the Adelaide system. Let me know if you want more info.

  11. #11

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    I think I'm beginning to understand the system a little better now. But I think I'm still a bit confused over the difference between a birth centre and a hospital. I know birth centres are for low risk pregnancies only and are run by midwives. As I am low-risk, I would prefer this since I want a water birth if possible and not to feel pressured to accept intervention when it's not necessary. Since the birth centres are attached to hospitals, I've been getting confused by the posts which refer to a hospital because I'm not sure if they're talking about the birth centre or the hospital. I just want to make sure I am clear on the distinction. Can you have a water birth in a hospital and have only midwives if you're low-risk or do you need to do that in the birth centre? I just want to make sure I'm not getting myself into a situation where interventions are standard. Thanks.

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