Becoming a parent is an experience that defies any words. However, this happiness comes with certain responsibilities and financial liabilities. After a baby is born, parents need to plan their finances well to ensure a good education and a healthy future for the child. But financial expenses start even before the baby sees the light.

Couples expected to be parents soon should invest in the right private maternity care insurance policies. Keep in mind that not all private health insurance plans include maternity care by default. Therefore, you need to buy health coverage, keeping maternity care in mind. However, the insurance policy cost has increased over time, making it difficult for people to afford it.

Despite paying high insurance premiums, a recent report states that around 60% of the hospital bill for maternity care turns into an out-of-pocket expense for the policyholders. Such a scenario has raised several doubts and questions about private maternity care. Is it still worth investing in private health insurance policies that include maternity care? Can couples planning to have babies afford policies with high premiums? Let’s explore the answers to these questions in the following section.

Challenges to the Private Maternity Services

The private maternity sector in Australia is shackled with many challenges in today’s time. Expectant parents who are ready to pay for a top-tier hospital cover may find that the coverage is disappointing since out-of-pocket expenses will be high. In the following section, find a discussion on some of the major challenges.

Closure of Private Maternity Wards: A report states that around 18 private maternity units have shut down since 2018. Amidst the possibility of closures of more maternity units, there could be a serious service lapse in private hospitals. Many hospitals claimed that private health insurers are not reimbursing adequately for maternity services.
Fewer Options, Fewer Obstetricians: Since the private maternity wards are getting closed, a growing number of obstetricians are visibly stepping away from the private delivery services. In such a scenario, the patients find fewer options for private maternity care. Nevertheless, the presence of fewer obstetricians also raises concerns.
Regional Disparity in Services: Regional disparity is another significant challenge when it comes to discussing private maternity care in Australia. While private hospitals in urban areas are still well-equipped to provide maternity services, the hospitals in rural or remote areas are crippled with manpower shortage, inadequate infrastructure, etc.

The Cost Breakdown for Private Maternity Care

The cost of maternity care at private healthcare centres includes private room cost, obstetrician’s fees, charges for various tests, and more. Couples expecting babies often invest in private health insurance policies to cover the expenses involved in maternity care. However, they surprisingly often end up paying hefty out-of-pocket expenses. Let’s explore the typical out-of-pocket expenses in private maternity care.

Obstetrician’s Fee: Often ranges between $3000 and $6000, the obstetrician’s fee is a typical out-of-pocket expense. Medicare may cover a small portion of the obstetrician’s fee.
Scans and Tests: Your private health insurance may not provide complete coverage for various maternity tests and scans, resulting in out-of-pocket expenses.
Newborn Care Costs: Most maternity care insurance policies do not include newborn care costs. Therefore, additional charges are incurred when the baby needs special care.

So, the overall out-of-pocket expense stands around $6000-$12000. Despite paying hefty premiums for comprehensive maternity care coverage plans, people often need to bear the out-of-pocket expenses.

Why Can’t Private Health Insurance Cover Everything?

Private health insurance policies that include maternity care coverage come with certain loopholes. Find the reasons why out-of-pocket expenses are so high in private maternity care.

Private Hospital Coverage: A private health insurance policy typically covers in-hospital medication, hospital accommodation, anaesthetic services, etc. The policy does not include an obstetrician’s maternity management fee.
Unregulated Obstetrician Fee: Obstetricians in Australia typically charge beyond the Medicare schedule. Despite Medicare rebates, the fee gap remains significantly high, resulting in a hefty out-of-pocket expense.
Policy Limitations: The health insurance policy that you may have chosen can exclude certain crucial tests and maternity care services. Therefore, your out-of-pocket expense may increase due to the wrong policy selection.

What Should Expecting Parents Do?

Couples planning for babies should keep a few things in mind when choosing a private health insurance policy. Here are some practical tips that will help you pick the right policy and reduce the out-of-pocket expense.

Review and Adjust Health Insurance: You need to review and adjust the health insurance policy for your convenience. Typically, most policies showcase a 12-month waiting period for maternity. Therefore, you need to plan to purchase the health coverage well-ahead.
Ask for Itemised Cost Estimation: Before you book an appointment with an obstetrician, you should ask for a written breakdown of all anticipated costs. This will help you to plan ahead and take necessary measures to prepare for a hefty out-of-pocket expense.
Choose a Known Gap Provider: Some obstetricians and maternity care providing hospitals participate in the known-gap arrangements. Choosing such obstetricians or healthcare facilities will eventually help reduce your out-of-pocket expenses.

Conclusion

Private maternity care can offer comfort, continuity, and choice—but today, it comes at a rising cost. Many families are discovering that even with comprehensive private cover, they’re still paying thousands out of pocket. To avoid surprises, it’s crucial to plan early, understand exactly what your policy covers, and explore all your birthing options—public and private alike.

Searching for the best private health insurance plan that includes maternity care? Visit Compare Your Health to find comprehensive health insurance plans suitable for pregnant women. We help you find the best plan so that out-of-pocket expenses are reduced.