Is health insurance with pregnancy cover worth it?

Hi all,
My SO and I currently have a health insurance policy each as I was previously told that the couple's one wasn't any cheaper (by one of those compare the market consultants). We must have cover for tax purposes.

We are planning to start a family soon and I'm just not sure whether it's worth going from our $120 per month plans (altogether) and go to plans that cover pregnancy at $300+ per month. These were private room etc at the hospital and potentially choice of obstetricians, although that's never gauranteed.

Also, we never claim extras.

Overall, my question is, if you are trying to save for upcoming family, is it important to have good health insurance that covers pregnancy. Any suggestions on good lowest priced plans that cover if you do recommend yes would be amazing.

Your thoughts are appreciated.

Comments

  • +2

    We were in the same position as you a couple of years ago. It depends on how important private care is to you. We opted to just go through the public system and save that money for the baby. We have no regrets, the public system is great and we were in and out in a few days.

    • +3

      As above, check out the Public Hospital you would be going to and seek out opinions from people who delivered in that hospital.
      Our experience with the public system was superb and the cost difference is truly staggering!

  • +2

    Depends on what the local hospitals are like.
    We went public and so didn't claim anything except ambulance as it went from 0-100 very quickly.

  • +6

    Yes. If you want to stay in a private hospital it is worth it.

    We have tried both, the first pregnancy nothing went wrong so it was fine in the public system. Second pregnancy, heaps of things went wrong (could have been worse) but there was a possibility that my wife would have to stay in hospital for a significant period prior to the delivery date, and it would have been not as nice in public.

    Ultimately, she delivered in private and was able to stay in hospital longer after the delivery, and had a private room all to herself.

    Also, we had the same doctor the whole time (this was not covered by insurance).

    By contrast my sister had pregnancy difficulties and went public. She had a different doctor each time, and they would not keep her in hospital prior to the birth, even though she was not able to be more than 10 minutes from a hospital. Conveniently my parents own a property within 10 minutes of a hospital so she could stay there, as her home address is not within 10 minutes of a hospital.

    When she delivered she was sent home from hospital within about 4 days, whereas my wife was able to stay over a week to recover.

    Having seen all of this, although the private experience was expensive, it was definitely money well spent, and I hold strong philosophical objections to the notion of private health.

  • +4

    We were in your position a year ago and I do have some advise:

    -We had 2 separate single covers ourselves with the Mrs having the pregnancy cover on hers - worked out to be cheaper than having a couple's cover with pregnancy cover.

    -Please note that one of the biggest out of pocket expenses you will have is the OBs pregnancy management fee which can range from anywhere from 2K to 5K (maybe even more depending on the OB). You get back some of the money thru medicare (you get a bit more back if you have hit the medicare safety net threshold which I'm sure you will anyway).

    -Overall, I would still recommend having private pregnancy cover as it gives you the flexibility to choose the ob (not guaranteed that he or she will turn up on the day, but you would have asked before hand to the OB on what their backup plans are in that case), the hospital and the treatment whereas if you were in the public sector you would not have much choice and you would be looked after by trainee doctors or midwifes. I'm not saying midwife's or trainee doctor's are bad, all i'm saying is I would rather put my trust into a fully qualified OB.

    -We had HIF's gold saver cover which gave us 3 days of private room for pregnancy and anything on top of that we had to make a co-payment of $40/day which I thought was fair.

    -Whatever you do, ensure that bub is also added onto one of your single's policy at birth or maybe at that point it might be cheaper to take out a basic family cover to cover bub as well to avoid MLS.

    -We dropped our extras cover after bub's birth as we weren't getting enough value out of it.

    Hope this helps.

    • Thank you, that was very helpful and gives me something to think about. Maybe just pregnancy cover on mine. Thanks again.

  • +2

    If you are likely to end up with a complicated pregnancy than it is worth it. The extra care and attention you receive and peace of mind that your doctor knows your case is worth it.

  • +3

    As others have said it depends on you intentions for pregnancy and birth and what your local hospital is like. For me personally continuity of care with a midwife rather than an OB was the most important thing for me. We went public for my first as they had the birth centre I wanted to use and they were fantastic. For number 2 (after changes to the birth centre catchment area) we opted for private midwife who is allowed to use birthing suites at the local hospital which was pretty expensive but private health cover wouldn't have helped at all. I am due to give birth to number 3 in a couple of weeks and have just gone with the group midwifery practice at the local public hospital. It has been wonderful - I have the same midwife for every appointment and she actually comes to my house for appointments and will do so for 6 weeks after the birth all at no cost. I was only in hospital for about 12 hours post birth with number 1 and was walking out the door after only 4 hours with number 2 - My husband and I felt we would just be more comfortable muddling through it all in our own home but again that is a personal preference you need to consider. If you feel you will want a week in hospital then that may not be an option going public if there are no complications. Research the options that are available in the your area and have a think about how you might want to approach pregnancy and birth. Some people like midwife led care others want a OB and that is your decision to make. All those sorts of things will help you to decide if the private cover will be worth it for you. One other thing to consider is the facilities at the private hospitals, here is Brisbane there are a couple of popular private hospitals for birth that are quite fancy for mum but if there is an emergency or major complications they just move you to the the public hospital with the better medical facilities anyway.

  • +2

    People value different things differently.
    If money is no object, you are keen on a surgical intervention (more likely with private) and you are content to pay an unknown amount of gap and extra fees not covered by insurance, by all means choose private cover.
    In the public system the treatment comes at no cost (besides taxes), but the care received varies tremendously, based largely, I think, on the patient's ability to participate in their care.
    By that I mean, if you have no birth plan or understanding of what is happening, the default process will be applied.
    The default process is designed to minimise mother/baby death while maximising efficiency of health system resources. This means a lot of standard policies don't give much consideration to maternal preferences, but tend to follow efficiency where this does not jeopardise safety.
    For example, it is possible for the OB/midwife to rupture the mother's waters in an attempt to accelerate labour. But if this happens, the mother must deliver the baby within a certain time frame because there is a slightly elevated risk of infection. If she has failed to deliver within that timeframe, she will be encouraged to be induced. That starts another clock and if the induction fails to result in a natural birth then the next step is caesarian.

    Since all mothers vary, and some progress slower than others, a seemingly innocuous decision early in labour can cascade into significant interventions later.

    So I would urge you to be an informed health system user and establish what you are looking for.
    Private hospitals make sense for elective caesarian where the major issue is recovery time after major surgery.
    Public hospitals maternity units and mid-wife staffed birth centres make sense for healthy women having normal births.

  • +2

    My wife took the cover with pregnancy and we thought it was the best decision we made - wife has some minor complication with the birth of our daughter but the private hospital (St George Private) really took good care of my wife 24/7. Started off at the birth suite for aroudn 24 hours, and then we manage to also get a room for 2 of us (i.e. a private family room - bed was a queen size) without any extra charge. The only thing i ended up paying was car park over 5 days and the $500 being the excess.

    Had nurses coming in to ensure that breastfeeding was done properly, bathing, eating etc…..

  • +2

    We have private health insurance and have had all three of our children in public hospitals. As an example, for our third child, my wife went in the private birthing room in the morning, our baby was born in the early afternoon and both were discharged the following morning (her choice) as all was ok. Now, if that had been private, it would have cost us several hundred dollars, and for what?
    Just remember, if there are major issues, then you will be transferred to a public hospital anyway.
    From what I am reading above, going private just means you will be allowed to stay longer. In my wife's case, she was happier to rest at home.

  • +4

    We are like you and have private health insurance, but aren't covered for pregnancy. Both pregnancies, for all tests, birth, etc, I don't think we'd have been out of pocket even $500 all up.

    We went public both times - the service was faultless. We were lucky enough to be in the local catchment area for the local birthing unit which meant that we got assigned one midwife (same one for both children too). To me it is more important to have a familiar midwife than OB, as you will be dealing with the midwife a lot more. Both births got complicated and ended in cesareans which meant getting transferred to a larger hospital the 1st time, and 2nd time it meant starting the birth in the larger hospital. But we still got the local midwife from the birthing centre - at no cost to us!

    Some public hospitals now have private rooms so 2nd time around we were lucky enough to have our own room. First time, we had to share a room, but hey its only for 3 days.

    Just keep in mind its not only the extra health insurance premiums you will be paying. I know people who went the private option and were still over $5k out of pocket. That's an awful lot of money to spend for the "luxury" of a few couple of days in a private hospital! I have also heard that if serious complications arise, you are likely to get treated in the public hospital anyway (but will be charged as a private patient).

    To the comment made above about how the person in private "Had nurses coming in to ensure that breastfeeding was done properly, bathing, eating etc….." - you get all that in the public system too.

  • Honestly, thank you everyone for your responses. It's such a hard decision to make as I've never had a child and so I guess i don't have a great understanding of the process. Depends on my preferences but I just don't have any because I don't know. Insurance is the worst, it's like gambling haha.

    I will keep researching the local hospital and see what people think about it. Also will look at consistent midwife v OB.

  • +3

    Yes, like everyone said it really depends; each situation is different. There are people that go public and love it, people that go public and hate it, people that go private and love it, people that go private and hate it.

    For us, my wife was adamant she would go private; in the end we went public at RNS (really nice, new facilities…the regular checkups during the pregnancy were also great). We had almost zero issues thankfully (the biggest issue we had was the seemingly impatient OB that wanted to hurry up the birth against the wishes of my wife and the midwives…perhaps she had other plans that night???), the only think she had was a little bit of happy gas. We went in for a scheduled checkup on the morning of due date (because my wife had gestational diabetes and they were considering inducing her), but she was already 5cm dilated so they sent us upstairs. She gave birth about 12 hours later.

    Slightly off topic (and sorry if it sounds like an ad) but knowledge is power. Learn as much about pregnancy and birth as possible if you don't know/haven't already. Do you know what oxytocin is? The benefits of skin to skin after birth? Did you know 1 out of 4 pregnancies end up as miscarriages??? All this and more you could learn in the below course.

    I would recommend attending calmbirth.com.au with your partner if you can afford it (part of it was covered by our private health insurance which was nice). It is a full 2 day crash course on the birthing process. We stayed the weekend in Bowral (drove from Sydney) because it is held by the creator/creator's daughter and it was also a mini getaway before becoming a 3 person family unit. FYI If you like Italian, Onesta for dinner is great…light and fluffy gnocci. My wife still dreams of going back down there just for it!

    If I were to describe the course it is "part educational, part mind over matter, part hippie, part motivational/part women are powerful/YOU CAN DO IT!". They mainly try to educate you that you should try for an intervention free natural birth where possible. They would only suggest emergency c-section or other aids in the event of complications (which can happen). But essentially, you only get out what you put in. You won't benefit as much if you went and didn't pay attention, or went and paid attention, but didn't practice the techniques in the weeks/months after.

    My wife and I did the meditation exercises and massages as often as we could in the weeks after the course and attributes a lot of the success to being able to stay calm for the pre labour and labour. She definitely got more out of it than me…I battled to stay awake through some parts to be honest and the "hippie, women are awesome, designed to give birth" parts were a bit cheesy, but my wife loved it. I did find it amusing when one partner asked what a placenta was!!!

    I am naturally a calm person, but learning about the birth process, learning massages I could do on my wife to help with the pain and really helped. I think it was also comforting for my wife to know that I knew stuff also??? I was also able to ask questions in the active labour stage when she was "in the zone" of a contraction that I would never have thought about if I didn't attend the course.

    The only other tip my wife would give (and has been confirmed by all her friends that have had babies) is not to let your mum in the delivery room (unless she is a calm person). The mum will almost always freak out/say things to annoy/upset the mum to be; which doesn't help at all…in fact does the complete opposite.

    My wife's best friend said her mum was running around like a headless chicken asking the staff to turn up the A/C, then moments later to turn it down…just flipping out. It really affects the mum to be!!! Imagine trying to give birth if your mum was running around like that!

    Another friend said her mum was saying "what's taking so long hurry up"… which just made her mad.

    Good Luck!

    • Wow I love that tip about the mum. My mum would be a nutcase, I will remember that.

      • +1

        Hahaha

        My MIL was pretty offended/felt rejected when my wife told her she didn't want her in the room or even at the hospital. She said she was going to ignore my wife's request at first… This caused a bit of friction between the two obviously.

        I think the only thing that helped was telling her to stay at our place so she would be rested and ready to help us on our arrival.

        She stayed a few weeks before she started getting on my wife's nerves, basically judging almost everything we did and saying we were doing almost everything wrong and our baby would die…she meant well… Hahaha

  • +1

    I had both my kids through the public system. We were told my first would have most likely not survived had we gone through private. Within seconds of her birth a team of 20 nurse's, doctors and specialists were on hand. Having said that, suffering from post natal depression afterwards…I wish I had hospital cover.
    Due to my previous depression. The second time around the public system were fantastic. Regular monitoring of my.mental health, medication etc. I got a private room, was allowed to stay for a week so they made sure everything was ok. Couldn't have asked for better care.
    It really comes down to peace of mind. You can still go through the public system with private health. If we could have afforded it I probably would have hospital cover and gone through public hospital as there are more resources on hand and at the ready.
    There are better programs for after care with private as well.
    Speak to your partner on what she would.feel comfortable doing. Everyone has different ideas on what they want in terms of comfort and care etc.
    Good luck.

  • +1

    Depends on personal preference for the most part. My wife went down the private road for both our children and couldn't be happier. While the core health side of things is probably much of a muchness, the "customer experience" in the private hospital we used was exemplary. My wife had a private room with private bathroom, double bed, lounge and sitting area in the room, fantastic views, staff and food on hand 24hrs, plus whatever the general hospital amenities were. She obviously also had choice of doctors all the way through … obstetrician, anaesthetist, pediatrician, etc.

    As others have mentioned, the costs to you (beyond what is covered by the private insurance) are largely the pre-birth obstetric plan and gaps on payments to the anaesthetist and pediatrician. Assuming you have no difficulties with the birth, either to mother or child, most services after that are public/community in any event.

  • +1

    With private care, there are generally more out of pocket costs than public.

    I don't believe there is any value to private care.

    If there are severe problems, you end up in KEMH or another public women's hospital.

    If you do go through with private health care, remember there is a one year waiting period for pregnancy care.

  • +1

    We went private for all 3 of our kids. Even with high level cover, it cost us a ridiculous amount out of pocket. Multiple thousands of dollars for each one. I personally thought it was money well spent. I had a very good doctor who monitored me throughout each pregnancy and attended each birth. The hospital was modern and comfortable and the care was fantastic. I was able to stay for a week with each child, this was particularly valuable with the first born. I was able to learn to all about feeding and looking after the baby with as much calm support as I needed. We had our insurance with HCF.

  • Hi @Angelajojo

    I'm in a similar situation where I don't know if I should go the public or private option.
    Could you let me know where you ended up and any feedback you would have?

  • We just had our first. Mrs was certain that she wanted to go private from the start.. who am I to argue - I'm not the one having the baby!

    Best decision she made. She was diagnosed with a rare, but serious complication late in the pregnancy after presenting very unusually. Thankfully, the OB that we'd seen the whole way along wasn't happy with emergency departments diagnosis over the queens birthday long weekend for the pain she was in, and the OB pushed until she got the tests done that she wanted. The second the tests came back, things moved very quickly - emergency C-Section in a matter of hours, etc. Bub was rock solid, albeit a month early, but Mrs deteriorated and ended up in their ICU for a stint as the complication worsened. Spent a couple of weeks in hospital in total - I never left mum or bub, even when she ended up in ICU, I could remain in the hospital so not to be far.

    Going into it, I didnt quite know exactly what an OB does, but they are one hell of a conductor in times of need. She performed the C-Section, and then pulled specialists from left, right and centre to make sure Mrs was getting the treatment and reviews to get right, and didnt let up until Mrs was where she needed to be. Paediatrician took care of bub, but OB took complete care of Mrs.

    All up, it cost us:
    Approx $3k more in PHI premiums for the 12months she held the policy (Teachers health only have a 9month wait period - we got pregnant quite quickly, so held the increase for just over 12months)
    Approx $5k in OB Costs during pregnancy - non claimable via Medicare.
    Approx $3k in "other" costs - mainly scans/genetic testing/excess/etc.

    In speaking with nurses about the complication, the only nurse that saw the condition that Mrs developed ended up with lifetime kidney dialysis required, and a contact of mine who we found out had it ended up losing a good part of their liver. Both were as results of late diagnosis through the public system - something I'm certain would have happened but for the OB's intervention.

    So $11k in total out of pocket. Seems cheap given the outcome of the two experiences we've heard. Granted, it was quite rare to develop this condition, but we literally had no issues throughout the pregnancy - until we had a BIG issue.