How to use Medicare to reduce IVF costs

Anyone undergoing fertility treatment will attest to the fact that fertility treatment is a large financial commitment. If you are considering or undergoing fertility treatment, read on for more information on how Medicare rebates can be used to reduce your out of pocket expenses.

What do Medicare rebates cover?

Medicare rebates are paid on outpatient services only, namely services that occur outside of a hospital stay. IVF cycle fees* are considered outpatient services and therefore attract a Medicare rebate.

What is not covered by Medicare rebates?

On the contrary to outpatient services, inpatient services refer to those services that occur once you have been admitted to hospital for which Medicare does not cover.

A large majority of IVF patients need to be admitted to hospital for things such as an egg collection or embryo transfer which are, therefore, deemed inpatient services and are not covered by Medicare.

If you have adequate private health insurance, your theatre and accommodation fees may be covered, if not, these fees are payable before admission to hospital. We advise all patients to check with their private health insurer (if applicable) before commencing IVF treatment to understand what items associated with IVF treatment are covered.

What are out of pocket expenses and Medicare thresholds?

The amount that Medicare does not cover is referred to as the “gap” or “out-of-pocket expense.” Over the calendar year, out-of-pocket expenses contribute to your Medicare threshold.

Many patients often misconceive the term “threshold” as negative but in fact it is very much a positive thing when it comes to out-of-pocket expenses: once a patient has reached the Medicare threshold for the year, further rebates will be available from Medicare, reducing the cost of your IVF cycle even further.

The Medicare threshold is set each year by Medicare. Your MyGov account will tell you how you are tracking towards reaching this threshold. It is important to note that the Medicare threshold resets on the 1st of January of each year.

How does this relate to my IVF cycle?

In 2022, the out-of-pocket expense associated with one IVF cycle for the calendar year is enough to take you over the Medicare threshold, thereby further reducing your out-of-pocket expenses for any subsequent IVF or FET cycles that year.

Our current fee schedule illustrates the difference in out-of-pocket expenses between reaching the threshold and having not reached the threshold. Please click here to see our latest fee schedule.

Let's look at an example.

In 2022, a patient returned to Concept to use stored embryos after becoming pregnant in 2019. This patient has had 3 FET cycles and 1x IVF this year and is now undergoing another IVF cycle in the hope of creating more embryos. This patient has reached the Medicare threshold for 2022 so the approximate out-of-pocket expense for their cycle will be just over $1000.

Whilst IVF treatment can place financial strain on families or individuals, Medicare rebates do help. Our accounts team are well-versed in all things Medicare so please do not hesitate to call us on 9382 2388 to better understand how Medicare reduces your IVF costs.

*Some items are exempt from Medicare rebates e.g., freezing costs.