Costs of miscarriage care: Medicare, public and private

You may have questions about the costs of miscarriage or pregnancy loss care. This could include costs for any part of your care, such as an assessment, treatment or follow-up appointments.

This article explains what Medicare may cover, the difference between public and private care, and what you may need to pay. 

If you need emergency care, get help straight away. You can ask about costs and payment options when it is safe to do so.

In Australia, you can receive healthcare through the public or private healthcare system.

Medicare is a part of Australia's public healthcare system. If you have Medicare (Opens in new tab), it can cover some or all of the cost of your doctor and specialist appointments, tests and hospital care.

The Pharmaceutical Benefits Scheme (PBS) (Opens in new tab) is another part of the public healthcare system. The scheme helps reduce the cost of many prescription medicines. Ask your healthcare professional or pharmacist if your medicine is on the PBS.

You can choose public or private care (Opens in new tab) depending on your circumstances and the services available to you.

Private care is care you receive as a private patient, such as from a private healthcare professional or in a private hospital. You may have more choice about your doctor or hospital, but you may need to pay some of the costs yourself. Private health insurance may cover some of the costs.

Having private health insurance does not mean you have to use it. You can still choose to be treated as a public patient in a public hospital.

If you have Medicare and are a public patient in a public hospital, you usually receive your medical treatment at no cost to you. The hospital chooses the healthcare professionals who care for you.

If you choose private care, you may have more options for your doctor or hospital. You may also need to pay some of the costs yourself.

Private health insurance (Opens in new tab) may cover some of these costs, depending on your policy. You may still need to pay an excess, co-payment or other costs.

Medicare may cover some or all of the cost of miscarriage care. This can include:

• doctor and specialist appointments
• imaging, such as an ultrasound (Opens in new tab)
• pathology tests, including blood tests (Opens in new tab)
• treatment as a public patient in a public hospital

If you have Medicare, you will not have to pay for miscarriage care when you are a public patient in a public hospital. This includes care through public hospital early pregnancy assessment services (EPAS).

What Medicare pays for depends on the service, where you receive it and how much the healthcare professional charges. Ask your healthcare professional about this.

What is bulk billing?

Bulk billing means your healthcare professional bills Medicare directly and accepts the Medicare benefit as full payment. You do not pay for a bulk-billed service.

Not every healthcare professional bulk bills. They may bulk bill for some services but not others. Ask about this when you book your appointment.

Your costs depend on where you receive care and if you use Medicare, private health insurance or both.

You may have to pay some of the cost yourself if the healthcare professional charges more than Medicare or your private health insurer pays. This is sometimes called a gap.

Will I need to pay for scans or blood tests?

Medicare may cover some or all of the cost of certain diagnostic imaging (such as an ultrasound) and blood tests.

You can ask your healthcare professional or the imaging or pathology service:

• "Will this be bulk billed?"
• "If not, how much will I need to pay?"
• "How much will I get back from Medicare?"

Will I need to pay for medicine?

You may need to pay for medicine you take during miscarriage care.

However, if your medicine is on the Pharmaceutical Benefits Scheme (PBS), you may be able to buy it at a lower cost. Ask your healthcare professional about this. What you pay depends on the medicine, if you have a concession card (Opens in new tab) and any additional charges.

If you are an Aboriginal or Torres Strait Islander person, the Closing the Gap (CTG) PBS Co-payment Program (Opens in new tab) may help you pay less for PBS medicine. Depending on your circumstances, your PBS medicine may cost less or be free. Some medicine may still have an extra charge.

You can ask your doctor or Aboriginal Health Practitioner about eligibility and registration for this program. Your local Aboriginal Medical Service (AMS) (Opens in new tab) or Aboriginal Community Controlled Health Organisation (ACCHO) (Opens in new tab) is another place to ask about receiving this support. The program does not cover over-the-counter or non-PBS medicine.

If you are considering private care, ask for a written estimate of the expected costs before you have any treatment, when possible.

Ask your doctor, hospital and private health insurer:

• “Is this treatment covered by my policy?”
• “Will I need to pay an excess or co-payment?”
• “Will I have any other costs I have to pay myself?”
• “Are the surgeon, anaesthetist and other specialists covered by my insurer?”

You have the right to receive information about expected costs before agreeing to planned treatment. This is called informed financial consent.

You can ask your healthcare professional about costs when you make an appointment or before agreeing to treatment.

You can also use the Australian Government Medical Costs Finder (Opens in new tab) to understand typical costs for some medical services.

If you have private health insurance, contact your insurer before you have planned treatment. Ask what your policy covers and what you may need to pay.

If you need urgent care, do not delay treatment while trying to confirm costs.

The Commonwealth Ombudsman Private Health Insurance has information to help you understand private health insurance (Opens in new tab).

The Australian Government has the Australian Charter of Health Care Rights in Easy English (Opens in new tab).