medicare

Know your benefits

 

As a Medicare cardholder, you're entitled to significant benefits for your IVF/ICSI treatment under the Medicare Benefit Scheme (MBS) and  Pharmaceutical  Benefits Scheme (PBS). The Health Insurance Act 1973 provides that you'll receive 85% of the MBS Schedule Fee for out-of-hospital fees and 75% for in-hospital fees incurred. When it comes to Assisted Reproductive Technology it is important to note that the benefits are only applicable for treatments arising from medical infertility and with a valid GP/Specialist referral letter.

For each treatment cycle, you're entitled to:
 

MBS

 

Medicare Schedule Fee benefits for majority of your treatment cycle fees

(see Table B: IVF/ICSI Cycle Medicare Benefits for full items and exclusions)

 

&

PBS

 

Reduced prices for medications under

the PBS

 

Pay up to $41.00 for each medication or $6.60 if you're a Concession/Health Care Cardholder

 

Determined by:

  1. MBS item number(s)

  2. In-hospital/Out-of-hospital treatment

  3. Medicare Safety Net Thresholds

  4. Benefit Cap on certain item numbers

 Determined by: 

  1. Medicare status (standard/ concession/healthcare cardholder)

  2. Medication Category (unrestricted, restricted or authority required)