Medicare rebate for IVF treatments

Medicare rebate

With Medicare’s assistance, fertility treatment is now more affordable. There have been substantial reductions in the cost of many fertility treatments since the introduction of the Federal Government Medicare Safety Net program. The savings generated from these out-of-pocket cost reductions have made fertility treatment more financially accessible for many couples.

Please remember, it is important that your referral letter to your specialist is current while you are undergoing fertility treatment, thereby ensuring you receive the Medicare rebate. You can check this by phoning your City Fertility specialist’s consulting rooms.

How the Medicare Safety Net works

In addition to receiving the standard Medicare rebate for fertility treatment, you may also be eligible for the Medicare Safety Net rebate.

The Medicare Safety Net is a Federal Government-introduced scheme whereby once you reach a certain amount of out-of-pocket expenses in a calendar year, Medicare will pay an additional refund.

The scheme is based on a calendar year, and the threshold is revised annually. The current threshold as at January 2024 is $2544.30. The Medicare Safety Net applies only to out-of-pocket expenses you incur out of hospital, not inpatient out-of-pocket expenses such as the anaesthetist, hospital and some doctors’ fees.

An out-of-pocket expense is commonly referred to as the “gap” between the doctor/clinic fee and the standard Medicare rebate. City Fertility fees are classed as out of hospital, so they will count towards the Medicare Safety Net.

Safety Net rebates are “capped” for assisted reproductive technology (ART) services. This means there is a limit on the Medicare Safety Net rebate you will receive. The Safety Net is not means-tested, nor is a restriction placed on the number of treatment cycles patients can undergo in a calendar year.

Individuals are automatically registered on the Safety Net threshold; however, there are benefits in registering as a couple or family. For more information and to check your registration status, access Medicare online services at www.medicareaustralia.gov.au/online or visit your nearest Medicare office.

Medications and PBS Safety Net

Fertility medication for your treatment cycle is provided via a prescription obtained from your fertility doctor and dispensed through a pharmacy.

Patients who are eligible for the Pharmaceutical Benefits Scheme (PBS) will pay a co-payment to the pharmacy per prescription. The PBS Safety Net threshold reduces the co-payment rate once reached. You can combine your family’s PBS amounts to reach the Safety Net threshold sooner.

To access the Safety Net arrangements, you need to maintain records of your PBS expenditure on a Prescription Record Form. These forms are available at all pharmacies.

Medicare online

Medicare online is available at all City Fertility clinics. This is a secure and convenient way for patients to claim their rebate without having to visit a Medicare office.

Please contact your nearest Medicare office, or go to www.medicareaustralia.gov.au/online to register your bank account details.