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Does Insurance Cover Vasectomy Procedures?

Does Insurance Cover Vasectomy Procedures?

You can choose to use Private Health Insurance (PHI) to contribute to the cost of your vasectomy or you can use Medicare only. However, for those looking to make the most of the PHI cover they have, it’s important to understand some basic information.

Navigating the world of private health insurance can be difficult, particularly when you’re looking at how much coverage you have for a specific treatment or procedure. To help you steer the murky waters of insurance towards the bright light of your vasectomy, MSI Australia has broken it right down, so you can confidently estimate how much your vasectomy will end up costing you.

What are the types of health insurance?

There are two types of private health insurance. There’s “hospital cover” and “extras cover” (sometimes referred to as ‘general treatment,’ or ‘ancillary cover’). Extras are for dental and physio for example.

Most insurance providers will offer a bundle where you’re covered for both. We’re going to be focusing on private “Hospital” cover, as this is the coverage relevant to a vasectomy when done in one of our specialist Day Hospitals.

does private health insurance cover vasectomy
‘Hospital cover’ is the coverage relevant to a vasectomy when done in one of our specialist Day Hospitals.

What is ‘hospital insurance’?

Depending on your individual policy, hospital insurance is designed to help cover some, or all, of the cost of in-hospital treatment, either as a private patient in a public hospital or a private hospital or a licensed day hospital practice.

Generally, any medical service listed under the Medicare Benefits Schedule (MBS) such as vasectomy can be claimable on some form of private hospital insurance, depending on your policy. Almost all clients who have private health insurance “Hospital” cover who are paid up on their membership will be covered for vasectomy in all our hospitals.

Our hospital will run a final check for you a few days before your procedure date to confirm this. You can also contact your insurer and have them check in advance by quoting item number 37623. If you’re covered and you book at one of our day hospitals, you may have to pay an excess and/or a gap fee (both explained below) depending on your policy.

What is a ‘premium’?

Your premium is the amount that you pay your insurer for your coverage. Some people choose to pay this annually, while others are debited on a weekly, fortnightly, or monthly basis. If you miss payments you may not be covered for services.

How to get vasectomy covered by insurance
You are entitled to a Medicare rebate when you have a vasectomy.

What’s an ‘excess amount’?

An excess is an amount that you pay towards the cost of your care, in return for lower premiums. Depending on your policy and provider you might need to pay an excess every time you are admitted to a hospital or day procedure facility.

Remember to ask your health insurance provider if you have an excess amount before booking a procedure. This helps to budget accordingly for the procedure. The excess can range from $0 – $750 or more but the average is usually $250 or $500 paid once for the whole year.

How much ‘coverage’ do I need?

Before you sign up for a policy, make sure you check what it covers; especially if you have a specific procedure in mind that you want to claim, such as a vasectomy. Not all policies are comprehensive (cover everything), and some might leave you with out-of-pocket expenses.

Does insurance cover vasectomy
Before you sign up for a health insurance policy, make sure you check what it covers.

What is a ‘gap fee’?

A gap fee is an amount that remains after the Medicare rebate has been applied and your insurance has paid the amount you are covered for towards the cost of your care.

Essentially, some providers will charge more for their services than what Medicare and insurance will cover, and in those instances, the patient must pay the difference or the “gap”. This amount will vary depending on what the medical provider is charging.

In our case, we have arrangements which mean that the highest gap you will pay is $100 and in many cases, there will be no gap for your whole service including the doctor and the hospital.

This link from the Australian Health Department is also helpful in understanding Private Health Insurance out-of-pocket costs.

More FAQs

If you require additional information about insurance coverage and vasectomy, please don’t hesitate to contact us today. Below you can find some other frequently asked questions on the subject:

Does Medicare cover vasectomy?

No, Medicare doesn’t cover the total cost of a vasectomy. However, you will be entitled to a Medicare rebate, so the total out-of-pocket cost to you will be less if you have a Medicare card.

How much does a vasectomy cost?

The cost of a standard vasectomy varies depending on a number of factors. See our list of costs below:

  • From $480 with local anaesthetic in a medical centre
  • From $690 with local anaesthetic in an MSI Day Hospital
  • From $750 with intravenous sedation in an MSI Day Hospital
  • Minimal or no gap with private hospital insurance

Will my health insurance cover a vasectomy reversal procedure?

It is extremely rare for an insurance plan to cover vasectomy reversals. Normally you will have to cover all of the costs yourself. At your initial consultation, we will always emphasise that a vasectomy should be considered an irreversible procedure and only suitable for men who don’t want more, or any, children.

Can I get a vasectomy for free or at a low cost?

There is no way of getting a free vasectomy in Australia. Some clinics in Brisbane will offer ‘low-cost’ treatment but it’s important to remember that a vasectomy is a surgical procedure and should only be carried out by highly trained and experienced healthcare professionals.

Does the price of vasectomy differ based on what procedure you have done?

Yes, the price of vasectomy will vary depending on the type of procedure you have done and ​​a number of other factors including where you have it done and the type of sedation you choose to have.

About the Author

About the Author

Dr Justin Low

Justin received his medical degree from the University of Sydney in 1987 and completed the RACGP Family Medicine Program (FMP) in 1991. He became a Fellow of the Royal Australian College of General Practitioners in 1993. He has performed over 9000 vasectomies since 2011 during which time he developed the MSI No Scalpel Open Handed technique with painless needle technique. He is responsible for training an quality assurance of MSI Vasectomy services across the country.

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You can choose to use Private Health Insurance (PHI) to contribute to the cost of your vasectomy or you can use Medicare only. However, for those looking to make the most of the PHI cover they have, it’s important to understand some basic information.

There seems to be quite a lot of debate regarding what type of anaesthetic to have for vasectomy. Some doctors only provide IV sedation in a hospital and some only offer local anaesthetic in a GP Clinic and believe that IV Sedation is not necessary.

If you have Private Health Insurance (PHI) and are interested in getting a vasectomy, then we have the perfect option that allows you to use your insurance and pay minimal or no gap.

Alright boys, it’s time to talk about the big V! Maybe you’ve had all the kids you want to have, or maybe you’re crystal clear on never wanting any at all. Either way, you’ve been thinking about committing to firing blanks. So what’s holding you back?

Most men have, at some point in their lives, experienced an impact or blow to their testicles. It’s an unfortunate side-effect of having them located where they are. For many men, just the recollection of such an event is enough to bring tears to our eyes. And this memory is often one of the factors that deters men from committing to a vasectomy.

If you’re in a heterosexual, monogamous relationship and have decided not to have any/more children, then you and your partner might be weighing up your options around permanent contraception methods, also referred to as sterilisation. The two to consider are tubal ligation and a vasectomy.

When it comes to finances, the choice between condoms and a vasectomy seems pretty obvious. Well it might be time to think again, because not only is a vasectomy far more effective at preventing pregnancy, it also turns out to be a lot more affordable over a lifetime.

The age of men who have vasectomies can vary as much as their reasons for getting one. Legally anyone over the age of 18 is allowed to have one.

There’s a lot of misinformation around vasectomies and sex post-vasectomy. In fact, most people don’t understand what’s involved in the procedure or the impact it can have on your body and sex life. So let’s look at what a vasectomy is NOT!

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