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Is Vasectomy Covered By Medicare?

Some men are surprised to learn that a vasectomy is covered by Medicare.  Medicare is a universal health care insurance scheme operated by the Australian federal government and funded through taxes including the medicare levy.  Medicare helps contribute to the total costs of most medical services in Australia including vasectomies. So yes!  Vasectomies are covered by Medicare.  

 

Medicare was created in 1975 and all Australian citizens are eligible to enroll in Medicare.  If you were born in Australia, you were probably enrolled at birth.  Other groups are also eligible for Medicare including; New Zealand citizens who have lived in Australia for a minimum amount of time, permanent residents, and citizens of Norfolk Island, Cocos Islands, Christmas Island and Lord Howe Islands.

 

Medicare has reciprocal agreements with visitors from the United Kingdom, Sweden, the Netherlands, Belgium, Finland, Norway, Slovenia, Malta, Italy, Ireland and New Zealand. This is limited to emergencies and critical care.  If you are a visitor from one of these countries and planning to have a vasectomy in Queensland, your vasectomy will not be covered by Medicare.

 

Prisoners have medical services provided to them by the Queensland government. This does not extend to vasectomies in Queensland.  Prisoners are not eligible for Medicare.   

 

Australian Defence Force members still have access to Medicare although defence also provides medical care.  Currently serving ADF members may be able to get a vasectomy covered by defence but this is usually a traditional vasectomy, under general anesthesia, and in a hospital. Members wanting a no scalpel vasectomy at vasectomy Queensland will have to claim via Medicare.  If you have a gold card it won’t cost you a thing, just please give us a call to book in.

 

There are thousands of medical services covered by Medicare and each of these is given a code (or item number) and recorded in the Medicare Benefits Schedule.  The Medicare item number for a vasectomy is 37623 and each item number has a scheduled fee. You can see the vasectomy item number in the following link to the Medicare Benefits Schedule  

http://www9.health.gov.au/mbs/search.cfm?q=vasectomy&Submit=&sopt=S

Medicare does not pay for the entire procedure. Infact Medicare usually does not even pay the full fee in its own schedule.  Most people will get 85% of the Medicare schedule fee back from Medicare however this may increase if you have reached your safety net.  Each year the Medicare Benefits Schedule is updated but has gone extended periods of times where the Medicare fees has been frozen. As a result there has been a growing gap between the total fee of medical services to patients and the amount they get back from Medicare.

 

Storing sperm is not in the Medicare Benefits Schedule and thus not covered by Medicare.  This is entirely private although it can be a good insurance policy.  I highly recommend it for young men without children.

 

Vasectomy reversals are in the Medical Benefits schedule and are covered by Medicare. However this is very small amount of the total costs. 

 

After your procedure at Vasectomy Queensland there are several ways of claiming your medicare rebate back from Medicare.  Our receptionists will help claim it for you immediately following your procedure although sometimes Medicare does not accept our data.  If you are in any doubt you can easily take a photo of your receipt and upload it to your medicare app.  You will need to enter the item numbers (23 & 37623), the price, the date of the vasectomy and Dr Sheehans provider number.  All these details are on the receipt. 

 

This link provides several ways you can make a medicare claim for a vasectomy

 

Even though a vasectomy is covered by medicare you will still have a gap between the total amount and your rebate.   Medicare rebates aside a vasectomy still remains the most cost-effective family planning method available to Queensland men.

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