Cost of a vasectomy with health insurance

In Australia, private hospital insurance can cover some of the costs of a vasectomy on a Bronze or higher tiered policy. When you’re treated as a private patient and claim for your vasectomy, your private health insurance will pay 25% of the Medicare Benefits Schedule (MBS) for your vasectomy doctor and anaesthetist, and some or all of the hospital fees. Medicare will then pay the remaining 75% of the MBS, although, if your doctors charge above the MBS fee, you may have to pay the difference out-of-pocket.

Depending on your health fund, doctors, and the hospital or vasectomy clinic you’re treated in, you may be able to eliminate or reduce your out-of-pocket cost through your health fund’s gap cover scheme. Before making a vasectomy booking, you should consider reaching out to your health fund to discuss their gap cover options.

Vasectomy pricing can vary a lot depending on where you live, who treats you and the type of vasectomy service you choose. However, in 2022-23 the average amount for doctors’ fees for a vasectomy across Australia was around $1,200, with Medicare paying $340 towards this amount. The average hospital fee was around $780, which Medicare doesn’t contribute to.²

With private health insurance, only 66% of patients had an out-of-pocket cost for their doctors, and of those who did, the average cost was only $420. If you were treated privately without insurance, you’d need to pay all of the hospital fees, and some of the doctors’ fees, adding up to an average total of $1,640.

When you upgrade or take out a hospital insurance policy including cover for the male reproductive system, you will need to serve a 2-month waiting period before you can claim for any of the associated healthcare services such as a vasectomy if the condition is not considered to be pre-existing. Pre-existing conditions can carry a 12-month waiting period.

If you’ve already served these waiting periods on your current health fund, you should be able to transfer these waiting periods to a new fund if you switch. This means that if you’ve found a policy with a different fund that better suits you needs, you won’t need to reserve your waiting period before being admitted for a vasectomy. You should be able to switch and get treated as soon as your transfer certificate has been applied to your new policy.

A vasectomy is completed by cutting the tube connecting the testes and penis, the vans deferens, to prevent the mixing of sperm with the seminal fluid during ejaculation. This is typically done through a small incision in the scrotum.¹

When you book your vasectomy appointment, you can choose between being treated under general anaesthetic or local anaesthetic. With general anaesthetic, you will be under complete sedation, whereas local anaesthetic only numbs the area, so you’ll be fully conscious.

Once your vasectomy is complete, it can take several months and up to 20 ejaculations to completely clear the remaining sperm from your system. A semen test is typically undertaken three months after the procedure to confirm it was successful.

Keep in mind that while this surgery is very effective at preventing unwanted pregnancy, it won’t protect you from sexually transmitted diseases.

While a vasectomy is considered a permanent surgery, in some cases it can be reversed. However, there is no guarantee that a vasectomy reversal will restore fertility.³

Vasectomy reversal surgery is also not typically covered by Medicare or private health insurance, so it can be a costly procedure. Because of this, you should strongly consider if this surgery is right for you before booking in.

While every surgery comes with risks, a vasectomy is considered a very safe procedure. After your surgery, you can expect some minor pain, bruising and swelling. If you experience more severe pain or bruising, you should contact your doctor.

The biggest risk associated with a vasectomy is infection, which can typically be avoided through correct wound care. Your doctor can tell you how to change your dressing and advise you when you can safely resume sexual activity.