Infertility is not an easy path and, for many couples, in vitro fertilization (IVF) is their way out. But the biggest one that people ask is: Does insurance cover IVF? But the answer isn’t always so clear cut, and can depend on many things, such as where you live, what your insurance company is and which coverage you have. This article will show you how IVF insurance works, what your insurance should tell you, and what to do when you want to apply for financial help for fertility treatments.
What is IVF?
In vitro fertilisation is an all-too-common assisted reproductive technology (ART) for infertile couples. It’s the combination of eggs and sperm outside the body, in the lab, and transplanting the embryo(s) into the woman’s womb. IVF is generally considered when other fertility treatments have not worked or there are fertility conditions for which natural conception is not viable or unlikely.
Does Insurance Cover IVF?
In a nutshell: It depends. Coverage for IVF is extremely based on your location and your plan. Some health insurance plans cover 100% of the IVF care; others only partially or never at all. You will be able to know which types of IVF qualify and which variables affect coverage.
Factors That Affect IVF Coverage
There are a few reasons IVF treatment might or may not be covered by insurance. The basics: Here are the highlights:
1. Location and State Laws
It is state laws that will determine if your insurance company will pay for IVF in the US. There are now 19 states that mandate insurance companies to provide fertility coverage in some form, but the terms vary. Other states require that insurers pay for IVF; some only for diagnosis and simple treatments of infertility. Depending on the state, coverage and number of IVF cycles covered will be different.
For instance, mandates are generous in Massachusetts, Rhode Island and New Jersey – usually multiple cycles of IVF. In contrast, Texas and Georgia might require no coverage for fertility treatments at all. If you’re not sure, call your insurance company or the healthcare authority of your state for the latest updates.
2. Type of Insurance Plan
The type of insurance you have affects your IVF coverage as well. It is more likely that workplace health insurance will cover fertility treatments such as IVF at least in part than individual health insurance plans. Employers include fertility insurance in a more comprehensive healthcare plan to recruit and retain workers, particularly in competitive industries.
But remember that even with employer-sponsored plans, coverage for IVF varies. Other companies might cover everything including several cycles of IVF; others might only cover diagnostics or medication. You might have to check the fine print of your policy to see whether IVF is covered and, if so, what.
3. Fertility Diagnosis and Medical Necessity
It is usually only when fertility therapy is deemed medically necessary that insurance companies cover IVF. This means the couple or treatment patient often has to be diagnosed with infertility. When a woman is over 35, it is known as infertility if after one year of trying (or six months) she does not get pregnant.
Some insurance companies will ask for diagnostic or medical records to show infertility prior to making the decision to cover IVF. Insurance coverage is more likely if the infertility is the result of a certain medical condition (eg, blockage of the fallopian tubes, low sperm count, ovulation disorder).
4. IVF Cycles and Limits
Even when IVF is covered, insurance policies limit how many IVF cycles they will cover. There are not many insurers who will pay for more than one to three cycles of IVF. After that, patients might be forced to cover the costs of other cycles out of pocket.
Remember to know how many IVF cycles your insurance covers. Other plans might cover medications and testing, while others only the surgery. Take the time to read your policy or contact an insurance agent to learn more about your coverage.
5. Out-of-Pocket Costs
If your insurance covers IVF, you still might have a lot of costs to pay out of pocket. Insurance may cover only part of the treatment, so you still have to pay for co-pays, deductibles and whatever is not covered. These costs are easily multiplied if you have to undergo several cycles or additional treatments like egg harvesting, sperm-analysis, or embryo freezing.
You might also find policies that cover IVF but not other fertility services like egg freezing or genetic testing. You’ll want to take the time to check the contents of your policy so you know exactly what is covered and what you will have to pay out of pocket.
What Happens If Insurance Won’t Pay For IVF?
If your insurance doesn’t cover IVF or even partially does, there are a few things you can do to lighten the financial load:
1. Fertility Grants and Loans
There are even some companies and charities that give grants to pay for IVF treatment for people who cannot afford it. Such grants are usually competitive and might be regulated. So, too, fertility loans are also available from certain banks that let you amortize IVF.
2. Payment Plans and Discounts
A lot of fertility centers have payment plans or discounts for patients who are paying on their own. These can be plans that make IVF less overwhelming by structuring it into smaller, cheaper payments. There are some clinics that also provide bundle pricing so you pay for multiple cycles at a reduced rate.
3. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs)
If you have an HSA or Flexible Spending Account (FSA) through your insurance company, then you can use those funds to pay for IVF. You can use these accounts to put aside pre-tax dollars for medical expenses and make IVF less expensive.
4. Employer Benefits and Fertility Assistance
There are employers who provide fertility as part of their health benefits, such as IVF or an upfront lump sum for fertility. There are also companies that have partnerships with fertility clinics that offer discounts or financial assistance to workers who want to undergo IVF. Visit your HR department to see what your rights are.
Conclusion
So, does insurance cover IVF? No answer is simply yes or no. That depends on your state laws, who your insurer is, what plan you have, and whether or not fertility procedures are considered medically necessary. If you know the nuances of your insurance policy and what fertility coverage is out there, IVF can become a lot less expensive.
If you don’t have insurance, grants, loans, payment plans and employer subsidies aren’t the only ways to get IVF on the table. Be proactive, ask questions, and do your research to find everything you can to help keep fertility treatment money in check.
For infertile individuals, IVF can be an lifesaving treatment. Even if insurance doesn’t cover IVF, it can be confusing, and if you know what to expect, you can make decisions about your care and costs.
