In this “Fertility Chronicles” blog, we continue to discuss ways patients can manage the costs of their IVF treatments. To help you make a more informed financial decision on IVF, check out the free online Univfy IVF Cost Calculator. Our calculator can help you decide between various IVF packages available from your clinic, given your chances of IVF success.
If you’re an infertility patient, you may have just been told that in vitro fertilization (IVF) offers you the best chance for pregnancy. Your next question might well be: “Will my insurance plan pay for IVF costs?” Here are a few things you should know about infertility insurance and IVF insurance coverage, specifically
Before you start an IVF cycle, be sure to ask your doctor which IVF costs are included in the treatment plan and which services are additional. For instance, you may be quoted a cost per ultrasound, but be sure to ask how many ultrasounds are typically needed. Ask for a written estimate of costs, including medications or ancillary services not performed by your doctor. Be sure to ask your doctor for a breakdown of costs that are covered by your IVF insurance coverage and those that will be your responsibility. Ask whether the balance must be prepaid upfront, or if you can pay in installments. Most clinics are very willing to answer these questions, and some even provide a financial counselor.
Mandated Insurance Coverage. If you have health insurance, your plan may pay for some, but not all, parts of infertility treatment. For instance, perhaps medications are covered, but not procedures. Some plans pay for IVF costs but may limit the number of cycles.
Fifteen states mandate that health carriers offer plans that either cover or offer to cover some infertility treatments, ranging from diagnosis and low cost treatment options to full IVF insurance coverage for all IVF costs. The states include: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. Three of these states, California, Louisiana, and New York, require coverage for infertility but specifically exclude IVF insurance coverage.
Because states and plans within states vary widely, you need to ask for a written explanation of what exactly is covered in your benefit plan. Even if you live in a mandated state, you still may not be covered, depending on how the benefit is structured. For instance, some states exempt small business employers or include other limits, such as lifetime caps on coverage, exclusion of IVF, or coverage specifically for heterosexual married couples, excluding single women and same-sex couples.
Infertility Coverage in Non-mandated States. Even in non-mandated states, you may find that your employer has elected to offer employees infertility insurance as an extra-cost benefit. The InterNational Council on Infertility Information Dissemination, Inc. (INCIID) offers a list of employers who are infertility- and adoption-“friendly”. You should carefully review all the plans offered through your employer (and your spouse’s employer) annually to see whether infertility is included in at least one of the benefit plans offered to employees. Employers may not widely advertise this option. Sometimes if a benefit is not specifically excluded, it is included by default. You may have to pay extra for this coverage and must elect to enroll in an infertility treatment-covered plan either at the time of your hire or annually when you re-enroll for your benefits.
Healthcare Reform. The Affordability Care Act, sometimes referred to as Obamacare, is expected to impact infertility insurance coverage, but whether the net effect will be positive or negative for infertility patients is still unclear. Every state, including the 15 currently mandating infertility coverage, will be required to select a model plan that establishes the minimum coverage that all plans must provide in that state. By selecting a model plan, each state will determine which health benefits to include as part of their state’s Essential Health Benefit (EHB). The EHB may or may not include infertility coverage. If the model EHB plan does not include infertility coverage, states with infertility mandates must decide whether to drop the mandate or to pay for the added coverage. Given this choice, some states may elect to exclude infertility coverage in their EHB. With the advent of insurance exchanges, you may be able to buy a plan with infertility coverage even if your employer does not offer such a plan, but exchanges are still a work in progress, so their impact is still unclear.
Insurance may cover general aspects of infertility treatment plans. Even if your current insurance plan does not cover IVF or even infertility treatment per se, it still may provide coverage for certain procedures (e.g. ultrasounds or medications) that are not specific to infertility. Before agreeing to any medical treatment, you should ask your provider to give you a list of procedures with their procedure codes (called CPT codes) that they plan to submit to your insurance company in order to receive payment for their services. Share this list of procedure codes with your insurance company, and ask for a determination, in writing, of which procedures are covered and which are your out-of-pocket responsibility.
Your employer may be open to adding infertility benefits. If your current plan does not cover infertility treatment, your employer might be open to adding coverage at the next enrollment period. Several advocacy groups including RESOLVE: The National Infertility Association and Fertility Within Reach have advice on their websites to guide you in discussing this request with your HR Department. Research shows that companies that have elected to add infertility coverage often find that it does not significantly increase their costs and helps companies recruit and retain employees.
Our next post, IVF Costs: What to Consider if You Don't Have Insurance, will discuss other options for paying for treatment if you have no infertility insurance.
Visit Considering IVF for more fertility health information and interactive tools to personalize your fertility path.