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Coverage Complications: Does Insurance Cover IVF?

May 27, 2020
Kylie Manuppelli

Though being medically diagnosed as infertile is likely already a shock, for many women, learning that this medical condition is not covered by their health insurance is almost just as surprising and disappointing. With insurance coverage for fertility care varying across the board, it is important to understand what options there are when it comes to accessing care like in-vitro fertilization (IVF). In this article, we’ll discuss the answers to the following questions:

  • Does my insurance cover IVF?
  • What type of costs are associated with IVF?
  • So what are my options if my insurance doesn’t offer coverage?

Does My Insurance Cover IVF?

Not a whole lot of states have fertility treatment coverage, and even less have coverage for IVF

Seventeen states currently have fertility insurance laws, and Colorado is in the process of joining this list. These laws essentially establish that fertility medical services are treated the same as other covered medical services, and there can’t be any differences in the copays and deductibles. 11 of those states have coverage specifically for IVF, and Colorado will be the 12th. When it comes to fertility treatments and insurance, things can get really complicated. Not only do you have to pay attention to exactly what treatments are covered (since an even smaller percentage covers IVF specifically), but you also have to take note of how your state actually defines “infertility,” as there can be some inconsistencies for same-sex couples and insurance coverage. 

In terms of figuring out specifically what type of coverage you have with your insurance, it is important to know what types of questions to ask your insurance company. When asking about fertility benefits, you might consider asking first about what types of treatments are actually covered, because as we have mentioned, unfortunately there can be some limitations depending on your state. It is also important to ask if fertility testing is covered, as well as medications or evaluations by specialists. Ask about what types of limitations there are in terms of age, marital status, and coverage for same-sex couples. Lastly, in terms of learning more about IVF, you can ask some specific questions regarding whether or not there are any limitations in coverage before moving on to IVF as a treatment. 

A person is signing a legal document, a process involved in understanding insurance benefits.
Insurance coverage regarding fertility treatment can be extremely complicated. For treatments such as IVF, the restrictions on coverage can be even more confusing. While there are not a whole lot of states at the moment who offer insurance coverage for IVF specifically, there are many questions to keep in mind when learning more about what type of fertility care access you might have. 

What Type of Costs Are Associated with IVF?

Fertility treatments can get expensive

IVF and other fertility treatments can rack up a pretty hefty bill depending on how many expenses are involved in your care. Given this, it is important to know what types of expenses couples should expect when seeking out fertility treatments such as IVF, as it is easy to forget about some parts of the treatment plan. Here are some of the parts that contribute to the overall cost of your IVF:

  • Appointments and evaluations. You’ll likely have quite a bit of doctor’s appointments and evaluations by specialists before you start your treatment journey, since evaluating exactly what is going on is an important and early part of the process.
  • Various testing. Blood samples and testing to assess hormone levels is another crucial part of fertility treatment. You’ll also be looking at other tests like ultrasounds to check for things like ovarian cysts, and to assess the overall condition of your reproductive system before starting your treatment. 
  • Medications. Everyone’s journey is unique, but it is possible that yours could involve various medications or injections to assist with egg retrieval and other parts of the process. Coverage for medications can be another complicated subject in terms of insurance.
  • Embryologist. Aside from the fertilization of the egg as well as the transfer process, you will have to consider the cost of the actual embryologist who will be monitoring the embryo. 
A man is viewing a sample under a microscope, which is part of the process for an embryologist assisting with fertility care.
With the complex relationship between insurance coverage and fertility treatment, it is important to understand what types of expenses accompany your care. With treatments like IVF, there are many steps in the process that can sometimes slip our mind when thinking about where the costs are coming from.

So What Are My Options If My Insurance Doesn’t Offer Coverage?

There are still options for you in terms of affording your IVF

So you have your heart set on IVF therapy but have no idea how you’ll afford it without insurance coverage. Don’t fret, we’ll cover some of the options you have in terms of financing your care. Here are some routes to consider:

  • Nonprofit Organizations. There are organizations out there that could potentially offer financial assistance during your infertility journey. Organizations like Hope for Fertility Foundation and Baby Quest Foundation are two among many that offer grants for fertility treatment.
  • Financial Counselors. A lot of fertility clinics offer counseling services to help guide you through managing your finances for treatment. You can also ask your medical practice if they offer any types of financing options.
  • Employers. Benefits can vary across the board in terms of employers. With changes being advocated for as we speak, it is likely that different employers could offer significantly better fertility benefits than others. 
  • Advocacy. Organizations like Resolve offer ways that you can advocate for better coverage and fertility benefits in your state.  
A woman stands with her arms open, feeling happy and at ease.
If your insurance offers little to no benefits in terms of coverage for your fertility care, you still have plenty of options. Not everyone can afford to pay out of pocket for their care, so luckily there are organizations and other services that may be able to help with your finances. 

Insurance coverage for fertility treatments like IVF can get extremely complicated. Depending on your state, employer, and coverage plan, you may or may not have benefits in terms of financing your fertility care. Whether or not you have coverage, it is important to understand what costs are associated with your treatment, and what options you have for funding. 

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