HOW CAN I PAY FOR FERTILITY TREATMENT?

If you’re thinking about having fertility treatments such as IVF to start your family, you may be worried about how you will pay for it. Health insurance can play a part in financing your treatment but how much it will pay out varies enormously from state to state and even then, it depends what sort of insurance policy you have.

Let’s take a look at some facts about what may be available to you.

The Affordable Care Act and how it may help you

The Affordable Care Act (ACA – sometimes called Obamacare) stipulates that health insurance companies must provide the same essential benefits. These include for example, emergency services, hospitalization, outpatient care, prescription drugs as well as maternity care and care of the newborn. The insurers may also add extra health benefits onto a plan if they wish.

Sadly, treatment for infertility is not one of the essential benefits stipulated by the ACA. So if your existing health insurance didn’t already cover treatment for infertility before the Act was passed, it doesn’t have to do so now.

However, there is good news too. Infertility is classified as a pre-existing condition. Before the Affordable Care Act, a pre-existing condition could have meant that you would be denied health insurance. Since 2014, a health insurance company is not allowed to refuse you cover if you have been given a diagnosis of infertility.

All States are not equal…

Currently, fifteen states mandate some coverage of fertility treatment. The states are:

Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia – all of which require some cover. To complicate matters, they don’t all require the same coverage.

Colorado does not currently mandate coverage. However, your own insurance may cover some of your diagnosis and treatment. The coverage offered by your policy is determined by your insurance company and your employer.

Get to know your policy

Health insurance policies generally come under one of these five:

• No insurance cover for fertility
• Insurance cover for the diagnosis of infertility only
• Insurance cover for the diagnosis of infertility and some (limited) treatment
• Full Insurance cover for Infertility
• Insurance cover for medication (which may or may not include drugs for fertility)

If your insurance policy covers diagnosis and some treatment for infertility, read it carefully to be sure of exactly what that means. Make sure you’re clear about possible cover (or not) for oral ovulation drugs, injectable fertility drugs and intrauterine insemination.

What about Your Partner’s Policy?

If your partner is male, check his health insurance to see if his testing and treatment for infertility is covered.

If you are in a same sex relationship, take some time to investigate what coverage your health policies give. Check if you have cover for same sex spouses or domestic partners. This sort of coverage varies by state and by individual policy so it’s important to be clear.

Full infertility coverage

If this is your insurance policy, that’s great! Just to be sure, go over the small print and ask your fertility doctor if any of the following are recommended:

• Egg freezing,
• Preimplantation genetic diagnosis (PGD) or
• Intracellular sperm injection (ICSI)

Medications

This can be a confusing area so it’s best to ask your fertility doctor about what drugs are covered by your plan. This is especially important as some policies will happily pay for one drug but not another – at their discretion, regardless of what you need.

Egg Donors Don’t Need Health Insurance

As mentioned in our article on Egg Donor Reimbursement, throughout the entire process of donating eggs, all medical expenses are covered, as well as attorney fees, donor insurance, travel expenses, and in some cases hotel accommodations, airfare, and a per diem. The amount of financial reimbursement usually varies with each case, but can range from $5,000 to $ 10,000 in some cases.

I’m not covered. Help!

Even if your insurance does not provide any coverage for fertility treatment, don’t give up. There are many financing plans and other methods of helping you to pay for treatment and to build your family.