Under most insurance plans, you can count on maternity coverage and newborn care to be included in your list of benefits. However, if you’re considering infertility treatments as a way to grow your family, you might be disappointed. These costly medical services frequently aren’t covered under health insurance policies.
Healthcare plans purchased through the federal marketplace typically do not cover infertility treatments. The same is true of Medicare and Medicaid. But, if your healthcare plan is offered courtesy of your employer, there’s a chance you might be pleasantly surprised when it comes to your health insurance and infertility treatment coverage.
What Is Infertility and How Is It Treated?
The U.S. Department of Health & Human Services defines infertility as “not being able to get pregnant after one year of trying (or six months if a woman is 35 or older).” A variety of medical issues, both in women and men, can result in infertility.
Infertility is a relatively common problem in the United States. The Centers for Disease Control and Prevention (CDC) reports that around 12 percent of US women (ages 15–44) have trouble getting pregnant or carrying a pregnancy to term.
To diagnose infertility, your doctor may want to run tests on you and your partner. This may include bloodwork, semen analysis, ultrasounds, and more. To treat infertility, doctors often turn to medication, surgery, artificial insemination, or other types of assisted reproductive technology (ART).
Some common (and typically pricey) infertility treatment options include:
- Intrauterine Insemination (IUI)– Sperm is injected into the uterus with a catheter.
- In Vitro Fertilization (IVF)– Eggs are retrieved from the female, fertilized with sperm, and (if successful) viable embryos are injected back into the uterus.
- Intracytoplasmic Sperm Injection (ICSI)– Sperm is injected directly into the eggs retrieved through IVF. Once the sperm and eggs mix successfully in a lab, they are surgically deposited into the fallopian tubes.
Your healthcare plan may cover some, none, or (less likely) all of these costs. Even if your insurance does cover some infertility diagnosis and treatment options, there may be a limit on what’s actually covered. There may also be a lifetime price cap.
Check State Infertility Coverage Laws
In most states, health insurers aren’t required to cover infertility coverage. However, there are15 states that currently have laws on the books requiring insurance companies to offer infertility treatment coverage.
These states are as follows:
|New York||Ohio||Rhode Island||Texas||West Virginia|
Even if you live in one of the 15 covered states, that doesn’t mean your health insurance policy has to give you carte blanche when it comes to covering infertility treatment. Coverage requirements vary widely from state to state.
If your state requires coverage for infertility treatments, still keep the following in mind:
- All types of fertility treatment may not be covered. For example,California, Louisiana, and New York laws all specifically exclude IVF coverage.
- Some state laws may only require fertility treatment insurance coverage for large group plans. So, if you work for a smaller company, the state mandated coverage requirements might not apply.
- If you work for a large employer, it might be self-insured. Self-insured employers are exempt from the requirements imposed on state-regulated insurance plans.
- State laws may limit where you can have procedures performed, if your plan offers infertility treatment coverage.
Ask about Coverage and Limitations
If you do have medical insurance which covers infertility treatment costs, you should thank your lucky stars. Still, the amount of coverage you may take advantage of can vary widely from policy to policy.
Check with your provider up front about your coverage limitations so that you won’t be faced with any surprises down the road. Some important questions you may want to ask your insurance provider include the following:
- Are infertility medications or treatments covered under my healthcare plan? If so, which ones (and which ones are excluded)?
- Is there a limit on how many cycles of infertility treatment will be covered?
- What other coverage restrictions, limitations, or caps should I know about in advance?
- Am I required to try certain medications or treatments before others?
- Are any specific tests required to qualify for infertility treatment coverage?
- Will I need to get referrals to see infertility specialists from my regular doctor?
- Does my plan offer coverage for surrogacy or adoption?
How Much Does Infertility Treatment Cost?
According to the CDC, the average round of IVF is estimated to cost between $10,000 and $15,000. However, research from the University of Iowa suggests the average cost of an IVF cycle hovers between $12,000 and $17,000.
If you’re paying out of pocket for some or all of your infertility treatment, you will want to check with your doctor to find out how much money the process could cost you. Though there are many different types of treatments and medications, each one with a different price tag, your doctor should be able to give you an idea of how much you might need to prepare for financially.
About the Author: Michelle Lambright Black, Founder of CreditWriter.com and HerCreditMatters.com, is a leading credit expert with over a decade and a half of experience in the credit industry. She’s an expert on credit reporting, credit scoring, identity theft, budgeting, and debt eradication. Michelle is also an experienced personal finance and travel writer. You can connect with Michelle on Twitter (@MichelleLBlack) and Instagram (@CreditWriter).