Insurance Coverage for Infertility and In Vitro Fertilization – IVF
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How to Afford Fertility Treatments: Infertility Insurance Explained

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What Is Infertility Insurance?

For people trying to conceive, infertility can be difficult to talk about and even more difficult to live through—but infertility insurance can make it a little more bearable. 

IVF (in-vitro fertilization) is an umbrella term that refers to a set of fertility procedures that help couples otherwise unable to conceive do so through the artificial or in-vitro fertilization of retrieved ovaries. 

In the United States, on average one cycle of IVF can cost between $12,000 – $15,000 USD. An individual may need to undergo between three to nine cycles of this treatment, making it a highly expensive process. 

This is why IVF is an option often only available to those in a certain income bracket. While there are other methods such as financing to pay for IVF, a good option to consider is IVF insurance, which can cover a certain percentage of the total cost of your fertility procedure. 

We’ll dive into infertility insurance and how it works below, so you can determine if it’s the right option for you. 

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How Infertility Insurance Works?

Infertility insurance usually isn’t a separate policy but can be covered under your existing policy. It’s for those who are struggling to conceive or carry to term and can cover a range of treatment options. 

It’s important to note that in the United States, only 17 states mandate infertility insurance in some form. This means that these states require insurance providers to offer infertility insurance, although the coverage can vary significantly between states and providers. Most insurance providers also have a set of criteria related to the age and history of the couple before they can approve such insurance. 

What Does Infertility Insurance Cover?

Treating infertility can be complex and each insurance provider can offer different coverage, which makes it even more challenging to understand coverage. However, some of the services covered under infertility insurance can include: 

  • Artificial insemination
  • Diagnosis and testing
  • Egg retrieval
  • Intracytoplasmic sperm injection (ICSI)
  • Gamete Intrafallopian Transfer (GIFT)
  • Zygote intrafallopian transfer (ZIFT)
  • Medications

Plans that cover infertility insurance will most commonly pay for testing and diagnosis, but IVF is typically the most expensive, so it can be tough to find IVF insurance coverage.

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IVF Insurance Coverage

Although infertility is a medical diagnosis and IVF is the best medical treatment for the diagnosis of infertility, a 2018 analysis of the IVF insurance market by Mercer, found that 74% of Americans do not have insurance coverage for IVF. 

Many plans only cover testing and diagnosis of infertility but don’t cover IVF because of how costly it is. If they do cover IVF, there’s often a lifetime maximum benefit, because of how many rounds of IVF it can take to become pregnant. Lifetime maximum benefits can often range between $10,000-$25,000, which keeps insurance costs down for providers but may only cover one or two rounds of IVF. 

How to Choose Fertility Insurance Coverage?

Because fertility insurance coverage isn’t offered in every state, your first step should be to find out if your state is mandated to cover fertility insurance. You’ll then want to find out which treatments are covered by an insurance provider; the more options, the better. 

You’ll also want to find out which local providers are covered, and their reputations and track record around infertility. This can help you ensure you get the best possible treatment down the line. 

Another critical piece of information you’ll want to know before choosing a provider is how many rounds of IVF they cover because it can take multiple rounds to be successful. 

Last, but certainly not least, you’ll want to understand the costs surrounding infertility insurance. These include co-pays, deductibles, out-of-pocket expenses, and more. Fertility treatments can be incredibly expensive, even with insurance coverage. You’ll want to know what costs you can expect, even if an insurance provider seems to offer good coverage. 

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Final Thoughts On Infertility Insurance

Navigating infertility insurance can be complex. Each provider has its own criteria for infertility insurance, in addition to state laws that may address infertility issues very differently. You should definitely check with your insurance provider on the infertility insurance coverage before proceeding with any tests or treatment because coverage can be tricky. 

If you or your partner is having trouble getting or staying pregnant, infertility insurance can be a great option to afford fertility treatments or at the very least, get the answers you need. 

FAQs
Infertility insurance is designed to help pay for infertility tests, diagnosis, and treatment. These can be very expensive procedures, making infertility insurance a good option if you can find local coverage.
Yes, but it can be tough to find. Only a fraction of states have any form of mandated coverage, and even then it’s likely not comprehensive.
You should speak to your doctor about your options for treatment. If IVF is the best course of action, you may need to pay out of pocket or keep searching for IVF insurance coverage.