One of the first questions anyone new to the world of fertility care will ask is whether or not the treatment they need to build their family will be covered by insurance. Insurance coverage for fertility treatment is complex, with no firm answer that can be given across the board. Your level of coverage will depend on a few different areas, including your current insurance plan, where you live within the United States, and what (if anything) is offered by your employer.
How Insurance Coverage for Fertility Works
Health insurance is designed to help cover all or a portion of the costs associated with medical care so the entirety of this financial burden does not fall on the patient. However, at this time, health insurance does not typically cover fertility treatment. Because of this, patients often find that they are responsible for all or close to all of the costs associated with intrauterine insemination (IUI), in vitro fertilization (IVF), and third-party reproduction (egg donation, surrogacy, etc.). When insurance plans do offer coverage, there are typically limitations in place; for example, you may receive coverage for diagnostic testing but not IVF or you may need to try IUI a certain number of times before being eligible for IVF coverage.
It’s essential that patients starting treatment review the coverage offered under their policy as early as possible. You can often request a call or meeting with a representative from your insurance provider to discuss coverage in-depth. Before beginning treatment, you will also have to confirm that your fertility clinic accepts your insurance.
State Laws and Fertility Insurance
State insurance laws can have a significant impact on your level of fertility insurance coverage. Fertility care coverage requirements vary from state to state, with only 19 states in the US having any specific legislation in place. Some of these states have specific stipulations about IVF and/or fertility preservation, but most do not.
However, even if you live in a state that has fertility care coverage included in its insurance laws, it is not a guarantee that coverage will be provided. For example, in Illinois, companies with less than 25 employees are not required to provide fertility care coverage as part of their employee health insurance package.
How Your Employer Factors Into Fertility Insurance Coverage
The majority of people in the US receive insurance through their employer. Because of this, fertility patients can ask their employer about expanding coverage to include fertility care. It will be up to your employer to determine whether coverage will be extended to fertility care, but you could address your points with questions such as:
- What fertility treatments are covered?
- If limitations exist, what are they?
- Are fertility medications covered?
- What could I expect in terms of co-pay or deductibles?
You can find a comprehensive checklist for these types of questions here.
IVF Costs With Insurance
IVF costs can be challenging to predict in full. They encompass testing, medications, appointments, embryo creation, egg retrieval, and implantation. Even with insurance coverage, you may still find yourself facing unexpected fees. As noted above, coverage may only cover part or a very limited amount of your care. Or, you could find that your coverage does not extend to treatment that applies to your situation.
How to Afford Fertility Care Without Insurance
Without insurance coverage, affording fertility treatment can call for thinking outside the box. Some patients will finance their fertility journey by taking out loans, applying for grants, or even turning to crowdfunding. However, all of these options are limited if you end up needing more than one IVF cycle, which is a reality that the majority of fertility care patients face. It’s estimated that only one out of four patients will successfully conceive after one round of IVF.
One way to plan ahead for your fertility journey with or without insurance is through multi-cycle packages, such as those offered by Bundl. Bund offers fertility care financial packages that combine multiple fertility care treatment cycles into one, typically for a discounted price. These packages come with shared-risk protection guarantees, which protect your investment in various scenarios. To learn more about which Bundl package best suits your growing family’s needs, schedule a consultation with one of our patient care experts.