Insurance coverage for fertility treatment varies by state and your insurance provider. Currently, 17 states have laws around coverage for infertility diagnosis and treatment.
- New Hampshire
- New Jersey
- New York
- Rhode Island
- West Virginia
Fertility Insurance Basics ExplainedInsurance coverage for fertility treatment can vary depending on your state of residence, whether you have public or private coverage, and the specifics of your insurance plan. IVF costs with insurance may be significantly reduced if your state offers laws that require insurance providers to cover fertility treatments. Coverage does not mean free, as you are still responsible for any copays if you have private insurance. Coverage varies across the states, and some procedures may not be fully covered. You may need to provide proof of infertility diagnosis and meet other criteria such as age and number of IVF attempts. Additionally, if your insurance plan is fully-insured, your insurer is required to follow state insurance laws. If your plan is self-funded, the insurer may be exempt from state insurance laws. Lastly, because many fertility treatments are not considered “medically necessary” by insurance companies, they are not usually covered by private insurance plans or Medicaid programs. Medicare benefits may cover necessary services associated with infertility, though exact types of treatments are not specified.
Does my insurance cover IVF?Some states require insurance to cover IVF but may impose limits on the maximum amount that insurers must cover, or the number of IVF cycles that can be covered. Patients may also have to provide proof of history of infertility. Coverage may also vary depending on whether donor or partner eggs or sperm are needed. Many insurance providers will not cover IVF until a few cycles of IUI have been attempted without success. Coverage may also be limited to individuals who have had coverage from the insurer for a year or more. If you are wondering if you have insurance that covers IVF, first check with your state’s insurance coverage laws. Next, if your insurance is through an employer, ask your HR representative about IVF coverage benefits.
Does my insurance cover IUI?IUI is sometimes covered by insurance. Some states have laws that require insurers to cover all or part of IUI. However, even in states that have IUI coverage laws, not all patients are eligible for IUI coverage. For example, if your employer self-insures, they are exempt from state laws that require fertility treatment coverage. Additionally, sometimes coverage has a limit on the number of IUI cycles or a limit on the amount of money they will cover. Consult your state’s fertility treatment coverage laws to determine whether your insurance will cover IUI. Then, reach out to your insurance provider for more details.
Questions to Ask Your Insurance Provider about Fertility Care CoverageThe best way to know if IVF is covered by your insurance plan is to ask. There are a few questions you should ask your insurance provider to determine your IVF and IUI coverage:
- Does my insurance cover IUI?
- Does my insurance cover IVF?
- How much will IUI/IVF cost with my insurance?
- Does my insurance cover other fertility treatment costs like medication, tests, and other procedures?
- Does IVF require a certain number of IUIs before IVF is covered?
- Are there age limits on my insurance coverage for fertility treatments?
- Are there any other limitations on my insurance coverage for fertility treatments?