Will my insurance cover my fertility treatments?
Real Mom Problem
“We have our first appointment with a reproductive endocrinologist but my insurance does not cover any treatment. Is this pretty typical? What was your coverage like and how much did you have to pay out of pocket?”
- 1. How much of your infertility treatment is covered by insurance depends on your particular insurance plan
- 2. Some women report that testing to diagnose infertility was covered by insurance, but any subsequent treatment was not covered
- 3. Some women have to make difficult decisions about which procedures to pursue based on what their insurance will and will not cover
Real Mom Solutions
If you pursue fertility treatment, expenses can quickly add up, and many treatments are not covered by most health insurance plans. Learn more about insurance coverage of fertility treatment from these women's experiences.
Some Cover Testing, but not Treatment
My insurance doesn't cover any fertility treatment, but it does cover up until you get the infertile diagnosis. So check and see if your insurance covers up to the point of the diagnosis, and if they do, then make sure the doctor codes things correctly so your insurance will cover it. (I had to fight with my local clinic about it, but they figured out they'd done it wrong, fixed it, and my insurance paid for all the diagnostic testing.)
Most insurances cover testing, but not treatment. So they will take you far enough to say - you can't have a baby on your own and we're not paying for you to have a baby, good luck. If you have things that can be treated then they usually cover that too, just not IUI, IVF.
Some Things Might Be Covered
We are currently trying to conceive, and luckily have 50% coverage. But we have a $10,000 lifetime limit, so I'm thinking IVF for us would not be an option. But we have talked about adoption if I don't get pregnant after a few more IUIs.
It's not going to be easy finding insurance that covers any infertility related expenses at all! A lot of companies have moved to limited payment plans; i.e. they cover about four doctor visits a year, thereby keeping the premiums low. There are a few out there that have some infertility coverage but they are few and far between. Most fertility care is not deemed medically necessary which is how they get by without having to pay. We looked for years trying to find any type of coverage so that I could have my tubal reversal surgery (which is about a third of the cost of IVF) with no luck at all.
My insurance only covers office visits, ultrasounds, blood work, etc., but NONE of the actual treatments, so IUIs or IVF are all out of pocket.
The trouble with infertility is that it's hardly ever covered. I have one of the best insurance policies in the nation, and yet infertility is only "partially" covered. All monitoring appointments are covered, but no medications and only $2,500 for lifetime for ART treatments (IUI, IVF, etc.). Believe me, that dwindles pretty quickly. Even if you do have insurance that covers infertility, there may be a waiting period required before you are able to use that part of the insurance. Sometimes it could be up to a year. Just do a ton of research. The best insurance policies (and the cheapest) are usually those that are associated with a job of some sort. My insurance is given to me through my work.
My insurance covers most of everything. I only have to pay my co-pays. They even cover my meds at $12 a month for Femara and $30 for my Ovidrel injection. They normally do not cover the trigger shot, but my reproductive endocrinologist wrote a letter to the insurance and they approved it.
Mine is covered 100% (I have Kaiser). If you're a military family, TRICARE should pay all meds, and labs, and ultrasounds.
Some Couples Pay for All out of Pocket
Our insurance has NEVER paid for infertility treatments, so it's been very hard financially on us.
My insurance didn't cover infertility one bit! It averaged about $350-$400 per visit out of pocket for me at my reproductive endocrinologist.
My insurance does not cover infertility treatments! We just had out first round of IUI and it was $475 plus $100 for the trigger shot. Still don't know if I will get an extra bill for all the ultrasounds I had.