Infertility health insurance coverage is extremely rare and very difficult to find. Most medical plans choose not to cover infertility for a simple reason: the cost of providing such a benefit may far exceed the premium most policy holders are willing to pay.
Many people are confused by insurance regulations, and go about finding what they need ineffectively. Most people end up self-paying for infertility treatments without insurance, and need help finding alternatives to better afford getting pregnant.
A small fraction of people are able to get insurance covering infertility, and need help understanding how it works.
Find assistance with:
- How to get covered for treatments
- Supplemental policies for infertility
- Employers that offer coverage
- Approvals and limits
- Infertility treatments without a policy
How to Get Insurance to Cover Infertility Treatments
Infertility health insurance must pay for the cost of the Artificial Reproductive Technique (ART), medical treatment of the resulting conception, extra monitoring of high-risk pregnancy, and NICU confinement of premature infants connected with high order multiple birth. As a result most carriers resist covering infertility treatments – doing so makes poor business sense.
Getting insurance to cover infertility treatments is very hard to do, but it does happen. Savvy couples understand that insurers don’t want to take on this risk, but state laws require they do in specific instances. By understanding how state regulations work, who must comply, and where the loopholes are, you may be able to find a policy that pays benefits for your ART and/or IVF.
State Infertility Mandates
Fifteen states mandate that medical plans include infertility and/or IVF. Each state mandate is different. Mandates vary based upon who is required to comply, what treatments are included in the mandate, and who is excluded. Regulations apply based upon In Situs status – your key to finding infertility health insurance coverage no matter where you live.
IVF insurance is even more difficult to find than programs for many first line infertility treatments – except for those who work for an employer based in a mandate state that stipulates in Vitro Fertilization exclusively. Without the right plan costs can be staggering. IVF refund programs offer an interesting choice for many couples.
Supplemental Health Insurance for Infertility
Supplemental health insurance for infertility allows you to bet that your efforts will work. Purchase the additional policies while you are still trying to conceive. Benefits are paid when you deliver your baby. Your benefit for normal delivery may greatly exceed the premium you pay. Use the surplus to offset some of your costs.
Couples who are trying to conceive often finance infertility treatments to get pregnant, and then experience a high risk pregnancy, and then pre-term delivery associated with high order multiple births, followed by an unpaid maternity leave. Supplemental health insurance protects your family finances by replacing income, and filling holes in hospital plans.
Couples undergoing artificial reproductive treatments often experience high-risk pregnancies. Some couples are starting later in life, while others choose a fertility procedure that results in multiple pregnancies. Supplemental health programs may replace mom’s income during bed rest if she misses work prior to delivery, or needs to be confined to the hospital prior to her due date.
Many infertility treatments are associated with multiple pregnancies. Multiple pregnancies often are delivered pre-term. When this happens your infants may spend time in the Neonatal Intensive Care Unit (NICU). You may be left with extra hospital bills. Supplemental hospital policies may also make payments upon the hospital stay for mom’s normal labor and delivery, and may pay additional benefits for each infant confined in the NICU for medical reasons.
Employers that Offer Infertility Insurance
Most people get their health plans through their employer. Finding employers that offer infertility insurance may be your best bet. The state mandates referenced above apply mostly to employers rather than individuals.
Only a handful of states have mandates, but you only hear people complain when they live in a mandate state, but their employer does not have to comply because they are headquartered in a non-mandate state. Turn that complaint around. Many employers are headquartered in mandate states, and provide employment in other states. If one spouse has the flexibility, changing jobs may be the best answer.
Companies that Offer Plans
Many people ask “which insurance companies cover infertility treatments?” If that is your question, your odds of success rise by reframing the question. As mentioned above most companies will refrain from addressing infertility unless required to do so by law. Follow through on the logic.
The Federal Employees Health Benefit Program is exempt from the fifteen state infertility mandates. If you are a federal government employee, you may need to consider your spouse’s employer sponsored plans, or look more closely at the option for people without a policy.
Infertility Health Insurance Limits and Approvals
Those lucky enough to have infertility health insurance coverage will need to understand policy limits and seek approvals before beginning any treatments. Every policy has limits in terms of the types infertility treatments, number of cycles allowed, age of the mother, and more.
Consult with the finance advisor at your fertility clinic for advice on what procedures will be included, and at what level. The advisor can also help you get approvals from the carrier in advance of any treatment. Nobody wants like unpleasant surprises.
Infertility Treatment without Coverage
Getting a denial letter from your carrier can be deflating. Most people will find they have to self-pay for infertility treatment without insurance. You have plenty of company if you say, “my insurance does not cover infertility.” Most couples have limited resources and need to make every penny count, but there are some alternatives to help make things more affordable.
Infertility treatment costs when paid for out of pocket can cripple many couples financially. The cost of getting pregnant can vary widely. The cost of treatments and fertility drugs are multiplied by the number of attempts needed to get pregnant. Accurately forecasting expenses is a key to keeping more of your money via the tax code.
Follow our preconception tips. Couples who are trying to conceive should investigate supplemental plans, flexible spending accounts and deductible medical expenses before getting pregnant. Supplemental programs need to start preconception. Medical expense deduction limits are crucial variables any couple paying for IVF should understand.