Estimating how much you need to spend out-of-pocket in California to bring home a baby via In Vitro Fertilization (IVF) involves four different factors. The average $15,000 per cycle price tag is just a starting point.
Getting your health insurance to pay for any part of the treatment could affect affordability dramatically, but most couples are not that lucky. The infertility mandate has holes.
However, laws unique to CA apply to everyone and combine to support a hidden money-saving strategy. Condense multiple IVF cycles into a single calendar year to maximize clinic discounts and income tax reductions.
Your ability to borrow and repay money can be the key that unlocks the savings!
How Much IVF Costs in California
In Vitro Fertilization in California costs the least for couples who can afford to attempt multiple cycles into one calendar year and pay for optional services that boost success odds.
Bringing home a baby after the first cycle is most affordable – but not guaranteed. Therefore, a multi-cycle, single year strategy can help more couples save money – if they have the resources to pull it off.
You might be surprised to see financing charges listed as the most crucial cost consideration for IVF. Beyond the apparent origination fees and interest expenses, Californians have a unique combination (compared to people in other states) of factors that make borrowing money safer and more beneficial.
Taking out a personal loan can help if you need extra money to realize these advantages.
- Funding multiple cycles in a single calendar year maximizes savings on federal and state income tax returns (see below)
- Paying extra for optional services that increase the per-cycle price can boost success rates which lower the number of cycles needed (see below)
- Many clinics offer substantial discounts to couples who can afford to make a multi-cycle commitment
- CA state disability insurance makes it easier to repay any borrowed funding while mom is out on pregnancy disability or at home bonding with her baby
- CA maternity leave laws allow mom to take up to seven months off and still have a job once she is ready to return to work
- Infants born prematurely or with very low weight may qualify for SSI benefits which help offset repayment expenses
The average per-cycle price of IVF in California is about $15,000 as it is across the country. However, every couple could spend a little less or a lot more per attempt depending on their unique requirements.
Sometimes, paying extra for expensive options can improve your odds of success. Becoming pregnant on your first try is far more affordable than multiple failures. The financing advantages noted above pay off in this area.
- Donor eggs: $14,000
- Donor sperm: $2,000
- Fertility medications: a wide range of extra charges
- Intracytoplasmic Sperm Injection (ICSI): $2,000
The after-tax cost of IVF in California can be much lower because of the very high marginal rate many residents must pay. Most unreimbursed medical expenses for any infertility treatment are tax-deductible on your federal and state return.
Two considerations come into play.
First, qualifying medical expenses must exceed 10% of Adjusted Gross Income (AGI) before tax savings kick in on your state and federal return. Once again, the financing advantages noted above can help you condense multiple cycles in a single calendar year.
For instance, a couple with a $150, 000 AGI (9.3% CA and 22% federal) might yield these savings by bunching their IVF cycles ($15,000 average price) into one year instead of two or three.
- One: $0 ducked
- Two: $4,695 avoided
- Three: $9,390 dodged
Second, CA has some of the highest marginal state income tax rates in the country. High taxes translate into more significant savings when you deduct qualifying expenses. These are the most recent rates for a married couple filing jointly.
For example, a couple in the 9.3% bracket could shave $1,400 from a $15,000 IVF bill – if they have enough deductions to exceed the 10% AGI threshold.
Parsing out the cost of IVF at Kaiser Permanente (KP) in California is a tricky exercise because of the triune nature of this large organization. KP is an integrated managed care consortium offering three types of services:
- Healthcare plan providing prepaid services (HMO)
- Hospital system offering high-level care
- Medical groups of local doctors such as reproductive endocrinologists
In general, your expenses at Kaiser will be higher because the CA insurance mandate excludes HMO entities from the requirement to cover related infertility services. However, some participating groups can elect to include coverage voluntarily for artificial reproductive technologies. Check with your employer.
Insurance That Covers IVF in California
Having health insurance that covers In Vitro Fertilization in California can significantly reduce what couples must spend out-of-pocket to bring home a baby. However, in the Golden State, this is the exception rather than the rule.
While CA has an infertility mandate, it does not require coverage for IVF – although people working for multi-state employers sometimes get lucky.
The California infertility insurance mandate requires group healthcare plans to offer coverage for the treatment of infertility, except IVF, and communicate its availability. The law is notable for exempted groups and plans types.
- Religious organizations
- Self-insured employers
- Home Maintenance Organizations (HMO)
- Individual plans offered through Covered California
- Medicaid programs such as Medi-Cal
Treatment for infertility can include the following:
- Diagnostic tests
- Gamete Intrafallopian Transfer (GIFT)
Keep in mind that your employer has the option to add coverage for these infertility treatments as part of its employee benefits package. Also, if offered at your place of work, you must agree to opt-in during open enrollment.
Senate Bill 600
Governor Gavin Newsom signed Senate Bill 600 into law on October 29, 2019. The new regulation declares that standard fertility preservation services are a basic healthcare service when a covered treatment causes iatrogenic infertility to an enrollee.
- Iatrogenic means caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment
- Standard preservation services can include embryo cryopreservation, egg freezing, radiation shielding, ovarian transposition, surgical removal of the cervix, and sperm cryopreservation
Assembly Bill AB 767 is awaiting approval in the Senate as of the publication date of this article. If signed into law by the governor, it would require the state insurance exchange to develop options for the inclusion of IVF coverage as part of, or as supplementary to, coverage currently offered through Covered California.
While California does not have an IVF insurance mandate, other states do require group plans to cover this artificial reproductive technology such as Arkansas, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, Rhode Island, and Texas.
Companies headquartered in one of these mandate states may have field office employees located in CA, who might then enjoy the same benefits as their co-workers. Contact you the human resources department to verify coverage if your employer issues a group policy from one of these states. However, keep in mind that the mandates often exclude self-insured plans.