Where do you turn if your employer does not offer health insurance covering In Vitro Fertilization (IVF) and you cannot afford the treatment?
Non-group plans are the first alternative worth exploring.
Couples living in the eight states with legal mandates extending to the individual marketplace are lucky. Meanwhile, more people living in the remaining forty-two states can get non-group coverage addressing the intended outcome.
Self-pay plans are another valuable option available to all couples, regardless of where they live, that could lower treatment costs by 39% or more! You need to think about the problem differently.
Non-Group Health Insurance That Covers IVF
When your employer does not offer health insurance covering IVF treatment, non-group plans are the next logical place to seek help with this enormous expense. However, most couples will strike out or need to adopt a compromise solution.
Individual Market
Non-group health insurance covering IVF treatment is sometimes available in the individual marketplace for people living in one of the eight states with an applicable legal mandate.
Request a health insurance quote to get the process started. A licensed agent may contact you to review premium costs and take your application if you want to purchase the coverage, which you might do if your state has a legal mandate extending to individual plans.
| Arkansas | Connecticut | Delaware |
| Hawaii | Illinois | Louisiana |
| Maine | Maryland |
Unfortunately, people living in the remaining forty-two states without a mandate will find this a dead-end street. Insurance companies dislike covering IVF because they do not want to pay enormous claims for an elective procedure and only do so when the law requires it.
Therefore, most couples will need to try a compromise alternative, which you can read about next: covering outcomes rather than treatments.
AFLAC Insurance
AFLAC and other companies in the space (Colonial Life, Unum, Humana, Met Life, and more) offer non-group supplemental health insurance that covers IVF outcomes but not treatments.
Purchase supplemental infertility insurance at work for the best benefits. Employees own the AFLAC policies, not the group, and fund the premiums with payroll deductions. The coverage is portable, meaning they can continue the policies after separating from their employer.
Couples can enroll in AFLAC-type plans before conception and then file a claim for benefits when the artificial reproductive technology succeeds – when the mom becomes pregnant and has a baby.
- Replace lost income during unpaid maternity leave
- Offset unreimbursed expenses from a hospital stay
- Help with NICU costs after pre-term delivery
Self-Pay Health Insurance That Covers IVF
When your employer does not offer health insurance covering IVF treatment, self-pay plans are another terrific place to look for help with this enormous expense.
A High-Deductible Health Plan (HDHP) combined with a Health Savings Account (HSA) fits the description. Couples in all states can take advantage without defaulting to outcomes (mom’s pregnancy and childbirth).
High-Deductible Health Plans
A High-Deductible Health Plan (HDHP) is the first component of the self-pay insurance covering IVF. An HDHP will probably not cover infertility treatment, but you must establish one to utilize a Health Savings Account (HSA).
You can get an HDHP at work or through the individual marketplace.
Individual
Complete IRS Form 8889 to deduct your HSA contributions from your taxes yearly. Please note you do not have to itemize your deductions to realize significant savings beginning with the first dollar contributed (see below).
Work-Based
You can also enroll in an HSA-compatible HDHP at work, as many do if offered by your employer. This option is preferred because many companies subsidize a portion of the premiums to incentivize participation. Plus, the tax savings are better.
A work-based HDHP allows you to pay HDHP premiums and HSA contributions using pre-tax payroll deductions, which reduces exposure to three levies rather than just two.
| Pre-Tax Payroll | Deduct After | |
|---|---|---|
| Federal Income Tax | Yes | Yes |
| State Income | Yes | Yes |
| FICA (7.65% typically) | Yes | No |
Health Savings Account (HSA)
A Health Savings Account (HSA) is the second component of the self-pay insurance covering IVF treatment. An HSA allows you to utilize tax-favored dollars to pay for qualifying medical expenses, which may include the following services.
| Standard IVF Steps | Optional IVF Services |
|---|---|
| Ovarian reserve testing | Donor sperm and eggs |
| Semen analysis | Preimplantation Genetic Diagnosis |
| Infectious disease screening | Sperm washing |
| Fertility medications | Intracytoplasmic Sperm Injection |
| Egg retrieval | Cryopreservation |
| Sperm retrieval | Embryo storage |
| Fertilization | Assisted hatching |
| Embryo transfer | Frozen embryo transfer |
Contribution Limits
HSA annual contribution limits dissuade many couples from this self-pay IVF insurance alternative. However, do not give up so easily; you have a two-step workaround.
- IVF monthly payment plans allow you to pay the fertility clinic upfront while spreading the expenses over several years, provided your credit qualifications and income are sufficient.
- You can reimburse yourself with tax-favored money from your HSA, provided you have an HDHP in place before undergoing treatment and continue the program in later years, thus overcoming the annual contribution limits.
- Self-only: $3,850
- Family: $7,750
Projected Savings
The HSA projected savings are the clincher for this self-pay IVF insurance alternative. A middle-class couple could dramatically reduce their costs to almost 39%.
IVF is tax deductible, but you save much more money by using an HSA. You avoid paying FICA taxes if you sign up at work and realize first-dollar savings because you do not have to meet two thresholds limiting benefits.
- The standard deduction for a married couple is $27,700
- Medical and dental expenses above 7.5% of AGI
Consider this example for a hypothetical married couple (not retired) with a combined Adjusted Gross Income (AGI) of $100,000 who work in California while incurring $20,000 of IVF costs.
| Pay Using HSA | Deduct on Taxes | |
|---|---|---|
| Meets Standard Deduction | Not Applicable | Maybe |
| Expenses Above 7.5% AGI | Not Applicable | $5,000 |
| Federal Bracket: 22% | $4,400 | $1,100 |
| California Bracket: 9.3% | $1,860 | $465 |
| FICA Taxes: 7.65% | $1,530 | $0 |
| Total Saved | $7,790 | $1,565 |
| Percent Saved | 38.95% | 7.8% |
