Access to insurance coverage of many types has a profound effect on the average cost of In Vitro Fertilization (IVF) treatment costs in the USA.
Average figures are very misleading because some couples (with full insurance) pay virtually nothing, while others must fund the entire cost (with optional services) over multiple cycles.
Finally, those lucky patients who bring home a baby (or two, or three, or four) face a second wave of expenses that insurance can also affect. Lost income and higher medical costs often accompany a high-risk pregnancy and or premature infants.
Fortunately, couples can take steps before their next cycle to mitigate many of these exposures.
How Much Does IVF Cost With Insurance?
The state you live or work in can have a significant impact on how much In Vitro Fertilization costs with insurance. However, the location of the fertility clinic and the prices they charge are secondary concerns. Local laws have a much stronger influence on your total out-of-pocket expenses to bring home a baby or two.
The United States has one federal law that applies equally across the country – although it affects IVF costs indirectly. The Family Medical Leave Act (FMLA) comes into play after a successful embryo transfer. Moms often need the legal job and health insurance protections while on pregnancy disability work absence, and while she bonds with her baby at home.
On the other hand, the legal environment in each state can vary widely and have a profound effect on spending to bring home a baby in multiple ways.
- IVF insurance mandates exist in nine states with many cost-sharing features
- Balance billing
- Legal mandates for first-line infertility treatments apply in six other states
- Usury regulations frequently limit financing and loan options
- Temporary disability programs (six states) replaces salary during pregnancy disability absence
- Paid family leave benefits (three states) replaces earnings for caretakers of sick babies
- Family medical leave laws (ten states) extend FMLA job protections
- State income taxes present a second opportunity to deduct qualifying medical expenses
- Buying supplemental coverage before conception leads to better outcomes
The following breakdown applies these concepts to projected IVF baby costs in your area.
The cost of IVF in Texas with insurance is a complicated topic. While Texas is one of only nine states with a legal mandate for IVF coverage, the law merely requires healthcare companies to offer a plan in the group and association markets.
- Your employer is not required to purchase coverage
- You cannot buy a policy in the individual market
Therefore, lucky employees with IVF coverage at work drag down the average spending amount. However, the fortunate few do not read articles like these since they won the lottery. The remaining Texans pay the full amount out-of-pocket and do plenty of research.
Besides, Texas has no entitlement programs that help couples after they conceive. Texas does not extend FMLA job and health benefit protections with a supplementary law or temporary disability program. Furthermore, residents of the Lone Star State do not pay income taxes and cannot deduct these qualifying medical expenses a second time.
The cost of IVF in California with insurance is another tricky subject. California has a legal mandate that requires healthcare companies to offer a plan that covers “medical procedures consistent with established practices in the treatment of infertility by licensed physicians and surgeons.”
The California Health and Safety Code Section 1374.55 specifically excludes IVF from the mandate. Therefore, most patients are on their own – unless preliminary treatments fit the quoted definition.
On the other hand, California has the most robust entitlement programs helping both mom and dad after a successful cycle (conception). These benefits replace earnings and or extend legal job protections during work absences.
- CA SDI replaces mom’s earnings during pregnancy disability absence and after childbirth
- CA Pregnancy Disability Leave provides up to four months of legal job protection
- CA Paid Family Leave extends benefits to care for an infant at home
- CA Family Rights Act adds 12 weeks of job protections for baby bonding time
California also has the steepest marginal state income tax rates. Affluent couples might be able to deduct qualifying medical expenses and reduce their tax bill come April 15.
The cost of IVF in Florida with insurance is a meaningless number because the majority of residents cannot obtain coverage. Florida is one of many states without a legal mandate of any kind.
The only Florida families lucky enough to have insurance that pays for IVF typically work for employers headquartered in another region with a mandate. If the company does not self-insure, they may have to follow the laws in their home jurisdiction. Also, a tiny fraction could have coverage if their generous employer insists on adding the benefit.
As with many other states, Florida does not have any entitlement programs that kick in after a successful transfer (conception). People in the Sunshine state do not have a temporary disability program, or family leave laws that extend FMLA protections. The absence of state income tax means residents have no opportunity to deduct expenses.
The cost of IVF in New York with insurance has the broadest range of possible amounts for each couple. The laws in New York and neighboring states create several sets of winners and losers.
- One NYS law requires certain insurers to cover infertility treatment for women between the ages of 21 and 44 years. A 2019 revision expands IVF coverage for large private sector employers.
- Commuters to neighboring states (NJ & CT) can enjoy IVF benefits under those mandates, as do NY employees working for companies headquartered in those areas.
- The IVF grant program helps pay expenses for qualified applicants but is perpetually short of funding.
- Finance companies avoid lending to New Yorkers due to onerous usury regulations.
- The NYS disability program caps benefits at a woeful $170 per week.
- A more substantial Paid Family Leave benefit helps parents afford baby bonding time
- The progressive NYS income tax rate (4% to 8.82%) offers more significant savings to affluent families.
The cost of IVF in New Jersey with insurance is perhaps the lowest in the country. The reason is simple: New Jersey laws and entitlement programs touch every possible base associated with reducing the net expenses related to both treatment and a successful outcome – mom’s pregnancy and childbirth.
- NJ law requires healthcare companies to cover medically necessary infertility services including medications, surgery, IVF, embryo transfer, artificial insemination, GIFT, ZIFT, ICCSI, and four completed egg retrievals per lifetime.
- NJ TDI replaces 66% of salary during pregnancy disability absence with a generous weekly cap.
- NJ Paid Family Leave benefits continue at the same level during baby bonding time
- NJ Family Leave Act extends job and health benefit protections after FMLA expires
The New Jersey state income tax has a progressive rate ranging from 1.4% to 8.97% for the highest earners. However, couples cannot enjoy any first dollar savings from a Flexible Spending Account, as NJ does not recognize these pretax payroll elections.
The cost of IVF in Ohio with insurance is pertinent only to families who participate in a Health Maintenance Organization (HMO) – but only to a point. Ohio law requires HMOs to provide basic health care services, which include infertility services when medically necessary. However, IVF is rarely medically required.
Therefore, Ohio residents insured through a Preferred Provider Organization (PPO), Exclusive Provider Organizations (EPO), or Point of Service (POS) plan design pay 100% out-of-pocket. Compare this with HMO members who might have coverage for preliminary testing and other supporting services, but not for an embryo transfer.
Also, Ohio does not have any entitlements that help parents financially after conception (temporary disability, family leave laws). However, the top marginal state income tax rate of 4.997% provides an opportunity for couples to save money on deductible medical expenses.
The cost of IVF with insurance across the remaining USA reflects the diversity of our country. We have a constitutional republic where each state decides for itself what laws to pass and entitlements to offer. Therefore, there is no average figure that accurately represents this variety.
This chart summarizes the critical programs illustrated above for some of the larger areas.
- Legal mandate to cover IVF
- Legal requirement to cover other infertility services
- Temporary disability program
- Paid family leave benefits
- FMLA time & eligibility extensions
- Onerous usury laws restricting lending
- State income tax allowing medical deductions
Average IVF Treatment Cost without Insurance
Looking at the average cost in the USA for In Vitro Fertilization without insurance could be more helpful. The typical price ranges is about $12,000 per round with plenty of variation. Most couples must fund the entire treatment cost out-of-pocket by themselves with no help from an outside third party payer.
However, the spending on optional services and the number of cycles needed to conceive inflates the average figure. Some patients opt for the bare-bones approach, while others add every possible bell and whistle. Then, insurance may not cover elective services – even when required to pay for IVF under a mandate. Finally, some parents conceive on the first round, while others pay for multiple attempts without success.
Donor Eggs and Sperm
Adding donor eggs or sperm to your IVF treatment drives up the price for each cycle you must fund without insurance. On the other hand, donor sperm and eggs may significantly improve your odds of success. Higher success rates mean you could need to pay for fewer cycles before becoming pregnant.
Consider these example data. Your results will vary. Donor eggs and or sperm can reduce the expected cost of becoming pregnant by limiting the number of cycles needed. Consider it an investment that could pay off handsomely.
Intracytoplasmic Sperm Injection
Combining Intracytoplasmic Sperm Injection (ICSI) with IVF also drives up per-cycle costs without insurance, but improves the success rates at the same time. During the procedure, your endocrinologist will take a single sperm and inject it directly into an egg. This step increases the odds of successful fertilization.
As before, you want to combine the incremental expense of ICSI with the improved success rate to project the total number of cycles needed for live birth.
IVF medications also add to costs without insurance and improve your success rates, which may reduce the number of cycles you must pay for out-of-pocket. Each drug has a unique price point and dosage per treatment, and you might need to purchase multiple rounds for each attempt.
However, do not attempt to cut corners with your medications. Doing so may save a relatively small amount of money upfront but could lead to higher costs in the future (additional cycles after failed attempts).
Investing in medication success is often a better alternative.
The cost of gender selection with IVF ranges from $3,000 to $5,000 without insurance. This optional family balancing treatment is typically self-pay. Even plans subject to legal mandates decline to cover elective gender selection procedures.
However, couples may choose gender selection for medically necessary reasons – which could compel a healthcare plan to cover the optional treatment. Work with your reproductive endocrinologist to submit a narrative to your carrier for pre-authorization. For example, these sex-linked diseases could result in an approved claim
- Muscular dystrophy and hemophilia can affect the male offspring of mothers with the inherited disorder
- Parents who are carriers of Fragile X Syndrome or Autism can choose the gender that is less severely expressed by the disorder
Further Reading Resources