The New York State Infertility and In Vitro Fertilization (IVF) grant programs and health insurance mandate help many patients afford treatments.
At the same time, far more New York couples find themselves paying for these expensive procedures out of their own pocket – despite the infamous IVF grant program and insurance law.
Both options are full of holes. Follow this three-part outline for tips on how to get pregnant without going broke.
- Steps to take before borrowing money to pay for infertility or IVF
- Two hidden government grant programs that defray costs for all
- What treatments and people are included in the infertility mandate
Financing Infertility & IVF Costs in New York
Most New York couples find that financing and loans for infertility and In Vitro Fertilization offer the lone alternative to funding treatment costs. As you will shortly read, the state grant program and insurance mandate do not always offer much help.
However, be very careful about borrowing money to pay for your next cycle. Take several important steps to secure your finances before mom becomes pregnant.
If you meet income requirements a personal loan to fund infertility or IVF and begin treatment. A group of affiliated online lenders will review your borrowing credentials. The odds of approval are best if you have a good credit score, sufficient income, and a reliable work history.
Remember that you must repay the lender in monthly installments with interest. Most fertility clinics will not warn you about the financial impact of a high-risk pregnancy, or an extended NICU stay for twins or triplets born prematurely.
Mom may have to stop working long before her due date, and after her labor and delivery. Her hospital stay or a NICU confinement could result in large unpaid medical bills.
New York State does have one law that offers partial income replacement, but the amount is woefully lacking. Couples should be aware of what often happens nine months after successful infertility or IVF treatment. Act before conception to plug these holes.
- NYS short-term disability replaces 50% of mom’s income, up to a hard-dollar cap of $170 per week. This equates to a meager $8,840 annualized income. Many couples will fall behind on their bills quickly once mom stops working.
- Private short-term disability offers a higher level of income replacement during a pregnancy disability leave. However, you must purchase this policy prior to conception. Take this step before your next cycle!
- New York maternity leave laws offer unpaid job protections for only 12 weeks for approximately 40% of workers. Many women face job loss because they cannot work during a high-risk pregnancy, or their infants require care at home.
- Switch to a health insurance plan with lower deductibles and in-network coverage for your local hospital with a neonatal intensive care unit. The annual open enrollment begins in November and ends in January of each year.
NYS Government Grants for Infertility and IVF
New York State residents actually have access to two income-based grants opportunities that can help them pay for In Vitro Fertilization and other infertility treatments. One option enjoys great familiarity but perhaps a limited opportunity. The other comes cleverly disguised as tax savings.
The infertility demonstration program can help some low-income applicants, while tax deductions assist those earning more money.
Infertility Demonstration Program
The New York State Department of Health administers the infertility demonstration program. This income-based grant offers financial assistance to patients for In Vitro Fertilization (IVF), Gamete Intrafallopian Transfer (GIFT), and Testicular Sperm Extraction (TESE).
It is difficult to set an expectation for how many couples the infertility demonstration program actually helps, and how much assistance each obtains. However, we can read between the lines and develop a theory – only a small portion of patients get a small IVF grant through the state.
- The department of health website indicates, “Continuation of this program is dependent on the availability of funds.”
- Many of the approved providers do not promote the grant program on their websites. Those clinics that do, bury the information.
Qualified grant applicants may receive cost-sharing assistance ranging from 2.5% to 97.5% of the unreimbursed treatment charges. Low-income Medicaid enrollees do not qualify, as they do not have private health insurance. Those earning more money pay a higher percentage of the costs themselves.
Here are some of the eligibility criteria.
- Age between 21 – 44 years
- New York state residency
- Private health insurance
- Household income under $195,000
Government Tax Grants
Patients who work in New York State have two forms of income tax-funded government grants for infertility and IVF costs. Unreimbursed medical and dental expenses are tax-deductible items that can significantly reduce annual obligations.
Use IRS Schedule C to claim a federal government tax-based grant for unreimbursed infertility and IVF expenses. Publication 502 lists fertility enhancements and medicines as a qualifying deductible expense.
It defines fertility enhancements as two procedures to overcome the inability to have children.
- Procedures such as in vitro fertilization (including temporary storage of eggs or sperm)
- Surgery, including an operation to reverse prior surgery that prevented the person operated on from having children
It also defines prescription medicines in a way that include many fertility drugs. “A prescribed drug is one that requires a prescription by a doctor for its use by an individual.”
Complete New York form IT-201-D to claim the state version of the tax based infertility and IVF grant. Follow the instructions to transfer the federal itemized deductions to your state return.
New York Infertility & IVF Insurance Mandate
The New York State health insurance mandate regarding infertility treatments and In Vitro Fertilization creates tremendous confusion for many couples. The laws are very confusing – especially in how they apply to individuals and groups.
The insurance mandate is full of loopholes. In addition, many people commute into New York City from neighboring states. The neighboring states have different requirements.
IVF Insurance Mandate
New York State does not have an IVF insurance mandate. The law specifically excludes certain treatments from coverage.
- In Vitro Fertilization
- Gamete Intrafallopian Transfer (GIFT)
- Zygote Intrafallopian Transfer (ZIFT)
- Reversal of elective sterilization:
- Tubal ligation reversal
- Vasectomy reversal
- Sex change procedures
- Experimental treatments
- New Yorkers commuting out of state could gain coverage.
- People commuting to New York could lose a valuable benefit.
Infertility Insurance Mandate
The New York State infertility insurance mandate requires a group, and blanket accident and health plans to cover medically necessary expenses incurred in diagnosis and treatment of a correctable medical condition even if it results in infertility.
New York consolidated insurance laws – sections 3221 and 4303 contain the precise legal language. Warning – it is very dense and difficult to interpret.
Below is a summary of key concepts including the definition of infertility, the meaning of insurance policies, exemptions, and the listed treatments.
Definition of Infertility
The New York State law defines infertility by following guidelines published by the American College of Ob-Gyn (ACOG), and the American Society for Reproductive Medicine (ASRM).
The ASRM defines infertility as “the failure to achieve a successful pregnancy after 12 months or more of appropriate, timed unprotected intercourse or therapeutic donor insemination.”
The New York State infertility mandate includes the definition of insurance policies that must comply with the mandate: group, and blanket accident and health plans.
- A group insurance policy covers two or more individuals employed by the same employer.
- A blanket accident and health plans protect individuals while using certain services: common carrier services, employees while working, students on a college campus, etc.
- Exceptions are unions, self-insured employers, and policies regulated by the federal government.
- The union exception might be quite large. Teachers often belong to unions and may purchase employee benefits through a union. If so, many teachers may not be subject to the mandate.
- Large employers tend to self-insure, and New York is the headquarter location of some of the nation’s largest employers. The more employees, the more economical it may be to self-insure.
- Policies regulated by the federal government include Medicaid and Medicare. Therefore, Medicaid does not cover infertility treatments in New York.
The New York infertility insurance mandate includes a very short list of specified procedures that a plan must cover. Plans that include coverage for prescription drugs must also include fertility drugs approved by the FDA.
The following diagnostic tests and procedures are included:
- Endometrial biopsy
- Sono hysterogram
- Post-coital tests
- Testis biopsy
- Sperm analysis
- Blood tests and ultrasound
- NYS Department of Health
- NY Itemized Deductions
- IRS Deductible Medical Expenses
- Insurance Law Section 3221
- Insurance Law Section 4303