How much does In Vitro Fertilization (IVF) cost in New York State?

There is no single correct answer because access to insurance coverage, grants, and financing is different for each couple. Also, the pricing for optional services combines with per-cycle success rates to determine your total out-of-pocket spending.

Finally, several NYS laws factor into the equation when you look ahead to your intended goal (bringing home a baby or two or three). New parents always suffer lost income and sometimes lose their job and health benefits when they take extended family leave.

New York IVF Insurance, Grants, & Loans

Access to insurance coverage, grants, and loans are a critical input into the cost equation for In Vitro Fertilization in New York. A lucky few will find help from a third-party insurance company or grant program.

However, a larger number of couples will have to pay most of the expenses out-of-pocket and may need to take out a loan. Those lucky enough to conceive have additional concerns during mom’s future work absences.

Financing Charges

Request a personal loan to fund your out-of-pocket IVF expenses. Many couples do not have enough cash on hand to finance a single cycle – let alone a second attempt if the first one fails.

Having extra cash makes it easier to opt for additional services such as donor eggs, donor sperm, or ICSI that increase success rates. Paying for one cycle rather than two can have a massive impact on your finances.

Keep in mind that borrowing money will add to your outlay based on your level of creditworthiness (credit score, employment history, income).

  • Upfront origination fees range from 1% to 5%
  • Annual interest rates range from 5% to 30%

Income Replacement

Several New York State income insurance laws can have a profound effect on IVF outcome expenses. You could feel the impact of these regulations within nine months of a successful embryo transfer (during mom’s pregnancy and after labor and delivery) – when mom and or dad stop working.

  1. The Disability Benefits Law requires your employer to purchase a short-term disability policy. However, the paltry amount of only $150 per week does not offer much help during an extended pregnancy disability leave.
  2. Supplemental disability insurance can increase the weekly benefit amount to a suitable level, provided you begin coverage before your next cycle. Once you conceive, it will be too late!
  3. The Paid Family Leave Act provides up to 12-weeks of job and health insurance protections, plus partial income replacement while both mom and dad bond with their baby.

Infertility Mandates

New York State has several infertility insurance mandates on the books that can directly affect patient out-of-pocket costs for IVF – if they apply to you. Unfortunately, loopholes abound.

Earlier Laws

Earlier New York insurance laws (§ 3216 (13), § 3221 (6) and § 4303)require 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.[1][2]

Required Groups

The NY infertility insurance laws include definitions of policy types that must comply. These definitions can help you determine whether your plan will cover certain expenses.

  • A group health insurance policy covers two or more individuals employed by the same employer
  • Exceptions are unions, self-insured employers, and plans regulated by the federal government such as Medicare and Medicaid (see below)
Mandatory Treatments

These earlier NY infertility insurance laws also specify the treatments that subject plans must cover. The mandate lists the following diagnostic tests and procedures:

  • Endometrial biopsy
  • Hysterosalpingogram
  • Hysteroscopy
  • Laparoscopy
  • Sono hysterogram
  • Post-coital tests
  • Testis biopsy
  • Sperm analysis
  • Blood tests and ultrasound

Also, plans that include coverage for prescription medications must include fertility drugs approved by the FDA.

2019 Law

Governor Cuomo signed a new IVF insurance bill into law on April 12, 2019. The new regulation goes into effect on January 1, 2020. The updated law expands access to coverage in three areas.[3]

  1. Provides up to 3 IVF cycles (fresh embryo transfer or frozen embryo transfer) to patients with large-group coverage (more than 100 employees)
  2. Provides medically necessary treatments for people facing iatrogenic infertility (caused by medical intervention) in all commercial markets
    1. Individual
    2. Small-Group
    3. Large-Group
  3. Prohibits insurers from discriminating based on age, sex, sexual orientation, marital status, or gender identity

It is essential to note the people this rule does not address. You may have to pay the full cost of treatment if you fall into any one of these groups.

  • Employees of self-insured companies
  • Individuals covered by public policies
    • Federal government employees
    • Military veterans
    • Medicare and Medicaid recipients
Medicaid

NYS Medicaid does not cover IVF or any other infertility treatments due to loopholes in the rules. The two sets of laws noted above specifically carve out an exclusion for federal government-sponsored healthcare. Since both Medicare and Medicaid are federal programs, the requirements do not apply.

Do not bother searching around for an infertility clinic in your local area that accepts Medicaid patients. The exercise is pointless because the clinic will not receive reimbursement for any submitted claims.

GHI

Asking about whether GHI (Emblem Health) covers IVF offers an opportunity to learn about how the legal loopholes apply in real-life situations. GHI is a big company with many different plans offered through public channels, private employers, government agencies, and direct to individuals.[4]

Some GHI plans cover IVF per the 2019 mandate, while others only pay for lower-order infertility treatments according to the earlier laws, and some may not honor claims for any of these services.

GHI Plan IVF Infertility
Medicaid    
Large-Group X X
Small-Group   X
Self-Insured    
Individual   X
NYC Employees (CBP)   X

Demonstration Program

The New York State Infertility Demonstration Program offers grant money to only a tiny percentage of couples to help pay for In Vitro Fertilization (IVF), Gamete Intrafallopian Transfer (GIFT), and Testicular Sperm Extraction (TESE).[5]

First, the infertility demonstration program has strict eligibility criteria that eliminate many couples from contention.

  • Age between 21 – 44 years
  • New York state residency
  • Private health insurance
  • Household income under $195,000

Second, the grant website states, “Continuation of this program is dependent on the availability of funds.” It also points site visitors to participating clinics for more information.

Third, many of the participating clinics do not refer patients to this resource on their websites or bury the information. Meanwhile, they actively promote acceptance of insurance and financing options.

The conclusion should be obvious. The infertility demonstration program seems unable to help a large percentage of NY couples with grant money.

New York IVF Prices vs. Costs

Couples researching the cost of In Vitro Fertilization in New York should factor in the difference between treatment prices and the total spending needed to conceive and bring home a baby.

Success rates determine whether you must fund one, two, three, or more expensive (average of $15,000) IVF cycles before seeing the long-awaited positive pregnancy test.

Cheap Clinics

Using the fertility clinic with the cheapest price for IVF treatment often does not translate into lower costs when you consider success rates. A more expensive successful embryo transfer sets you back far less than multiple failed attempts at cut-rate prices – and results in the baby you want.

Couples often find they spend less overall by investing more money upfront on improving their chances of bringing home a baby in a single attempt.

  • Choosing the best endocrinologist
  • Donor eggs: up to $17,000 extra
  • Donor sperm: up to $2,000 more
  • Intracytoplasmic Sperm Injection (ICSI): $2,000 additional
  • Fertility medications increase risk of premature multiples

NYC

The cost of IVF treatment in New York City is slightly lower for many couples who work in one of the five boroughs (Manhattan, Brooklyn, Bronx, Queens, and Staten Island). The NYC prices are not any better, but the Paid Sick Leave law makes taking off from work for clinic visits more affordable.[6]

The NYC law provides private employees (not government) up to 40 hours of paid sick time each year. Using the paid sick leave for medical diagnosis, care, or treatment at an infertility clinic is a qualifying reason.

Footnoted Sources:

[1] Section 3221
[2] Section 4303
[3] Resolve
[4] GHI
[5] Demonstration Program
[6] Paid Sick Time