If you’re struggling with infertility, you’re not alone. About one in eight couples have trouble getting pregnant, and many turn to fertility treatments to help them conceive. But fertility treatments can be expensive, and insurance coverage varies widely. In this article, we’ll explore the ins and outs of insurance coverage for fertility treatments, including what’s covered, what’s not, and how to find the right policy for you.
Types of Fertility Coverage
When it comes to fertility coverage, there are three main types of insurance policies: employer-sponsored plans, individual plans, and state mandates.
Many employers offer some level of fertility coverage as part of their health insurance plans. These plans typically cover diagnostic testing and some basic treatments, such as medication and intrauterine insemination (IUI). However, coverage for more advanced treatments, such as in vitro fertilization (IVF), is less common.
If you’re considering fertility treatments, it’s important to check with your employer to see what type of coverage is available. Some employers may offer more comprehensive coverage than others, and policies can vary from year to year.
Individual Plans
If you’re self-employed or your employer doesn’t offer fertility coverage, you may be able to purchase an individual health insurance plan that includes fertility coverage. These plans are typically more expensive than employer-sponsored plans, but they may offer more comprehensive coverage for fertility treatments.
It’s important to note that individual plans may have more restrictions than employer-sponsored plans, such as age limits and restrictions on the number of cycles of treatment that are covered.
State Mandates
Some states require insurance companies to cover infertility treatments. Currently, 17 states have laws that require coverage for infertility treatment, including IVF. However, these mandates can vary widely in terms of what treatments are covered, how many cycles of treatment are covered, and what type of policies are subject to the mandate.
If you live in a state with a fertility mandate, it’s important to check the details of the law to see what type of coverage you’re entitled to.
What’s Covered?
The specific treatments that are covered by insurance vary depending on the type of policy you have. However, most policies cover some level of diagnostic testing, such as bloodwork and ultrasounds, as well as basic treatments such as medication and IUI.
Coverage for more advanced treatments, such as IVF, is less common. According to a study by RESOLVE: The National Infertility Association, only about one-third of employer-sponsored plans cover IVF.
If you’re considering fertility treatments, it’s important to check your policy carefully to see what treatments are covered and what your out-of-pocket costs will be.
What’s Not Covered?
There are several types of treatments that are typically not covered by insurance, including:
- Experimental treatments
- Surrogacy
- Egg or sperm donation
- Cryopreservation (freezing) of eggs or embryos for future use
If you’re considering any of these treatments, you should be prepared to pay out of pocket.
How to Find the Right Policy
If you’re considering fertility treatments, it’s important to find a policy that offers the right level of coverage for your needs. Here are some tips for finding the right policy:
Do Your Research
Start by researching different insurance companies and policies to see what type of coverage is available. Pay attention to the details, such as what treatments are covered, how many cycles of treatment are covered, and what your out-of-pocket costs will be.
Talk to Your Employer
If you have an employer-sponsored plan, talk to your HR representative to see what type of fertility coverage is available. You may be able to negotiate for more comprehensive coverage if needed.
Consider an Individual Plan
If your employer doesn’t offer fertility coverage, or if the coverage isn’t comprehensive enough for your needs, consider purchasing an individual health insurance plan that includes fertility coverage. Be prepared to pay more for these policies, but they may offer more comprehensive coverage for fertility treatments.
Check State Mandates
If you live in a state with a fertility mandate, make sure you understand the details of the law and what type of coverage you’re entitled to.
Frequently Asked Questions
Question |
Answer |
What types of treatments are typically covered by insurance? |
Most policies cover some level of diagnostic testing, such as bloodwork and ultrasounds, as well as basic treatments such as medication and IUI. Coverage for more advanced treatments, such as IVF, is less common. |
What types of treatments are typically not covered by insurance? |
Experimental treatments, surrogacy, egg or sperm donation, and cryopreservation (freezing) of eggs or embryos for future use are typically not covered by insurance. |
How can I find a policy that offers the right level of coverage for my needs? |
Start by researching different insurance companies and policies to see what type of coverage is available. Talk to your HR representative if you have an employer-sponsored plan, or consider purchasing an individual health insurance plan that includes fertility coverage. Check state mandates if applicable. |
Conclusion
Fertility treatments can be expensive, but insurance coverage can help make them more affordable. Whether you have an employer-sponsored plan, an individual plan, or live in a state with a fertility mandate, it’s important to understand what type of coverage is available and what you’ll be responsible for paying out of pocket. By doing your research and understanding your options, you can find a policy that offers the right level of coverage for your needs.
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