Does Insurance Cover IVF?

An estimated 10 percent of women in the U.S. who are trying to conceive require fertility assistance. That’s a huge number! As a result, many reach out to specialists to determine what they can do to succeed in having their own biological child.

Solutions vary according to each patient. Some problems are easily solved while others call for more complicated…and expensive…measures.
IVF – in-vitro fertilization – is often the answer. However, the healthcare system in the U.S. hasn’t gotten to the point where insurance companies automatically cover a round or two of IVF, despite the number of U.S. women who turn to this solution each year. While more and more employers are making attempts to find insurance that does indeed help with fertility services, they still tend to be the exception rather than the rule.

Different states, different laws

Gradually during the last 30 years or so, 16 states have passed laws that require insurers to either cover or offer coverage for infertility diagnosis and treatment. Those states are Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. More specifically, fourteen have laws that require insurance companies to cover infertility treatment and two states – California and Texas – have laws that require insurance companies to offer coverage for infertility treatment.

Still, there are plenty of gaps in that coverage and, often, patients considering IVF will need an insurance expert to do an in-depth analysis of their policy to determine where they sit as far as coverage is concerned. (Fertility practices usually have an employee who can do that.)

New Jersey laws, for example, include some restrictions as well as a religious exemption for employers that provide health coverage to fewer than 50 employees. (New Jersey State Bill 1076) In addition, coverage may only be for one or two rounds of IVF, though some very generous employers offer insurance that will extend further than that.

If your healthcare policy does indeed cover IVF treatment, our office will work with your insurance company to get you the maximum benefit allowed. You might still shoulder some of the financial responsibility but that can be determined before treatment starts.

Options when you’re not covered

IVF will certainly be cost-prohibitive for some individuals/couples who are not covered by their insurance. However, fertility practices do everything they can to keep the costs down and to help patients figure out a way to finance IVF treatments, recognizing that it’s the answer for so many women.

Our practice, for example, offers an “all-inclusive” IVF package at a fixed price that helps patients avoid surprise costs not mentioned up front. Alternately, some clinics charge separately for each component of the process, with costs piling up at every step. This can be devastating for self-pay patients who just aren’t prepared for the expense.

A few items, such as medications and genetic testing, may not be included in such packages but the patient will be informed of this as well as the potential cost of these items before committing to the procedure.

Since infertility is such a pervasive problem, we all hope the day will come when insurance companies won’t think twice about covering IVF and states will pass laws that make this a reality. In the meantime, keeping costs as low as possible for our clients is essential not only to good customer service but to a positive outcome for more and more women struggling with infertility.

For more information about our payment options and to learn more about your insurance coverage,contact Advanced Reproductive Medicine at (732) 339-9300