IVF and Insurance Coverage

As we talked about in our section on the cost of IVF, it is an expensive process. Unfortunately, the cost is prohibitive for some couples. Currently there are 15 states that mandate employers (of over 25 people) to offer coverage on their health plan for fertility diagnosis or treatments. They are: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. Of these states, California, Louisiana and New York require coverage of fertility treatments, but specifically exclude IVF. Unfortunately, in states that are not mandated to offer coverage, insurance for IVF treatments is hard to find and plans can be expensive and of a limited scope. Whether you live or work in one of these states and are covered under an employer’s plan, or are seeking to purchase supplemental coverage on your own, we want to offer some tips and things to look out for as you navigate these murky waters.

  • Is there a waiting period on your policy?
    Some policies will state that you must pay the premium for a certain amount of time before you can seek the benefits. Read the fine print and plan accordingly.
  • This may seem obvious, but make sure that the woman is the one explicitly named as the beneficiary of the plan. She will be the one undergoing the bulk of the procedures.
  • Are drugs covered?
    The drugs are a HUGE portion of the total cost of IVF.
  • Are office visits covered?
    These will factor into the total cost.
  • Is pregnancy covered?
    If you do not have pre-natal or maternity coverage on your current plan, you may be able to add this in.
  • As with any insurance plan, take a look at the cost. What is the deductible versus the premium?
    Lower monthly payments will mean higher out of pocket costs at the time the benefits are used. Figure out what fits in your monthly budget.
  • As mentioned above, check the verbiage of the plan to see what fertility treatments are covered. Fertility injections? IUI? Costs associated with donor egg or sperm?
  • Even in the states where coverage is mandated, some will pay for testing for infertility, but will not pay anything further once a diagnosis is made. More fine print.
  • Where is your company headquartered?
    If the state where your employer has its headquarters is one that mandates fertility treatment coverage, you may be eligible. Contact your insurance company for details.
  • Even with insurance, it is common to see a maximum lifetime coverage of $10,000-$25,000. Even at the high end of this range, only one IVF cycle will come close to being covered. If your first cycle results in a successful pregnancy then that is great! If not, you may find yourself paying out of pocket for another attempt.
  • IVF may be tax deductible! Any medical expense may be tax deductible in an amount over 7.5% of your Annual Gross Income (AGI). Keep vigilant records of the expenses you incur during the process: doctor visits, hotel stays, mileage, etc.
  • More on tax deductions: You cannot claim any portion of the expenses that were paid for through a Flexible Spending Account, as this money is already tax-free. Contact your tax specialist for details.
  • Also keep in mind for tax deductions: You will only want to claim the expense for deductions if it is above the total for the standard deduction for your tax category. In cases of IVF this is not typically an issue. Contact your tax specialist for details.
The most important thing you can do when starting the IVF process is BE INFORMED! Do your homework. This is the most important decision you are likely to have made at this point in your life (and one of the most expensive!). There is money to be found out there to help you if you need it. Don’t be afraid to dig, but protect yourself in the process.
We hope you find this information helpful. Remember, talk to your fertility specialist and contact your insurance company to discuss your options.