Insurance Coverage and Financing Options for IVF Treatments

Fran
Dani Milton
April 20, 2020

This week, Americans will commemorate National Infertility Awareness Week from April 19 – 25, 2020. Infertility issues can impact anyone, regardless of race, ethnicity, religion, sexuality or economic status. In vitro fertilization treatments (IVF) are one of the top procedures that single parents and couples use to conceive children.

Are you seeking to start a family using IVF procedures? Your health insurance policy may partially cover some of the costs of your procedure. In today’s guide, you’ll learn about different fertility benefits that are available for prospective parents. But first, make sure you have the right health insurance plan.

What are IVF Treatments?

The Centers for Disease Control and Prevention says that infertility affects one in seven people in America. According to RESOLVE National Infertility Association, almost 12 percent of American women have difficulty becoming pregnant and carrying their child to term. They often need the help of infertility services. Additionally, 63 percent of LGBTQ millennials are considering having children. They may need the help of an assisted reproductive technology (ART) to have a family.

IVF is an acronym for in vitro fertilization. It is an art that physicians use to help infertile couples conceive children. Doctors use a combination of medications, hormones and surgical procedures to extract mature eggs and fertilize them with sperm in a laboratory. During the first stage of IVF treatments, physicians freeze the embryos so patients can use them at a later date. A doctor later implants the frozen embryo inside the uterus to impregnate the patient. However, some women end up conceiving a child naturally, so they don’t have to use their frozen eggs during the IVF process. People refer to the children produced by IVF as “test-tube babies.” English woman Louise Brown was the first child conceived by the procedure in 1979.

Procedures and Costs of IVF

The vast majority of people pay for IVF out-of-pocket, and these procedures are expensive. Many patients endure several rounds before they carry a successful pregnancy to term. Fertility IQ, a patient education website, released a 2019 study about the average costs associated with IVF. In 2018, they surveyed more than 10,000 people and discovered most people paid an average of $22,000 per IVF round. This cost was a 7 percent increase over 2017. Fertility IQ estimates that IVF treatments will increase to $25,000 per cycle by 2025. A single retrieval cycle to get an appropriate amount of eggs can last three weeks long. Most patients will require $5,000 in genetic testing. A single retrieval cycle to get an appropriate amount of eggs can last three weeks. Additionally, the patient needs one to two weeks of hormone therapy to ensure that their natural hormones are turned off, followed by ten days of synthetic hormone injections to ensure that the body will produce multiple mature eggs. Patients will also pay embryo storage and retrieval fees averaging $500 - $1,500 every year. Financing options may vary between a 6 to 24 percent annual interest rate.

Financing Your IVF Treatment

Since IVF treatments are costly, many patients must secure multiple financial resources to pay for their treatments. Student Loan Hero, a debt management organization, conducted a 2018 survey of 776 employees who planned to receive fertility treatments. Almost 40 percent of respondents said that they felt stressed about paying for costs associated with IVF treatments.

Here are six potential sources you can turn to if you don’t have enough money for your procedures: Employee benefits

  • Health insurance that covers costs
  • Gifts from parents, in-laws, or friends
  • Personal loans, credit cards, or financing through fertility centers
  • Retirement accounts or 401(k) plans
  • Grants from organizations such as the Baby Quest Foundation, Fertility IQ, or the Hope for Fertility Foundation
  • Specialty pharmacies that offer discounts for medicines

More businesses now cover fertility benefits through their insurance plans. In the following sections, you’ll learn what treatments these plans cover and how to access them. Companies Offer Fertility Benefits

According to RESOLVE, 57 percent of companies cover diagnostic tests and initial infertility treatment for their workers. Only 47 percent cover less than half of the cost of a full IVF cycle.

Other plans cover counselor visits, fertility medicines, egg harvesting, and freezing. Big corporations and midsize companies with 500 employers or more are more likely to provide these insurance plan benefits rather than small businesses.

More companies are offering fertility benefits since more employees are demanding them. According to the International Foundation of Employee Benefit Plans (IFEBP), business owners realize that fertility treatments, like IVF, are a low-cost benefit. Since infertility issues can place an enormous amount of physical and emotional stress on couples, businesses realize that these benefits can earn them a high level of loyalty from employees who will use these benefits.

Industries with the strongest competition for talent – such as finance, consulting, and technology industries – realize that these fertility plans are valuable for employees. SHRM, a professional Human Resources organization, says that 75 percent of companies offer these benefits to support their inclusion and diversity goals for LGBTQ employees. Almost 59 percent use these plans to recruit and retain talented employees.

Private insurance falls into one of three categories: commercial insurance (Aetna, Cigna, United, etc); non-profit insurance companies (Blue Cross/Blue Shield plans); and self-insuring groups, such as employers, who pay benefit claims directly rather than using an outside insurance carrier (which may be hired to serve as a benefits manager).

Willis Towers Watson conducted a 2018 survey that found that 55 percent of companies offered some form of family building benefit to their employees. They predicted that this figure would rise to 66 percent of all employers by the end of 2019. They also projected this coverage for same-sex couples to rise to 81 percent of employers.

If your company doesn’t offer fertility benefits, you’ll need to advocate for them. You’ll need to contact your human resource office and find out who the decision-makers are for your company’s insurance policy. If you’re ready to advocate for a more comprehensive fertility benefits plan, you can use RESOLVE’s Coverage at Work Toolkit for resources to get started.

If you want to purchase individual health coverage for yourself or your partner, you can use SmartFinancial’s app to search for affordable comprehensive fertility insurance that suits your needs.

How Does Your Company Pay for Employee Insurance Coverage?

If you’re on a quest to use IVF, you should find out if your insurance can pay for some of these treatments. If not, consider switching to an individual or family health insurance plan.

Most workplaces offer group insurance policies for their workers, which helps keep the premium cost low by spreading the risk among all members. This coverage is either public or private.

First, schedule an appointment with your human resources director to find out how your employer pays for their health insurance plan. This information will tell you whether your workplace is subject to fertility mandate laws if your state has one. It may also affect whether your workplace can add these benefits to their insurance policy if you request them. Here’s what you need to know:

Public insurance includes government policies such as Medicaid (for the poor), Medicare (for the elderly or disabled), Veterans Administration (for the U.S. armed services) and TriCare for active military personnel and their families.

Private insurance falls into one of three categories: commercial insurance (Aetna, Cigna, United). Non-profit insurance companies (Blue Cross/Blue Shield plans). Self-insuring groups, such as employers, pay benefit claims directly rather than using an outside insurance carrier (which may be hired to serve as a benefits manager).

Insurance policies vary from employer to employer, so you should ask about the details of your company plan. You should also ask your company’s health plan administrator to give you a copy of the Summary Plan Description (SPD). It will outline which tests, drugs and services your insurance policy covers. It will also outline any exclusions and restrictions related to infertility diagnosis, treatment and reproductive health services. Here are some additional questions to keep in mind when asking about insurance benefits at your company.

Find out whether your current health insurance plan is a fully insured, self-insured or a government/military coverage plan. How your company pays for its health insurance plan will determine whether it is subject to state or federal laws.
  • Is your plan fully-insured or self-insured? Fully-insured plans follow state laws. If your employer has a fully-insured plan, it means they receive their coverage from an insurance company, who is taking all the risk for the plan. The insurer dictates what they will and won’t cover through their standard benefits plan. The employer doesn’t have control over the coverage options or design of these benefit plans. They can provide IVF Riders or Infertility Riders, which are benefit plans for these conditions. Employers can also offer this coverage through their standard benefits plan.
  • Self-insured plans are the ones big companies commonly offer to their employees. These policies don't abide by state fertility mandates since they fall under federal law. Businesses make decisions about what is covered and what isn’t in their policies.
  • Is the plan “Greater than 25,” “Greater than 50," etc;? Employers with fewer than a specific number of employees don’t have to provide coverage.

Does My State Have A Fertility Insurance Mandate Law?

Find out whether your state has a fertility insurance mandate law. Currently, 17 states have passed laws that mandate businesses to offer fertility benefits with varying levels of coverage to their employees. Some local governments require health insurance policies to pay for infertility diagnostic tests and treatments. These locations include Arkansas, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New Hampshire, New Jersey, New York, and Rhode Island. Coverage differs among states, so you’ll need to read the state mandate where your employer is based. For instance, Massachusetts has one of the most comprehensive fertility insurance mandates in the nation, which it provides at less than one percent of the total premium costs.

Compass Health conducted an analytic 2016 study of the Massachusetts mandate and found that the law only raised premiums as little as 0.12 percent to 0.96 percent. Barbara Collura, CEO of RESOLVE, estimates that 95,000 babies were born in Massachusetts thanks to its infertility insurance laws.

There is also legislation that requires companies to offer health insurance policies that cover infertility treatments available, but they don’t require employers to cover infertility treatment costs. These plans usually pay for diagnostic tests for infertility treatments. States that provide these options include California, Louisiana, Montana, Ohio, Texas and West Virginia. Visit RESOLVE’s site to read what each state mandate covers.

The Federal Employee Retirement Income Security Act

If your workplace is self-insured, you should remember that your business is subject to the Federal Employee Retirement Income Security Act. State laws do not apply to self-insuring companies because ERISA prevents states from being able to regulate self-insured companies. Although they don’t have to comply with state mandates, they can voluntarily provide IVF benefits.

In the future, RESOLVE believes the federal government can pass laws requiring insurance coverage for diagnosis and treatment of infertility. This legislation would supersede ERISA and require more companies to offer infertility insurance to their employees.

The National Pregnancy Discrimination Act guarantees some pregnancy-related services in most health care plan benefits. Infertility treatments, especially assisted reproductive technologies, are not insured under this act and their availability is extremely limited in the United States.

Only one in five self-insuring companies provide infertility treatments that vary in their reimbursement limits, comprehensive coverage, and eligibility requirements.

What Types of Fertility Treatments Are Covered by Insurance?

According to the National Council of State Legislatures, approximately 10 percent of American women of childbearing age have received assistance for infertility. If you’re searching for a fertility treatment plan, you may wonder what options insurance plans typically offer. Traditional fertility plans usually cover diagnostic screening and a single round of IVF or IUI, depending on the insurer.

Some benefit plans include medications, in addition to infertility diagnostic tests. Others provide intrauterine insemination (IUI) and IVF. The most comprehensive ones pay for egg freezing and storage fees, donor eggs or embryos and gestational surrogacy.

IFEBP conducted a 2018 survey found 31 percent of employers with 500 or more employees offered some or all of the following fertility benefits to their employees:

  • Egg harvesting/freezing services: 6 percent
  • Fertility medications: 14 percent
  • Genetic testing to determine infertility issues: 11 percent
  • In vitro fertilization (IVF) treatments: 17 percent

Limitations on Fertility Benefits

Even if your employer has a fertility benefit for workers, you should read the policy closely to see if there are any limitations. Some insurers won’t authorize IVF treatments unless patients have tried less invasive procedures such as IUs first. Other policies have dollar maximums that most patients will exhaust on less effective treatments. A single IVF treatment can also max out a policy.

When you submit a claim for your procedures, it should come with an Explanation of Benefits document which tells you which services are covered by the insurance company.

Same-Sex Couples and Fertility Benefits

Same-sex couples may also have a difficult time trying to obtain fertility benefits because some policies rely on a diagnosis of infertility. Most LGBTQ people seeking to use these policies may not be infertile. Some will have to use their money on multiple IUIs to prove to their insurer that they’re infertile before they can use these insurance policies. Additional challenges include purchasing sperm donations for those persons who cannot produce it. Most sperm costs $1,000 per 0.5 cc vial, and very few policies cover the cost of egg and sperm freezing, and surrogate mothers.

More companies are expanding these benefits to be more inclusive, so they can attract and retain top talent. Questions to Ask Your Human Resources Director About Fertility Benefits Before you schedule an appointment with a fertility specialist, you should speak with your human resources director to learn what services your benefits cover. Here is a list of 12 questions that employees should ask about their insurance coverage:

  1. What treatments are covered by my fertility benefits?
  2. Does it pay for genetic testing?
  3. Will it cover an evaluation by a specialist?
  4. Do you have limitations on coverage?
  5. Are there certain requirements before I can receive an IVF treatment?
  6. What are the dollar caps on IVF cycles?
  7. Do you have age restrictions?
  8. Is there a marital status restriction?
  9. What are the annual and lifetime maximums of my fertility benefits?
  10. What is the length of time on my existing policy?
  11. Does this policy have co-pays, co-insurance, or deductibles that compare with other health benefits?
  12. Are medications included in annual or lifetime maximums, or are they separate?

If you need to purchase insurance for your fertility treatments, SmartFinancial can help simplify the process. Our company provides customized insurance offerings based on your zip code. We’ll match you with a partnering insurance agent from our network of outstanding insurance professionals. You will only need to complete a quick, three-minute questionnaire to start the process.

Get a Free Health Insurance Quote Online Now.

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