Understanding Fertility Insurance Coverage: What You Need to Know

Figuring out your insurance coverage can be confusing. Here's what you should consider when finding out how much and what your insurance covers during IVF. 

1. What your benefits can cover

Here are the different areas that your insurance provider may cover- and keep in mind that in-network and out-of-network amounts may differ:

• Deductible for treatment
• The amount of your deductible that you've already met
• Co-Pay/Co-Insurance (the amount you pay after your meet your deductible)
• The percentage responsibility after the deductible
• Yearly dollar maximum
• Maximum number of treatment attempts
• Lifetime dollar maximum
• Whether or not medication included in lifetime maximum

2. Requirements for coverage to start

Find out if you have requirements you need to meet before your fertility treatment can be covered- such as trying to conceive unassisted for a certain period of time, or going through IUI before IVF.  

3. Restrictions on what may or may not be covered

You might also have restrictions on what clinics or providers you need to use to qualify for coverage. Additionally, some insurance plans require prior authorization (aka approval) before beginning treatment. You can ask your insurance company what documentation you need in order to be approved. 

4. Whether your benefits are included in your maximum.

If medications are included in your annual or lifetime maximum and you anticipate that your entire cost of treatment will exceed your maximum, you might save money by paying for your medications out-of-pocket. Insurance companies are billed at a higher rate for IVF medications. If you pay in cash for medication, you can use your benefits towards other treatments where insurance is billed the same rate that paying out-of-pocket.

5. Which specific tests, treatments, and procedures does your insurance cover?

See if your insurance covers the following tests, treatments and procedures:

Diagnostic tests

• Preconception screening labs, including STI testing
• Hormone testing
• Baseline and monitoring ultrasounds during IVF, IUI, & FET cycles
• Prolactin
• Semen analysis
• Hysterosalpingogram (HSG)
• Saline Infusion Sonohysterogram (SIS)
• Endometrial Biopsy
• Hysteroscopy  

Treatments and Procedures

• Intrauterine Insemination (IUI)
• Egg Retrieval for IVF or Egg Freeze
• Intracytoplasmic Sperm Injection (ICSI)
• Freezing Sperm, Embryos, & Eggs
• Assisted Hatching
• Frozen Embryo Transfer (FET)
• Genetic counseling and testing
• Donor sperm
• Gestational carrier options
• Acupuncture
• Embryo or egg storage

Use these questions as a starting point to understand how to make the most of your coverage. If you have any questions about how to navigate your insurance benefits, give our team a call or text!