Will Health Insurance Cover Infertility Treatment?

The purpose of health insurance is to guarantee those who are covered that they will not have to be responsible for the entire cost of their health care expenses. Since the Affordable Care Act was signed in 2010, every American now has access to health care. While health insurance plans do offer coverage for a wide range of services, policies and what’s included under them is complex. Unfortunately, many services are not fully covered, if at all; often, infertility is one of those services.

Infertility and Health Insurance

infertilityIf you have been trying to conceive for a period of one year or long and have not been successful, it’s likely that you have sought medical care to determine the reason why you are having a difficult time conceiving. It may have been determined that you, your partner, or both you and your partner, are infertile.

While learning that you are infertile is certainly a major blow, thanks to major advances in modern medicine, a diagnosis of infertility doesn’t necessarily mean that you are guaranteed unable to have children. Infertility treatments have made it possible for so many couples who have been unable to get pregnant naturally to receive the assistance that they need and realize their dreams of becoming parents.

While successful fertility treatment is certainly a wonder of modern science, there is a major downside; it’s exorbitant. Depending on the type and amount of treatments you receive, it can cost upwards of tens of thousands of dollars; if not more. For that reason, when many couples who have been diagnosed as infertile are ready to attempt having children with the assistance of infertility treatments, cost is always a primary concern.

Like most people who are considering treatments to improve their fertility, you are probably wondering if your health insurance will cover any of the expense. As with most things related to health insurance, whether or not your plan offers coverage for these types of services depends on a variety of factors; the specifics of your policy, the reason for fertility treatments, and the type of treatment you are considering.

Understanding Coverage

In regard to fertility treatments, there are five different groups of health insurance plans, which include:

  • No coverage at all
  • Coverage only for the diagnosis of infertility
  • Coverage for the diagnosis of infertility and limited fertility treatments
  • Complete coverage for fertility treatment
  • Coverage for fertility medications

To find out exactly which group your plan falls under, contact your health insurance company and review your policy. If your plan does offer coverage for any scope of infertility, find out exactly what types of tests and treatments will be covered. Not all policies that offer fertility treatment coverage will offer coverage for the same types of treatments.

Furthermore, the need for fertility treatment may also determine whether or not your policy will cover the services; for example, if it is determined that you are infertile as a result of a medical condition, but fertility treatments may improve your chances of conceiving, some of the services may be covered; however, if you have had gender reassignment surgery or are in a same sex relationship, treatment may not be covered. It really depends on the specifics of your plan, which should be clearly outlined in your policy. Speak to your health insurance company and request a written copy of your policy as it pertains to infertility treatment.

State Mandated Fertility Treatment

Currently, there are a total of 15 states that require that at minimum, a portion of fertility treatment be covered by health insurance companies. These states include:

  • Arkansas
  • California
  • Connecticut
  • Hawaii
  • Illinois
  • Louisiana
  • Maryland
  • Massachusetts
  • Montana
  • New Jersey
  • New York
  • Ohio
  • Rhode Island
  • Texas
  • West Virginia

It’s important to note, however, that if you do live in one of these states that the coverage for infertility treatment will vary. For example, in one state, fertility testing and treatments may be offered, but in another, fertility testing may only be covered by insurance companies. You can find out more information about the type of coverage that is offered in your state by contacting the National Fertility Association.

Other Options

If your health insurance does not cover infertility treatments, or if it doesn’t cover the specific services that you require (or it doesn’t cover enough), there are options available to assist with the cost. For example, you might consider investing in a personal loan, a home equity loan, or a loan against your 401(k). Another option might be applying for a medical credit card, which works similarly to a traditional credit card, but can only be used to pay for medical treatments. You can also speak to your reproductive endocrinologist to find if there are any payment plans available.

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