IVF medications are a critical part of fertility treatment, but their cost can add up quickly. Understanding insurance coverage and potential out-of-pocket expenses for these medications can help you budget and reduce financial stress.
Get in touch with us today to find local fertility clinics that can tell you what type of insurance they accept to help alleviate some of the cost that comes with this process.
In this article, we’ll take a look at what determines if insurance will cover IVF costs and how to get the coverage you need.
Does Medical Insurance Cover IVF?
The answer all depends on where you live and your insurance provider.
Federal law doesn’t mandate any health plans from insurance providers to cover infertility treatments. At the state level, as of June 2024, 22 states as well as the District of Columbia have passed laws that require some coverage for infertility services for some state-regulated health plans.
Health insurance lessens the financial burden of your health care expenses. But when it comes to IVF and insurance coverage, the following factors could determine if you are on the hook for all or some of the cost:
Policies include a package of medical benefits like IVF medication cost with insurance. Non-covered services require you to pay for any uncovered care you receive. Of the 22 states and the District of Columbia that have infertility insurance laws, 13 of them have IVF and fertility preservation coverage, two have IVF coverage, two have fertility preservation and some infertility coverage, one has fertility preservation and offers infertility or IVF coverage, two have fertility preservation coverage and two have some infertility coverage. If your state has infertility coverage laws in place, you can ask your employer about specifics of your plan. The size of your employer can also determine if they need to provide coverage or not.
How Much Does IVF Medication Cost Without Insurance?
A singular IVF cycle can cost anywhere from $15,000-$30,000 and medications can account for up to 35% of that cost depending on your fertility clinic and the medications you need.
How Much Does IVF Medication Cost With Insurance?
Although your costs will be lower, there is no predetermined cost of IVF medication with insurance.
There are no standard coverage care requirements for IVF care so the coverage for things like diagnosis, procedures and the medications needed for IVF depend on your insurance plan and where you live.
How Much Does IVF Cost in the US?
A singular IVF cycle can cost an average of $15,000-$30,000. There are a number of factors that influence the cost of IVF in the US such as facility fees, medications, procedures and more. There’s no set amount because the specifics of your situation can impact total cost.
What Medical Insurance Covers IVF?
When it comes to IVF medication and cost, what is covered ultimately depends on your insurance provider and your plan, but common components include:
- Medications: This could include IVF medication costs for ovarian stimulation to prescriptions specifically for your IVF cycle.
- Diagnostic Tests: Initial fertility assessments may be covered like blood tests, ultrasounds or even imaging studies to determine whether or not there are issues.
- IVF Procedures: From the egg retrieval to the embryo transfer, some or all of these procedures could be covered.
- Embryo Storage: If you need to store extra embryos for future use, insurance may cover cryopreservation services.
- Genetic Testing: Coverage could include genetic testing to determine which embryos are viable for use.
Understanding what is and what is not covered may be the difference in if it’s right for your situation or not. But you should always verify specifics with your insurance provider, as coverage can vary significantly between plans.
Does Medicaid Cover IVF Medications?
This February 2024 article from CBS noted that Medicaid only provides fertility treatment for New York and Illinois.
In New York, it covers some oral ovulation-enhancing medications while in Illinois; the costs of fertility preservation are covered.
Does Cigna Cover IVF Medications?
Cigna was named as one of the best options for high-end treatment when it came to fertility through insurance companies.
Although it does depend on your specific plan, the article notes that “…they are more likely to offer and approve coverage for this procedure than other major insurers.”
Does United Cover IVF Medications?
On Oct. 1, 2019, the United Healthcare Community Plan was adjusted to add infertility services as a benefit update. In order to be eligiblye for their infertility services, you must:
- Be 21 – 34 years old and are unable to get pregnant after 12 months of regular, unprotected sex.
- Be 35 – 44 years old and are unable to get pregnant after 6 months of regular, unprotected sex.
Some drugs for infertility are covered, but it’s limited to three cycles of treatment.
The Community Plan also covers services related to prescribing and monitoring of those drugs through services like:
- Office visits
- X-rays of the uterus and fallopian tubes
- Pelvic ultrasound
- Blood testing
Doe Blue Cross Cover IVF Medications?
Yes, Blue Cross Blue Shields’ Federal Employee Program covers IVF drug cycles.
If members are diagnosed with infertility, they can receive three annual drug cycles for IVF. They also cover one year of sperm and egg storage if your infertility is caused by a medically necessary or surgical intervention to treat a condition.
Does Tricare Cover IVF Medications?
No, Tricare does not cover assisted reproductive technology (ART) services. This includes IVF, IUI and cryopreservation.
What if Medical Insurance Does Not Cover IVF?
If your insurance does not cover IVF, it could still be an option for you to grow your family. There are alternatives such as
There are grants and scholarships available for those who need them that focus specifically on financial assistance for IVF and infertility treatments. Some fertility clinics have their own in-house financing plans, or partner with financing companies to help make it more affordable for you. There are financing companies that specifically deal with loans for medical procedures. This can reduce the upfront costs for you, spreading it out to make it more palatable.
What States Require Medical Insurance Coverage for IVF?
A state has an insurance mandate for IVF coverage if it has passed legislation that makes insurance providers have some sort of coverage in relation to infertility.
The following states have insurance mandates for IVF coverage:
- Arkansas
- California
- Connecticut
- Delaware
- Hawaii
- Illinois
- Louisiana
- Maryland
- Massachusetts
- Minnesota
- Montana
- New Jersey
- New York
- Ohio
- Rhode Island
- Texas
- Utah
- West Virginia
The strength of the insurance mandate per state determines what that state covers, some states may have almost complete coverage while others may have the bare minimum.
Reviewing Your Infertility Coverage: Steps to Take
When determining what’s covered, or not, by your insurance provider when it comes to infertility, it’s essential to ask questions. Preparing beforehand will allow you to learn the information needed to navigate your infertility treatment options confidently.
Here are some ways to help you review your policy and effectively communicate with your insurance provider:
Start by locating the section of your health insurance policy that pertains to infertility coverage. Look for details on what treatments are covered, any limitations, and the process for accessing benefits. Make note of covered services, such as diagnostic tests, medications, or assisted reproductive technologies like IVF. Be aware of any requirements, such as prior authorization or specific providers you must use. As you review your policy, jot down any questions or concerns you may have. This will help ensure that you cover all necessary points when speaking with your insurance provider. If you’re part of a larger organization, your HR department can be a valuable resource. They can assist in interpreting your policy and may have insights into the claims process or additional resources. Keep all correspondence, policy documents, and notes in one place. This will help you track your coverage and any changes that may occur.
If cost is a concern to you, reach out to us. We can connect you with fertility clinics that can let you know upfront what kind of IVF medication costs with them and the insurance providers they do or do not accept.