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  • Writer's pictureLaKesha Brooks

The Top 7 Questions People Have Regarding IVF Insurance Coverage

In vitro fertilization (IVF) is a medical procedure that can help couples struggling to conceive. However, the cost of IVF can be prohibitively high for many people. Yet, if any of the below apply to you, individual coverage may be a good option:

  • You have decided that IVF is part of your family-building journey for 2023

  • Your employer's health insurance plan does not pay for IVF treatments, including retrievals and transfers

  • You want the peace of mind that multiple cycles are covered

This article will explore the top seven questions people have about IVF insurance and provide some answers to help you better understand your options.

1. Does health insurance cover IVF?

The short answer is that it depends on your insurance plan. Some plans do cover IVF, while others do not. If your plan does cover IVF, it may only cover a certain number of cycles or a specific dollar amount. It's essential to check with your insurance provider to find out what your particular plan covers.

2. What is the difference between in-network and out-of-network IVF coverage?

In-network coverage refers to IVF services supplied by providers with a contract with your insurance company. Out-of-network coverage refers to IVF services delivered by providers who do not have a contract with your insurance company. In-network coverage is generally more favorable than out-of-network coverage, as the costs are typically lower and the coverage is more comprehensive.

3. What are the out-of-pocket costs for IVF?

The out-of-pocket costs for IVF can vary widely depending on your insurance plan, state, zip code, and the specific IVF clinic you go to. On average, it can cost $25,000 or more for one IVF cycle in the US, and often multiple cycles are required.​ The out-of-pocket costs can include things like the cost of the medications, the cost of the procedure, and any additional testing or procedures. It's important to understand the differences between your monthly premium, deductible, co-insurance and out-of-pocket maximum. Typically, you should select the plan(s) with the lowest out-of-pocket max. However, these plans will have higher monthly premiums because you'll spend less money out-of-pocket overall. Don't stress, though. We will work with you to find the best plan that meets your budget!

4. Are there any state laws that mandate IVF coverage?

As of June 2022, 20 states have adopted fertility insurance coverage laws – 14 specifically contain coverage for IVF. And 12 states have fertility preservation laws in cases of medically-induced infertility. Sweet Pea currently assists individuals who reside in Arkansas, Illinois, Connecticut, and Delaware and have reproductive endocrinologists in buying medical insurance plans from the healthcare marketplace, As a licensed insurance agency in these locations, we have worked with insurance carriers in these states to uniquely understand their IVF coverage. It's crucial to check with your state's insurance commissioner to determine the laws in your state. See the map below for a general idea of infertility coverage across the US.

5. Are there any alternative financing options for IVF?

Alternative financing options are available if your insurance plan does not cover IVF or you cannot afford the out-of-pocket costs. For example, some organizations provide grants or loans for IVF. Additionally, some employers may offer IVF coverage as part of their employee benefits packages. Of course, we can help you secure financing options for IVF that meet your needs too!

6. Why should I work with an independent brokerage like Sweet Pea to get IVF insurance coverage?

An independent broker isn't tied to any specific insurance company, which means they can provide you with a broader range of options and help you find a tailored plan. They have knowledge of different insurance plans, coverage, and costs and can help you compare the options available to you. They also have access to plans that may not be available to the general public, which can provide you with more comprehensive coverage. Furthermore, they will be able to give you expert advice and guidance throughout the process, which can be especially helpful if you have complex medical needs or if you are unsure about what type of coverage is best for you. In addition, they can help you understand the terms and conditions of the coverage and can help you negotiate with the insurance company if there are any disputes.

7. Does IVF insurance just cover the IVF procedure?

No, IVF insurance coverage can include more than just the cost of the IVF procedure itself. Some insurance plans may also cover expenses associated with fertility testing, medications, and other related treatments such as IUI or even genetic testing. It's important to check with your insurance provider to find out precisely what your specific plan covers.

IVF can be costly, but insurance coverage and alternative financing options can help make it more affordable. Therefore, it's critical to understand your insurance plan, check with your state's insurance commissioner, and explore alternative financing options to help you navigate the costs of IVF.

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