Does insurance cover IVF? To put it simply, sometimes…
When pursuing fertility treatment, challenges are inevitable, and in many cases, financial challenges are some of the first to present themselves when getting started. We know how difficult an infertility diagnosis can be, though we believe financial options for treatment don’t have to be difficult too.
In this article, we explain insurance and financing options for those seeking treatment for infertility. We cover state legislation, insurance, and financing options all below.
The Affordable Care Act
A mention from the Affordable Care Act (ACA), mandates that health insurance companies provide the same set of essential health benefits, including outpatient care, hospitalization, emergency services, prescription drugs, maternity and newborn care, preventive and wellness services, and pediatric services. They can also provide additional health benefits if the company chooses.
Unfortunately, infertility treatment is not recognized as an essential health benefit mandated by the ACA. However, infertility may be considered a pre-existing condition - as of 2014, an insurance company cannot refuse to cover someone diagnosed based on pre-existing conditions.
There are currently 17 states—Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia—that have passed laws requiring insurance companies to either cover or offer coverage for infertility diagnosis and treatment. Of those states, 15 have laws that require insurance companies to cover infertility treatment, and two states—California and Texas—have laws that require insurance companies to offer coverage for infertility treatment.
Insurance Coverage for Infertility Treatment
Depending on the health insurance plan, coverage will vary. Although it can be tiresome, by doing the necessary homework, those seeking infertility treatment can feel fully empowered to advocate for themselves when discussing options with their insurer. Researching one’s state legislation and what is covered by their current health insurance plan is an essential starting place while understanding financial options.
Most health insurance policies fall under one of the following five groups:
- No fertility insurance coverage
- Insurance coverage for infertility diagnosis only
- Insurance coverage for infertility diagnosis and limited treatment
- Full infertility insurance coverage
- Medication coverage (which may or may not include fertility drugs)
Keep in mind some employers offer fertility benefits too and they may be helpful in navigating a path to treatment if these benefits are available.
Financing Infertility Treatment
If health insurance does not cover treatment, some may find comfort in knowing there are a variety of financing options available. At PFCLA, we have partnered with Future Family to enable patients to create a customizable loan program to help fertility financing be less stressful.
If a patient is a US resident, we offer financing with approval granted for qualified applications within 48 business hours. If you have received pricing from another clinic, please feel free to share it with us and we can provide a comparison of the costs so you fully understand all your options.
When financing fertility treatment with Future Family, patients have access to one-on-one attention from a fertility financing specialist to address their every concern. If using a third-party provider with our IVF clinic, patients can incorporate all of their fees within a single loan, or individually. Future Family will disburse loan proceeds to each payment as directed by the patient.
Our patient loan program will be personally tailored to their fertility treatment. Once approved, a fertility financing specialist will work with a financial coordinator at PFCLA to ensure that the proper funds are secured prior to beginning treatment.
Get in Touch with Us
At PFCLA, we understand that insurance benefits and financial options can be difficult. Confusion and uncertainty about finances and other unknowns of a fertility journey can often prevent intended parents from moving forward with fertility treatments. Our patients are guided closely throughout the financial and insurance process with a financial coordinator to ensure a seamless path toward parenthood.
If you are looking for additional information, get in touch with our fertility team today.
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