Does health insurance cover IVF?
Between 1-2 percent of all babies born in the United States each year are conceived with the help of in vitro fertilization (IVF). IVF is a form of assisted reproductive technology (ART) in which egg and sperm are combined outside of the uterus in a laboratory setting. If fertilization occurs, an embryo can then be transferred to a uterus with the hopes that it will implant and a pregnancy will occur.
IVF offers tremendous hope to individuals seeking to grow their families who may be dealing with everything from infertility to a family history of genetically inherited disease to pursuing family building as an individual or within an LGBTQ+ partnership. However, it is also incredibly expensive. A full IVF cycle, with medications, costs an average of $22,000 per cycle in the U.S.
And for many people, insurance does not cover the procedure.
Before you begin investigating IVF with a reproductive endocrinologist and fertility specialist, here’s what to understand about how your insurance may or may not cover you throughout the process of a cycle.
What is IVF?
First, it’s important to understand what is being referenced when discussing a full IVF cycle.
Most simply, the process can be described on a high-level as having four distinct phases.
1. Ovulation stimulation
In the first phase, the partner with ovaries or a potential egg donor will take a series of injectable medications daily for approximately 10-14 days to stimulate the ovaries to produce multiple mature eggs. During this phase, the partner with ovaries being stimulated with these medications will also go in for regular monitoring appointments at their reproductive endocrinologist’s office. At these appointments, blood will be drawn to monitor the patient’s hormone levels, and the growth of follicles on the ovaries will be tracked through the use of transvaginal ultrasound. If large follicles can be seen on the ovaries, this indicates the presence of mature egg cells.
2. Egg retrieval
The next stage of the IVF process is egg retrieval. Once large follicles are detected, the partner with ovaries will undergo egg retrieval, a short out-patient surgical procedure in which the eggs are removed from the ovaries through a thin needle inserted through the vagina. Patients are under sedation during this procedure.
After the eggs are retrieved from the ovaries, they are then fertilized with a sperm sample collected from either the sperm-producing partner or a sperm donor. Sperm and eggs are either combined in a petri dish, where fertilization then may occur, or an individual washed and prepared sperm might be injected directly into a single egg through a process known as ICSI (intracytoplasmic sperm injection).
4. Embryo transfer
Once the eggs have been fertilized by the sperm, they will be monitored in a lab environment for anywhere between three and seven days, tracking their continued growth and development. Most commonly, the fertilized eggs that make it to the blastocyst phase, somewhere between four and seven days after fertilization, are then available for embryo transfer. Increasingly, more and more IVF patients are opting to freeze their embryos instead of directly going into a transfer cycle. This allows the hormone levels in the body to return to a more normal state, and for any additional chromosomal and / or genetic testing to be done to the embryos before transfer. Embryos are transferred into the uterus through a small, thin, flexible catheter inserted through the cervix and into the uterine cavity.
Fourteen days after an embryo transfer occurs, the partner with a uterus will go into their fertility doctor’s office for a blood test to check for pregnancy and whether hormone levels associated with pregnancy are rising in the body.
Insurance and IVF
Unfortunately, most insurance plans do not cover IVF. And for most people undergoing IVF, it will take between two and three cycles to achieve a pregnancy.
Keep in mind that every insurance plan is different, and insurance regulations on IVF coverage can vary by state. Because of the high costs associated with IVF, it’s best to familiarize yourself with your plan and any IVF mandates that might exist where you live before beginning treatment.
At present only 17 states have infertility insurance coverage laws. Additionally, seven states have fertility preservation laws for medically-induced infertility. The states that have some kind of law regarding infertility coverage are Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. The definitions of infertility and the kind of coverage offered through plans written in that state vary by state. Furthermore, there might be further restrictions on coverage tied to the use of the covered party’s own sperm and eggs (and barring use of donor sperm and eggs). Some states may cover other forms of infertility treatment, such as intrauterine injection (IUI), but not IVF. And some states may have limitations on the number of cycles of IVF covered. Again, individual restrictions and benefits vary by state and the laws governing infertility coverage there.
Even if your health insurance plan does not cover IVF, it may still cover some of the costs associated with your infertility treatment. Depending on your plan, if your fertility doctor is in-network on the plan, some visits associated with seeing that doctor during the diagnostic phase of your treatment may be covered, even if your treatment is not. If your plan does cover for the diagnostic phase of infertility treatment, even if it does not cover treatment itself, it will typically cover services rendered to determine that infertility does in fact exist. And, once this determination is made, it will then typically cover services rendered to determine the nature or cause of the infertility.
It is important to remember that even if your fertility doctor is listed as in-network on your plan, if your specific plan does not provide infertility coverage, for either diagnostics or treatment, you will still pay out-of-pocket to see that provider as that form of care is not in-network. Again, even with coverage, there might be lifetimes maximums on the amount a plan will pay for infertility treatment, the forms of treatments covered, the kinds of medications covered, and whether both diagnostic procedures and treatment itself are covered. It’s best to know the details of your insurance plan, so that you can then be best equipped to know whether coverage is a factor in selecting an infertility doctor, or whether you will be paying out-of-pocket no matter what.
As a result of the lack of insurance policies offering coverage for IVF, there are a number of loan and IVF financing options available, from financing programs to infertility grant and scholarship programs.
Military personnel and infertility
If you or your spouse are in the armed services, know that TRICARE does not cover IVF or IUI and may have limited coverage for other procedures.
However, TRICARE may cover diagnostic care, meaning that certain forms of infertility testing might be covered. And certain forms of fertility treatments are also covered, such as hormonal treatment, corrective surgery, antibiotics, administration of HCG, or radiation therapy, depending on the cause. These things are covered for both men and women service members. TRICARE also provides medically necessary appropriate medical care for erectile dysfunction.
Even though TRICARE does not cover IVF, there are a number of military treatment facilities (MTF) where IVF can be accessed. Service members are responsible for the full costs of IVF at these facilities.
Some infertility practices, however, offer discounted rates for active duty service members and veterans seeking out IVF treatment, though, so keep this in mind while looking for an IVF provider in your area.