Can I purchase a medical insurance plan that will cover IVF without going through my employer?

In Vitro Fertilization (IVF) and infertility treatment can enable couples to fulfill their dream of having a baby. However, health insurance coverage of IVF and other fertility treatments varies from one state to the next and among insurance carriers.

The Affordable Care Act (ACA)

Otherwise known as Obamacare, the ACA requires that health insurance carriers must provide essential healthcare benefits including emergency services, newborn and maternity care, pediatric services, outpatient care, preventative and wellness care, and hospitalization. These benefits are at minimum; the carrier can provide additional benefits if they choose to do so.

Infertility Treatment and the ACA

Unfortunately, infertility treatment is not considered essential and so it is not required coverage under the ACA. If one’s current health insurance coverage does not include infertility treatment, the carrier is not required to add it as a benefit. However, infertility is usually considered a pre-existing health condition. Thanks to the ACA, a person cannot be denied health insurance because of a pre-existing health condition. Fertility treatment is at least partially covered by ACA Marketplace carriers in 15 states. That includes:

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

Even if fertility treatment coverage is not provided by your state’s Marketplace carriers, your choice of insurance may cover a percentage of your treatment and diagnostic tests.

Types of IVF Insurance Coverage

For the most part, health insurance policies’ coverage of IVF and related treatments or diagnostic tests will fall into one of the following categories:

  • No IVF coverage at all.
  • Infertility diagnostic tests only.
  • Infertility diagnostic tests and a limited amount of treatment.
  • Complete infertility coverage.
  • Medication coverage though it may or may not cover fertility medications.

Before getting treatment, be clear on what is covered and not covered by your health coverage. If you are shopping around for insurance coverage and plan to undergo IVF, determine if the amount of coverage that the policy offers will be adequate for your needs. Do not hesitate to speak to the insurance carrier by phone to ask questions and receive responses to your concerns. Some of the treatments you may wish to inquire about include:

  • Oral ovulation medications.
  • Intrauterine insemination procedures.
  • Injectable fertility medications. Some will cover Clomid (clomiphene citrate) but not injectable medications.
  • Egg freezing.
  • Intracellular sperm injection.
  • Preimplantation genetic diagnosis.
  • Preferred medications versus alternative choices.

IVF Insurance Coverage Through Partners

If your partner or spouse has insurance coverage, it may cover part or all of the infertility diagnostic testing and treatments. If you are unmarried, be sure to confirm whether or not you are covered under their policy.

Financing Plans

If you cannot obtain sufficient health insurance coverage to pay for your infertility diagnostics and treatment, you may be able to pay for what you need through a financing plan. After you have a clear picture of the coverage for which you are eligible through the Marketplace, check with fertility clinics to see what they offer for financing.

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