IVF Insurance

Submitted by Kate Seldman Wed 06/22/2011

Medical insurance is almost vital if you want to go through treatment to try to conceive a baby. IVF can be very expensive. Such procedures can be quite expensive— according to the national infertility association RESOLVE, one cycle of IVF costs $8,158 on average, with an additional $3,000 to $5,000 for medications.
Many employer-sponsored group insurance plans don’t cover IVF unless their state insurance department requires they do so. Right now, 14 states have laws in place mandating that insurers either cover, or offer coverage options, for infertility treatment. These states are: West Virginia, Texas, Rhode Island, Ohio, New York, New Jersey, Montana, Massachusetts, Maryland, Illinois, Hawaii, Connecticut, California, and Arkansas. 12 of these 14 states’ laws require that insurers cover infertility treatment and diagnosis, and two – California and Texas – have laws mandating that insurers offer this coverage.
However, California and Texas laws exclude IVF as part of this treatment. Usually, health insurance pays for infertility testing, but after a couple has been diagnosed as infertile, the company often doesn’t pay for treatment. This could be because fertility testing doesn’t cost insurance companies as much as fertility treatment does. Even fertility testing can be tricky when you’re trying to get your insurance company to cover it.
If a test is performed for several reasons – say a woman is having abdominal pain, and fertility tests are conducted to see if that’s the reason for her discomfort, an insurance company might see these tests as for fertility purposes only, and refuse to cover them, even though they were needed for other medical reasons as well. Insurance companies may cover other forms of fertility treatments, including ovary stimulation and artificial insemination, but still refuse to cover IVF. It’s even possible that part of IVF treatment will be covered – for example, ultrasounds and blood tests – but not the actual IVF itself.
You can buy individual IVF insurance coverage, but it won’t pay directly for the procedure: instead, you’ll receive partial refunds for several cycles of treatment (each plan will pay for a different number of cycles). You may be able to get even more money back if your IVF treatment doesn’t result in successful conception. You can deduct the unreimbursed portion of your IVF expenses from your taxes, but there may be additional limitations – some medical treatments, or portions of your treatment, may not qualify as deductible. If you’re in a high income bracket, your tax deductions may be limited.
One way to make sure you get more money back is by using a flexible spending account. It’s possible to buy supplemental health insurance if you’re going to do IVF. You should purchase this insurance a few months before you begin your treatment.
This insurance can also help you if you end up conceiving – if you experience complications in your pregnancy or if you deliver a premature baby, as research shows sometimes happens with IVF mothers, you’re covered. Before deciding on insurance options, speak to your doctor and clinic, and get hard numbers as to how much everything will cost.
Make sure you know whether medical consults, testing, lab work and medications are going to be included in the clinic’s costs. Also ask what the costs are if you decide you need financial or psychological counseling.
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