Medical insurance coverage for infertility treatment and for IVF, in vitro fertilization can be straightforward or complicated. This is an effort to explain some of the issues regarding health insurance coverage for infertility testing and treatment. Because our fertility clinic is in northern Illinois and close to Wisconsin — insurance coverage for IVF and infertility in Illinois and Wisconsin will be specifically addressed.
Insurance coverage for infertility, artificial inseminations and in vitro fertilization varies greatly. Some insurance plans will cover no infertility services, some pay for all of it and many are somewhere in between. About 15 states have some type of mandate for infertility insurance coverage — so couples in those states will be likely to get some help with payment for their fertility services from their health insurance plan.
In states without any infertility coverage mandate, most insurance plans do not help much with payment for fertility and IVF services. This is because IVF costs more than other infertility testing and treatments.
We can see patients with any PPO plan. Health insurance plans will commonly but not always pay for services related to testing for infertility. However, many plans say that once the diagnosis has been established that they will no longer pay for fertility related services. This is likely due to the fact that covering diagnostic testing does not cost them very much. There are potential gray areas with coverage for tests. For example, a woman is trying to get pregnant and has heavy periods and very bad menstrual cramps.
She has a hysteroscopy at the fertility clinic to investigate the situation. Was the test done for her bleeding and pain, or was it done for infertility? What if it was done for all of those reasons? It can be a little complicated and confusing at times. Treatment for infertility is covered by insurance much less commonly than testing is.
Outside of a state mandated situation see below , when there is coverage for infertility treatment, it is fairly common to exclude IVF or to have a lifetime maximum benefit. This roundup will help readers find a health insurance policy that will provide them with the best coverage for fertility treatments.
The best fertility insurance provides you with coverage that allows for diagnostic testing and multiple treatment cycles, is available in many states, and has an affordable premium with reasonable deductible options.
UnitedHealthcare provides great fertility insurance, including coverage for things like insemination, surrogacy support, and ovulation induction, via a large network of providers that extends to all 50 states. UnitedHealthcare wins best overall because it offers affordable health care coverage through an extensive network of care providers in 50 states that, depending on your state and plan, includes fertility insurance.
UnitedHealthcare offers coverage for things like ovulation induction for women up to age 44 , insemination procedures, artificial insemination, intrauterine insemination, and assisted reproductive technologies. All required treatments in states that mandate certain kinds of fertility coverages are covered. Excluded are certain kinds of treatments like paying for donor eggs and sperm, as well as long-term sperm, egg, or embryo storage.
They have a network of more than 1. Your plan costs, deductible, and copay options will depend on what plan you choose, your state, and the level of coverage you choose. UnitedHealthcare allows you to manage your care and payments via a mobile app, making it simpler to connect with fertility specialists. A well-respected insurer, UnitedHealthcare was founded in Read the full UnitedHealthcare review. Cigna provides cost-effective coverage that includes in vitro fertilization IVF in many of their plans, while also covering a significant number of diagnostic fertility tests and other fertility treatments.
Our winner for best IVF coverage because it offers a comprehensive array of assisted reproductive technology coverage, including IVF, through many of its plans, Cigna provides coverage for diagnostic tests like hysteroscopies, semen analysis, and testicular biopsy. Fertility treatments like ovarian reserve testing, tubal recanalization, assisted embryo hatching, gamete intrafallopian transfer, and testicular treatments and surgeries are approved procedures in many cases.
Cigna offers members a large network of providers and has a mobile app to help members manage their care. Medicare plans, group plans, and individual and family plans through the health insurance marketplace are offered in 10 states Arizona, Colorado, Florida, Illinois, Kansas, Missouri, North Carolina, Tennessee, Utah, and Virginia.
Your deductible and eligibility for fertility coverage will depend on the plan you have and the state you live in. Founded in , Cigna has built a reputation for providing comprehensive care at a reasonable price. AM Best currently rates them A for their financial strength and claims-paying ability. Read the full Cigna review.
Aetna is a well-known health insurance company that offers fertility treatment and a comprehensive host of resources to help you determine your likelihood of success with fertility treatment, find an infertility provider, and learn about fertility treatments via videos and other resources. Its extensive online library of tools, videos, and resources around infertility that will help you learn more about fertility care and how to access it helps Aetna earn the best additional resources spot.
They exclude people trying to get pregnant over 40 from some of their fertility health care. Aetna has a rating system that identifies a small number of fertility care facilities as Institutes of Excellence IOE.
This is a limited network of facilities and providers who have a great track record of providing fertility care with positive results. Aetna does not offer individual and family plans on the health insurance marketplace.
They only offer Medicare, Medicaid, and employer-sponsored plans. They have an app that helps you manage your care to make navigating your coverage easier. Founded in and headquartered in Hartford, Connecticut, Aetna operates in 50 states and Washington, D.
The company received an A rating from AM Best in the category of financial strength. Read the full Aetna review. Wellcare provides government-sponsored health coverage through Medicaid and Medicare contracts that provides both basic and comprehensive infertility services. This allows you access to cost-effective support for your fertility care needs. Wellcare wins for the best provider of affordable fertility coverage because they offer Medicaid and Medicare coverage that includes some fertility coverage.
Its coverage supports members who experience infertility between the ages of 21 and They cover basic infertility services like semen analysis, endometrial biopsy, treatment of ovulatory dysfunction, and testis biopsies. They also cover comprehensive infertility services like pelvic ultrasounds, laparotomy, and artificial insemination.
They do not cover things like in vitro fertilization, donor ovum or donor sperm, storage costs, or reversals of vasectomies. Wellcare has a network of over , health care professionals that they work with nationwide. They sell plans in all 50 states, and your plan premium and deductible will vary depending on your state and the plan you choose.
They have an app to help you manage your care. Founded in , Wellcare is known for providing good care to its members. Read the full Wellcare review. Progyny is a premium fertility insurance benefit that companies are able to offer their employees to provide them with the best access to assistive reproductive technologies. Whether to grow your family is an emotional decision, no matter the means of getting there. Undergoing fertility treatments can increase the weight of it, too, because of the addition of financial pressure.
These procedures often come with a hefty price tag. Mark P. And the average IVF patient undergoes two cycles, which makes the total cost on par with a year of college. But there are ways you can offset some of these costs.
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