Fertility Treatment and Insurance: What’s Covered and What’s Not in the Quest to Have a Baby

The cost associated with fertility treatment is one of the most important considerations for families that are hoping to conceive. You may be wondering if your health insurance will cover at least some of the treatment. Insurance coverage for fertility treatments is varied and can often contain fine print to sift through. Before you go forward with your fertility treatment, be sure to research your health insurance plan and state laws so that you can take advantage of as much insurance coverage as possible—and plan for raising the funds that you might need for out-of-pocket costs.

Whether health insurance plans are required to cover at least some fertility services is highly dependent on state laws. Currently, about 15 states have mandates for some coverage for fertility treatments. Some states will mandate that health insurance companies offer at least one plan that covers some fertility services. However, many of these coverage plans will have restrictions. For example, your treatment must be considered “medically necessary.”

Large employers with over 500 people are also more likely to cover some fertility services compared to smaller employers. For people employed by the military, Tricare (the U.S. military’s insurance plan) offers some coverage including diagnostic services if it is deemed “medically necessary.” Veteran Affairs will offer some coverage (from the initial diagnostic testing to IVF) if the infertility is service-related and the couple is legally married.

Diagnostic tests such as lab tests, semen analysis, and imaging studies are much more likely to be covered by insurance than treatments such as IUI or IVF. Fertility drugs and some treatments that address the root causes of infertility are more likely to be covered. This is probably because diagnostic tests, drugs, and simpler treatments are less expensive than IUI or IVF cycles.

For most people undergoing fertility treatments, insurance will not cover the bulk of it. Fortunately, there are alternatives to health insurance that you can take advantage of to raise the funds you need. Fundraisers, crowdsourcing, grants, credit cards, and starting a side business are only a few of the creative ways you can fund your fertility treatment. Read more about funding your fertility treatment here.

To learn more about your options for fertility treatments and how to pay for them, get in touch with us at the Alabama Center for Reproductive Medicine by calling 205-778-4819 today.