Infertility and Insurance: Avenues for Funding Treatment
For many couples facing infertility, the largest hurdle is how to finance costly infertility treatments. Luckily, there are products now that provide infertility insurance as part of a general health insurance package.
Out of Pocket Cost
When you examine the costs behind the high technology infertility treatments, it becomes evident why paying out of pocket may be out of reach. The most effective clinical treatment, in-vitro fertilization, can cost tens of thousands of dollars for a single attempt. While some get lucky, most couples will need to undergo more than one cycle of in-vitro fertilization to become pregnant. Even more “intermediate” infertility procedures such as IUI can run upwards of $4000. On top of that, fertility medications themselves, whether used alone to increase a woman’s ovulation or in conjunction with IVF can cost around $1,000 a month.
Clearly these costs are out of reach for many couples. Even if your general health insurance plan does not include coverage for infertility treatments, there are supplemental infertility insurance packages for couples that can make treatment much more affordable. Often these supplemental policies are “riders” to your general health insurance policy, sold and underwritten by the same insurance company. Supplemental infertility insurance can vary widely in scope of coverage and required preconditions, so it is worthwhile to investigate multiple insurance options before committing to one if you believe you may need infertility treatment.
What’s Covered by Infertility Insurance
The insurance companies offering supplemental infertility insurance charge a separate a monthly premium for a range of fertility treatments that typically include include diagnostic fertility tests, artificial insemination, and other types of assisted reproductive technology. Some policies require that a couple be married for some period of time and have tried to get pregnant without success, as documented by reports to the woman’s OBGYN or primary care provider. Most plans will also require that a couple attempt less involved treatments like medication or IUI before considering coverage for IVF. Once a couple is pursuing IVF, their insurance plan will probably limit the number of IVF attempts that can be made — typically between three and five. It’s important to understand at what point an IVF cycle is determined to have commenced by the insurance company, so as to avoid having aborted cycles counted against them. It’s also important to be aware that most plans will not cover the use of donor eggs or donor sperm.
3 Most Common Forms of Infertility Insurance
There are three different types of infertility insurance. First, there is standard health insurance. This type of insurance requires that you pay a monthly premium in exchange for specific fertility coverage.
Second are refund programs offered by clinics. Under these programs a couple pays upfront a lump sum of money for a set number of treatment attempts, and receives some percent of the money returned if the couple does not conceive as a result of the treatments. Of course, the down side of these programs is that the couple is typically required to pay up front for more than one IVF cycle, and if that couple succeeds in getting pregnant, no money is refunded. (Usually the happiness that accompanies such a success eases the sting of some of that “lost” money.)
Finally, loans financing infertility procedures may be available under which the couple is not required to pay back the loan in full if they are ultimately unable to have a baby. Lenders may require that a couple satisfy a number of prerequisites before approving a loan, many similar to those described for a standard premium-based plan as described above.
Finding the right insurance policy can require a lot of research, and even advance planning in case a policy requires that premiums be paid for a year or more before treatment can commence.
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