Getting Health Insurance Coverage for In Vitro Fertilization (IVF)

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Choosing to build a family comes with its ups and downs. There are the fun parts, like picking names and baby showers. And then there are the not-so-fun parts, like trying to answer the question – How do I pay for it all?

 

When it comes to fertility treatments, that answer depends on where you live. There are 15 states that require health insurance providers to cover fertility treatments:

  1. Arkansas

  2. California

  3. Connecticut

  4. Hawaii

  5. Illinois

  6. Louisiana

  7. Maryland

  8. Massachusetts

  9. Montana

  10. New Jersey

  11. New York

  12. Ohio

  13. Rhode Island

  14. Texas

  15. West Virginia

 

But these states are just mandated to offer some coverage, meaning that how much help you’ll actually receive varies. The type of fertility treatment coverage that insurance companies offer fall into the following categories:

- No coverage

- Coverage for infertility diagnosis

- Coverage for infertility diagnosis with limited treatment

- Coverage of medications

- Full infertility insurance coverage

 

Here is a detailed breakdown of the specific treatments each state covers.

 

How to avoid surprise bills

Whether you have some coverage or full infertility insurance, it’s still important to ask your insurance provider and doctor(s) questions to avoid surprise bills. The more specific your questions, the better. For example, just because your insurance plan covers medications, that doesn’t necessarily mean that they’ll pay for the particular fertility drugs you’ll need.

 

Asking what drugs they cover beforehand will help you make an informed decision when choosing your health insurance plan. And you want to always make sure that any labs or specialists that you are referred to are in-network. This will keep your medical costs low as well.

 

Getting maternity coverage

Thanks to the Affordable Care Act, insurance plans are required to offer some coverage during your pregnancy. And health insurance plans can’t turn you down or overcharge you because you’re pregnant.

 

Plans must offer folic acid supplements, gestational diabetes screening, Rh incompatibility screening, breastfeeding support and counseling and more. But what specific services are covered and how much you’ll have to pay varies from plan to plan.

 

 

This is an overview of the kind of maternity coverage Anthem, Kaiser, United Health Care , Aetna , and Cigna offer. Getting a document called a summary of benefits (SBC) from each plan will help you better compare their maternity and fertility treatment coverage.

Open Enrollment is almost over, but keep in mind that having a baby or adopting a child qualifies you for Special Enrollment Period (SEP), which gives you more time to get health insurance without being fined. This means that you have 60 days from the date that you gave birth or adopted a child to sign up.

 

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They say it takes a village to raise a child and the same goes for dealing with your health insurance. We’re here to help (for free). In just 5 minutes, we can show you the best plans available, making it even easier to choose the right health insurance plan for your unique needs.

 

And after you get your plan, we’ll help you with any issues that come up, whether it’s fighting a bill, getting your medications covered, etc. This way, you’ll have the time to focus on the fun parts of building a family.