Will my insurance cover fertility treatments?

Fertility treatments large and small have one thing in common: they usually have a significant price tag attached. Even medications with relatively low prices will start adding up after multiple doses. Because these treatments often come in the form of medications, procedures, and miscellaneous health recommendations, it would seem like health insurance would cover the costs. How can you know whether your treatments will be covered?

Your insurance plan

Only 15 states in the U.S. have laws that require insurance coverage for fertility treatments: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. The laws in those states vary, and some have certain requirements that could mean your treatment isn’t covered. If you live in a state not listed here, your insurance might still cover your treatment, it’s just not legally mandated. You can click here to check and see if your state mandates IVF coverage. 

If you look at your insurance policy, you should be able to see which services are covered and which are not. If your fertility treatments aren’t covered services, you’ll be responsible for paying those costs yourself.

However, something not being included in your health insurance policy doesn’t mean it’s not a worthwhile treatment; it just means your specific plan doesn’t cover it. Policies vary from person to person, even with the same insurance provider, so you’ll want to check your specific plan to see what benefits you have.

Your employer

If you have insurance through an employer, you may be guaranteed certain fertility benefits. In the 15 states where insurance coverage for fertility treatments is required, some benefits are automatically covered, though there are some exceptions for different types of employers. In many states, employers who self-insure, run a religious organization, or have a small business (ranging from 15-50 employees depending on the state) do not have to provide coverage.

That being said, some employers do offer coverage for fertility treatments as part of their insurance benefits packages. You can find out which ones are covered by looking at your policy. If your employer doesn’t include fertility benefits, it’s possible that they’re just not aware of the need for them. Some women have found success in petitioning their employers to add fertility benefits to their insurance options, citing that the cost isn’t as high as they might think and that it makes for overall healthier employees.

Your fertility treatment

Another factor in determining whether your costs will be covered is what treatment you’re undergoing. Some plans won’t cover fertility prescriptions or medications if they don’t cover general fertility treatments, and even states that are required to cover fertility treatments often have exceptions for IVF. There are also frequently limitations on how many cycles of treatment you can have or how much money you can spend on treatment.

If you need to fill in gaps where insurance doesn’t cover your treatment, there are options. Many pharmacies offer coupons for fertility medications like Clomid, and there are need-based grants allotted specifically for fertility treatments. If you need more information on what your health plan offers, reach out to your insurance provider for specifics.

  • “Insurance coverage.” Resolve. Resolve: The National Infertility Association. 2016. Web.
  • “Insurance coverage in your state.” Resolve. Resolve: The National Infertility Association. 2016. Web.
  • “State infertility insurance laws.” ASRM. American Society for Reproductive Medicine. 2016. Web.
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