Health Insurance That Covers Fertility Treatment

Health insurance that covers infertility is not available to every American. When insurance coverage is not available, a variety of financing options are used to pay for infertility treatments.

States

• Only 15 states (Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia) require that employers cover or offer to cover diagnosis and treatment of infertility. Check out your state's regulations on www.Resolve.org, a national support and advocacy group for infertility issues.

Types

• Among the states that mandate insurance to cover the diagnosis and treatment of infertility, benefits vary widely. Limitations may include: no coverage for older women, disallowing use of donor sperm, lifetime maximums for certain procedures, exclusion of in-vitro fertilization, and no coverage for freezing and storage of excess embryos. Mandated states often exempt small companies with fewer than 25 or 50 employees from these requirements.

Policy

• In non-mandated states, two patients with the same insurance company may have different limitations or exclusions for infertility. Your employer may have opted out of the fertility coverage option. When the option exists, you may have to pay extra for your policy to receive infertility coverage. You should always ask your insurance company to provide you with an explanation of covered benefits, in writing, before you start treatment.

Self-pay

• Self-pay patients can expect thousands of dollars in out-of-pocket expenses without insurance coverage. Never start treatment until you have a written estimate from the fertility clinic of your anticipated out-of-pocket expenses. Once your physician gives you a diagnosis and determines you treatment plan, the fertility clinic should be able to give you a good estimate of expenses you can expect.

Loans

• Some banks offer loans to pay for health care and will partner with the health care provider to offer loans. As with any loan, read the loan document over carefully before signing anything. Resolve has information regarding some of the infertility financing programs on their website, www.resolve.org.

Flexible Spending

• Your employer may allow you to set up a health spending account to use pre-tax dollars to pay for non-covered health care expenses. Although this will not reduce your health care expenses, it will reduce your tax bill. Check with your HR department to find out what restrictions and limitations may apply.