Is IVF Covered by Insurance?

by | Aug 18, 2022 | Fertility 101, Grants, Resources

Fertility Insurance Coverage and Other Ways to Afford IVF

Whether your IVF is covered by insurance depends on many factors, including where you live, your employer’s insurance plan, and what specific fertility treatments you intend to use. While we believe that all insurance plans should offer comprehensive fertility treatment coverage, many currently do not. Read on for more information about why IVF isn’t always covered by insurance, how to find out if you have coverage, and additional options for paying for IVF. Additionally, we’ve included some updates on insurance laws in Washington State and around the country.

How Much Does IVF Cost?

IVF stands for in vitro fertilization, a fertility procedure in which eggs and sperm are combined in a lab to develop into embryos, which are then transferred to a patient’s uterus to develop into a pregnancy. IVF is a common and effective treatment for infertility, which affects approximately 1 in 8 couples. Due to the complex medications, monitoring, and laboratory procedures involved, IVF requires a significant financial investment. A single IVF cycle averages $15,000 in the United States. Patients using donor eggs, donor sperm, or a gestational surrogate face increased expenses.

Why Doesn’t Insurance Always Cover IVF?

In 2017, the World Health Organization (WHO) officially defined infertility as a disease that merits insurance coverage. At PNWF, we agree with this definition. Unfortunately, many insurance plans in the US see infertility treatments as optional or non-essential services, and therefore do not cover fertility treatments. Because there is no federal mandate requiring infertility insurance coverage, each state has different rules, and most do not require fertility coverage. When states do include infertility coverage, they often require strict criteria, such as a cancer diagnosis or specific ovarian reserve levels. They may also apply heterosexual, cisgender, and partnered standards to their qualifying definitions. This narrow definition of infertility leaves out wide sections of the population, such as LGBTQ+ and single parents, who may have healthy reproductive systems but need collaborative or assisted reproduction to conceive and/or have biological children.

Some employers, especially in tech, offer private insurance plans that cover IVF and other fertility treatments. These employers often also provide higher salaries, which can make expensive fertility procedures more feasible. This has led to an equity issue in fertility treatments, in that BIPOC, LGBTQ+, and low-income individuals are much less likely to have insurance that covers fertility, or to be able to afford uncovered fertility treatments.

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How Do I Know If My Insurance Covers IVF?

If you have employer-sponsored insurance, review your plan or speak to your provider about the specific coverage. Many employers who offer fertility insurance do so through Progyny insurance, which offers comprehensive coverage options. If your employer-sponsored insurance does not currently cover fertility treatments such as IVF, consider asking them to expand their coverage. Employers are increasingly realizing the value of providing fertility coverage to their employees as part of a competitive benefits package. However many companies expand their coverage only once an employee has asked.

If you have insurance through a state-sponsored plan, you’ll need to check the rules and regulations of your state’s coverage. As mentioned, each state has their own approach to IVF insurance coverage, so it’s best to directly contact your insurance provider to ask.

How Do People Afford IVF Without Insurance?

Even without insurance that covers IVF, many people figure out ways to afford fertility treatments to build their families. Some may be able to save up money over time, or have family members who agree to donate or lend them funds. Other patients may use crowdfunding sites to help raise the necessary amount. Some lending companies provide fertility-specific loans or financing options. And finally, several organizations offer grants or stipends for different fertility treatments. For more information on available fertility grants, read our article here.

PNWF Offers Financial Fertility Counseling

Fertility treatments are complex medical procedures that come with correspondingly high costs. If you are fortunate enough to have insurance that covers IVF and other fertility treatments, that can provide an enormous benefit to your peace of mind on your fertility journey. However, while insurance makes paying for fertility treatments easier, it’s not the only option. Our financial counselors work with patients to chart out a feasible financial plan and make family building an accessible option.

On a positive note, over the last few years, advocates for fertility equity have brought several bills to state legislatures to require fertility coverage. For instance, PNWF co-founder Dr. Lorna Marshall has actively worked with the Washington Building Families Coalition, which brought a bill mandating comprehensive and inclusive fertility insurance to the Washington state legislature earlier this year. We hope that more and more states will understand the need for equitable and affordable access to fertility treatments. In the meantime, we’re here to help you create a path to parenthood.

For more information, reach out to us today.