IVF is a common treatment option for many couples experiencing infertility, although it can be quite expensive. This leads us to the question, of how to get IVF covered by insurance.
For a lot of people, it already will be covered as 17 states have laws requiring the coverage of IVF and other fertility treatments. These states have laws dictating that fertility treatments need to be covered but IVF coverage could be separate from general fertility treatments, including the diagnosis of both halves of your couple. Since each state has its own rules, let’s dive in to see what those are state-by-state.
- Infertility and IVF Insurance Coverage in States
- Talk to Your Employer About Getting Coverage
- Ask Your Insurance Company
- Purchase a Different Policy
- Find Research Trials
- Find A New Employer
Infertility and IVF Insurance Coverage in States
In Arkansas, coverage is required if you can show a two year history of fertility issues, however you do need to try less costly fertility treatments covered by insurance before turning to IVF.
What’s Covered in Arkansas state:
- Any individual or group policies which provide maternity coverage must also cover IVF
- Maximum of $15,000 lifetime coverage
- Preexisting condition limit is 12 months
There are some other miscellaneous requirements regarding where the IVF procedures must be completed and some options for insurers to include other fertility treatments, but they don’t hinder the availability of IVF in Arkansas.
Unfortunately, California fertility treatment laws don’t require IVF coverage, but they do require coverage for fertility treatments.
Insurers in California must provide the following, but employers are not required to offer them to employees:
- Diagnostic Testing
- And Gamete Intrafallopian Transfer (GIFT)
In Connecticut, you only need to prove a 12-month history of infertility to be covered, but you do need to have the coverage for all 12 months as well. You are also required to attempt less expensive and less invasive forms of fertility treatments before IVF will be covered by your insurance.
IVF Insurance in Connecticut will cover the following:
- Lifetime maximum coverage of 4 cycles of ovulation induction
- Lifetime maximum coverage of 3 cycles of Intrauterine insemination
- Maximum of two implantations covered for IVF, GIFT, ZIFT, or low tubal ovum transfer
IVF coverage in Delaware is required for anyone who isn’t having success with less expensive fertility treatments. They may require up to three treatments of ovulation induction or intrauterine inseminations before covering IVF, however.
There is an exemption to that last rule, though, is IVF is deemed medically necessary before those treatments are completed.
Coverage in Delaware can include:
- Cryopreservation services
- Intrauterine insemination
- Six completed egg retrievals per lifetime
There are more items covered in Delaware, however there are also exemptions for experimental services and surrogate payments.
Hawaii’s IVF coverage laws are a little more strict than other states. There must be a 5-year history of infertility for IVF to be covered.
There is an exemption to the 5-year requirement if certain diagnoses are made.
Illinois laws only require a one-year history of infertility before IVF may be covered. The coverage is required for group insurers and HMOs who provide maternity coverage.
You are required to attempt less expensive treatments before turning to IVF.
Coverage in Illinois will include:
- Up to 4 egg retrievals
IVF, GIFT, and ZIFT are required if deemed necessary
Louisiana laws don’t specifically state that IVF needs to be covered by insurance, however they do have laws to aid in treatment of infertility.
Louisiana laws prohibit insurers from denying coverage for the diagnosis, and treatment, of medical conditions because they cause infertility. While not outright specifying that IVF is covered, the laws do say infertility must be covered.
Maryland fertility laws require a 2-year history of infertility before coverage will be provided, unless a diagnosis is made deeming it necessary.
Coverage may include:
- If less expensive treatment options are attempted, then up to 3 IVFs per live birth could be covered.
Lifetime maximum of $100,000 of coverage
Fertility laws in Massachusetts require coverage if conception is not achieved within 6-12 months, depending on age.
Any insurer providing pregnancy-related benefits will need to provide coverage for the treatment and diagnosis of infertility conditions.
Insurance in Massachusetts will cover:
- Artificial insemination
- Sperm and egg procurement and processing
- Medication coverage shall be the same for non-fertility drugs
- There is no limit on the number of cycles or spending cap
Unfortunately, Montana law only requires infertility services to be covered by insurance if your insurance plan is part of an HMO. There is no specific language that requires IVF coverage, but fertility services are covered.
Now insurance provider can impose any rules or limitations on fertility treatments that don’t also apply to other treatments and healthcare.
Coverage of fertility treatments in New Hampshire can include:
- Diagnosis of infertility conditions
- All medically necessary fertility treatments
- Evaluations, lab tests, egg services, and donor eggs are all covered
New Jersey law only requires 6-12 months of infertility before coverage begins, but they do require you to attempt less costly treatments before turning to IVF.
IVF is covered by insurance in New Jersey, even when using donor eggs or surrogates.
Coverage can also include:
- Artificial insemination
- Diagnosis and testing
- 4 egg retrievals
Non-medical costs will not be covered, such as surrogate payments.
New York fertility coverage laws are similar to New Jersey’s in that only 6-12 months history are required for coverage.
A long list of diagnostic tests are covered by insurance, along with 3 IVF cycles. There may some limits on people who are part of insurance groups of less than one hundred people, but prescription medications will be covered as normal.
Medical insurance laws in Ohio don’t specifically require insurers to provide coverage for IVF, but what they do specify, is coverage for “Basic Health Care Services” which includes fertility services.
They don’t mention IVF, but they are required to cover surgical procedures to correct or diagnose medical conditions causing infertility. IVF, GIFT, and ZIFT could be covered, but they laws don’t require it.
The laws of Rhode Island are vague when concerning fertility coverage by insurance plans. They do specify that fertility treatment and diagnosis must be covered as a basic health care service, but IVF isn’t specifically mentioned.
They do require coverage for preservation services when medical treatments may lead to infertility, such as radiation, surgery, or chemotherapy, but again, IVF and other similar services are not specifically mentioned.
Group insurers are required to offer IVF coverage, but it’s up to employers to decide if the coverage is provided. If your insurance does not cover IVF in Texas, it may change just by finding a new employer or even just asking your employer to cover it.
An exception for many of these state laws relieves employers who self-insure from covering fertility treatments such as IVF. This means you may need to be part of a group coverage or change insurers.
West Virginia has joined the “Vague Law Club.” They don’t specifically require IVF coverage by insurance plans, but they do require fertility services as a basic health care service like some other states do.
If a state doesn’t require IVF coverage, that doesn’t mean it won’t be covered by your policy. It just means it hasn’t been mandated.
There are two easy ways to find out if your insurance covers IVF. First, call your insurer and ask them. It may take 20 minutes to get a live person on the phone, but you will get the answer.
The other option may be easy, as you’re calling your own company’s benefits department. They should have knowledge of what’s covered under the insurance plans they offer.
If they give you an answer you don’t like, then you have about five options for getting your IVF treatment covered.
- Talk to your employer about getting coverage
- Ask your insurance company
- Purchase a different policy
- Find research trials
- Find a new employer
Talk to Your Employer About Getting Coverage
It may seem intimidating to ask your employer for something that’s going to cost them more money without getting anything in return, but in reality, you do have a leg to stand on. One of the main reasons your employer may not offer the coverage is because they may not see the need.
Just a few years ago, statistics show us that IVF treatments accounted for 1.5% of all births in the U.S. When you consider the whole country, that is a lot.
This means that the odds are in your favor someone else at your company may be interested in IVF, or even other fertility treatments. Get some of them to support you, and suddenly your leg to stand on just got a whole lot steadier.
And remember, don’t stop at just the women. Men at your company may have their wives on their coverage so they might want IVF coverage as well.
If your employer doesn’t see the need for coverage, then they won’t provide it. That is likely the reason they don’t provide coverage for IVF, which means you’re actually solving a problem for them.
They want to know if they need to do more for their employees because they need to stay competitive in the human resources department. They want to attract the best talent, and they have ways to include IVF in their plans.
Odds are, they already give you the option of choosing between multiple plans, so they include IVF coverage in one of those plans, or create a new one that will cover it.
Easy peasy, right?
Ask Your Insurance Company
One reason your company may give you for not providing IVF coverage on their policies is that their insurer doesn’t want to offer. Now, in most cases your company’s representatives would go to bat for you to let your insurer know that you need it. >>Top 5 Insurance Companies That Cover IVF
If that doesn’t work, you can appeal to them directly.
They may take it on a case by case basis, and if that’s true you’ll need your doctor’s help convincing them you’re a good investment. Make sure he can tell them you’ve got good odds and you’re a good candidate for IVF.
Barring that, you’ll need to convince them that covering IVF is cheaper for them in the long run. Fact is, IVF done outside of insurance often results in multiple babies. The insurance provider will need to cover these babies once they’re born.
This matters because when IVF is covered by insurance, there’s a better chance of only having one baby, which is significantly cheaper for them.
Purchase a Different Policy
At the end of the day, your company and your insurer just may not want to cover IVF for you. If that’s the case, you can always go buy some non-group insurance. This will be significantly more expensive, but in the end it’ll be cheaper than paying for IVF outright.
The best way to find these plans is to contact your state’s insurance department or to find a non profit who helps people in your situation. Fertility non-profits often have resources to help in situations like these, so search for one near you and reach out to them.
Find Research Trials
While they’re not guarantees, they can often be a cheap or free way tog et what you need. You need to be careful to read the fine print of what you’re agreeing to, the reason being that trials are conducted on experimental treatments, so you understand what you’re getting into.
Odds are there’ll be some experimental process or medication as part of your treatment, and you need to understand the effects it will have on you and your future baby.
Find A New Employer
Easier said than done, right?
However, there are many ways you can take advantage of employers who offer this coverage for you. First, you can look for one down the street and ask about their benefits during the interview. You can also wait until they offer you the job and ask then as part of negotiation of your pay.
It could be a situation where no one has asked for the coverage before now and if they want you bad enough, they may add the coverage to one of their plans.
The other way this works is that certain states require IVF coverage. If your company isn’t in a state where the coverage is mandatory, you can find a company headquartered where IVF coverage is mandatory.
Companies don’t want to separate policies by states, so if your employer operates in one of these states that require IVF coverage, then odds are you’ll be covered no matter what state you live in yourself.
Some companies headquartered in these states include:
- Exxon Mobil
- American Airlines
- Kimberly Clark
- Southwest Airlines
- Waste Management
- Whole Foods Market
- C. Penney
- Walt Disney Company
- Taco Bell
- Red Lobster
- Panda Express
- Princess Cruise Lines
There are a lot more, but these are just some examples of companies headquartered in a state which requires IVF coverage. This means that no matter where you live, there should be a policy covering IVF you could get.
The bottom line is this, if you want IVF coverage, just start by asking for it. Ask your employer or your insurer, but just ask.
Odds are, one of them is going to help you find a policy that covers IVF. IF not, then you can go to more drastic measures.