IVF & insurance coverage: Tips to help you lower costs

The decision to start fertility treatment isn't easy and navigating the costs around treatments can make it that much harder. In the U.S., each IVF cycle costs $15,000 or more and multiple rounds may be needed. The good news? There are many ways to work with your insurance (and Maven) to help manage some of the costs of IVF. 

Insurance coverage differs across state and country lines

According to patient advocacy group RESOLVE, 20 states require insurance providers to cover infertility treatments as of 2022—and only fully-insured plans are required to cover IVF specifically, meaning the laws don’t apply to many self-insured employers. Another limitation is that only fully-insured plans are required to cover IVF specifically, with laws  RESOLVE offers a state-by-state tool for patients to learn more about the fertility laws in their area. It provides a list of states, their policies, and exemptions. According to RESOLVE, the most “IVF-friendly” states include Connecticut, Illinois, Maryland, Massachusetts, New Jersey, and Rhode Island. What does it mean to be “IVF-friendly”? These states have IVF insurance mandates, ensuring coverage of at least some kind of infertility treatment.  

As a result of different laws, national funding, and insurance, countries around the world vary greatly in how they support people trying to conceive. For example, in India, general health insurance policies do not cover IVF procedures—but IVF is significantly cheaper, ranging from $3,600 to $5,000. This is different than countries like Canada, which has universal healthcare and public-funded treatment coverage in select provinces. Canada’s healthcare system is often supplemented by employer-funded insurance. 

The IVF process is complicated—but you’re not alone. If you ever need help navigating fertility in your country or finding a high-quality clinic in your area, remember that your Maven Care Advocate is here for you.  

Read the fine print of your coverage

Take a good look at your plan to see exactly what’s listed under “infertility services,” because there may be stipulations. For instance, you may be required to undergo a less expensive treatment first—i.e. several rounds of IUI—before you’re eligible for IVF coverage. You may also need to use only certain brands of fertility medication, or select the insurer’s “preferred” labs. What’s more, certain insurance plans might cover IVF but set a ceiling on how much coverage they provide, so make sure you understand what contributes toward that upper limit. Some insurance, in the U.S. and globally, will only cover IVF in instances of medically-diagnosed infertility, which excludes same-sex couples and single parents by choice. 

Cost savings through Maven

For additional support, check out if your company offers Maven Rx. Maven Rx is Maven’s partnership with leading fertility pharmacies offering you fertility medication discounts. Through partnerships with two leading pharmacies, members get 20-30% discounts vs. average cash pay prices, as well as next day shipping, unboxing and injection support from licensed pharmacists. If you have access to MavenRx, you also have access to one to two years of free egg or embryo storage at high quality clinics in the U.S. and globally. 

Double (or triple) check with your insurance provider before making medical decisions

It’s normal to feel unsure about your benefits even after reading the fine print on your policy—insurance policies can be incredibly confusing. Before you visit a fertility clinic, make sure you understand the details of your coverage. Read through the policy, writing down any notes and questions as you go. Then, call your carrier and confirm your coverage. 

If you do have fertility insurance, here are some questions to ask your representative that may help clarify your coverage: 

• What are the basics of my health insurance plan? 
• Does my insurance cover fertility treatment and medications, either oral or injectable?
• Is there a separate cap for medical bills and pharmacy bills? 
• Do my co-pays or co-insurance differ if I see an in-network or out-of-network fertility provider? 
• Is pre-authorization required at any point in my fertility treatment? 
• Does my insurance cover telehealth appointments?
• How is infertility defined in my policy, and do I meet that definition? 
• Is a diagnosis of infertility a requirement? Does insurance cover the process of diagnosing infertility? 
• What is my copayment for fertility services at a clinic? Is there a different copayment for fertility charges at a hospital? 
• What is the annual or lifetime maximum benefit for infertility treatment?
• Is there a limit on the number of IVF cycles?
• Does my insurance require the use of a specific lab or pharmacy?

If what’s being relayed to you doesn’t seem to match what your state mandates, ask for more details. Request that your insurance representative explains the reasons for any discrepancies. Maven’s reproductive endocrinologists can also help you compile a list of questions related to cost to bring to your in-person provider.  

Get creative with coverage

Even if the actual IVF procedure isn’t covered by your insurance, other aspects of your medical care (such as certain drugs, diagnostic exams, and blood tests) may be reimbursed. Don’t be afraid to ask questions and figure out the best way to keep costs down. If you have a health savings account (HSA) or a flexible savings account (FSA), these are also options you may want to consider—using pretax dollars to cover fertility expenses can save you money. 

Talk to your clinic’s patient financial counselor and create a plan

Planning financially for fertility treatment is often an added source of stress for hopeful parents, but meeting with your clinic’s patient financial counselor can help make the process more transparent. Your patient financial counselor will go over your fertility benefits and coverage, explain what your health insurance will cover, and what you should expect to pay. The total cost of treatment is dependent on the number of rounds your provider expects you may need, along with any additional costs. Taking a good look at this information, asking questions, and evaluating your options can help you choose the best long-term financial plan for you. 

Sign up for Maven for global fertility support through personalized care teams, with access to fertility specialists, mental health specialists, reproductive endocrinologists, and more. 

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