If you’re determined to try to have a family, but your health care plan doesn’t offer IVF coverage, what can you do? your homework. there are some options to access insurance, but it is not an easy process. The extra work may seem overwhelming when you’re already feeling down and drained, but the effort could make all the difference in your conception process.
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It was worth it for me. I struggled with female and male infertility and recurrent miscarriages for over a decade. i learned how to access ivf benefits not offered by my employer. my efforts resulted in two ivf babies out of every ten pregnancies. I was able to overcome feelings of helplessness by taking some control over my benefits and my ability to pay for what I felt was so important to my life: having a family.
Reading: How to get insurance to cover ivf
Professionally, I focused my attention on conducting research with legislators, employers, and insurers to learn what they needed to know to support IVF benefits. All the information you want is available in a resource I created, the Policy Makers Guide to Fertility-Related Health Benefits.
My advice is to consider all your options and start with the one that connects with your strengths and comfort level.
These are five key ways to ensure IVF coverage.
1. ask your employer about benefits
This may seem like a bold move if your company doesn’t already offer them. however, some employers take the advice of the insurance brokers they work with and don’t always realize that they may ask them to add coverage for fertility treatment. they can ask their broker to:
- Find an additional ivf benefit to add to your existing plan.
- provide two health plans to its employees. one that offers IVF benefits and one that doesn’t.
- replace a current plan with one that provides IVF benefits.
- You are how the employer finds out there is a need for IVF coverage.
- The more employees contact their human resources departments, the better employers will understand that there should be no limitations on the scope of coverage provided.
- Employers want to be competitive, so they want to know which companies offer coverage and what benefit packages they offer.
- Employers are either self-insured (insurance companies administer benefits, but employer pays claims) or fully insured (insurance companies administer benefits and pay claims). Self-insured employers are motivated to offer IVF coverage once they learn of the cost savings associated with providing benefits.
Employers need to listen to their employees. why?
With reasonable infertility benefits, patients tend to transfer fewer embryos in an IVF cycle. The estimated health care cost associated with a singleton pregnancy (until birth) is $21,458, while twins are $104,831 and triplets are $407,199. There are also savings on mental health benefits. when employers are told this could affect 1 in 6 employees, they take it more seriously.
2. ask your insurer for coverage
When you apply for coverage, your personal story will make your request for additional benefits (called a waiver of benefits or predetermination of coverage) memorable. With a letter from your doctor and further investigation, you should try to convince the insurance company that you are a good investment with a good chance of success (you have a greater than 5% chance of being born alive), have a medical need (ivf it’s their only option), and it can save them money (patients with IVF benefits have more singleton births). these reasons will help justify creating a win-win solution.
You can remind the insurer that IVF benefits provide access to affordable healthcare, allowing patients to make treatment decisions based on medical advice, rather than financial concerns.
many people believe that the insurance coverage they are offered is finite. but you can request special consideration.
The goal is to make it easier for the insurance medical director to override the company’s policy and provide you with benefits. It can remind the insurer that IVF benefits provide access to affordable healthcare, allowing patients to make treatment decisions based on medical advice, rather than financial concerns.
You can share research showing that without insurance benefits, patients tend to transfer multiple embryos, which will increase the chances of high-risk pregnancies and premature babies. There are quotes from insurance company medical directors who draw a direct line between insurers offering IVF benefits and significant savings on the maternity and neonatal side. these data are just a google search away or within policy makers’ guidance on fertility-related health benefits.
3. buy non-group insurance
I bought non-group insurance to cover my IVF cycles. I found a non-group plan (or an individual plan not offered through an employer) that provided IVF benefits. These plans have a hefty monthly premium; however, it is significantly less than paying out of pocket for a full IVF cycle.
many people believe that the insurance coverage they are offered is finite. but you can request special consideration. these plans exist. States have designated organizations and/or a department of insurance to help consumers navigate through available insurance plans to determine which one will work best. To find your state’s resources, you can search for “(state name) health plan locator organization” and/or “(state name) insurance department.” The nonprofit I run, Fertility Within Reach, also has a direct link to list each state’s insurance department. You can usually apply for these plans if there’s been a change in your life (job, family, etc.) or during an annual open enrollment period.
4. participate in clinical research trials
Applying for a research position at a fertility clinic is another option for paying for treatment. Fertility centers often seek patients for clinical trials. treatments and discounts offered by clinics may vary. you can search online or visit specific websites like centerwatch.com or clinicaltrials.gov to find trials by condition and location. Once you have located a research essay that interests you, you should apply.
If you’re selected to participate, read the fine print in the agreement. You want to make sure you clearly understand what your responsibilities are and what the clinic offers before you sign up. those who participate receive a significant benefit while helping to improve health care.
5. seek employment from a company that provides infertility coverage
Some people assume they will be guaranteed insurance coverage if they live in a state with an infertility mandate. While there are states with laws that require fully insured employers to provide IVF coverage, self-insured employers may choose not to offer this benefit. what matters is the state where the employer is based and which companies provided insurance benefits.
for example, let’s say you live in arizona, a state with no mandatory benefits, and work for cvs. CVS is based in a state with a law that requires IVF benefits, which means you’ll have benefits even if you live in Arizona. The good news is that many types of businesses offer benefits, from retail (TJ Maxx), banking (Bank of America), to technology (Apple). In theory, everyone should be able to find a job where they can apply their skills at a company that offers benefits.
Not all companies offer the same variety of benefits. One company may voluntarily provide $15,000 in coverage to use for IVF, while others may contribute $4,000 or up to six IVF cycles. You can often gather substantial information about the benefits offered by different employers by participating in online forums and surveying your personal community. forums can be found on facebook or other online communities.
If you can’t find a full-time job with IVF coverage, you may want to consider a part-time job where it’s offered. Pregnantish has featured the story of Christian Borrero-Colon, a US military man who took a job at Starbucks specifically to obtain infertility insurance coverage.
Please note that seeking or adding a job with an employer that provides IVF benefits does not have to be a lifelong change.
Despite the many challenges of infertility, feeling informed and empowered helps you navigate the winding road with a little less stress. If these options don’t appeal to you or don’t work for you, that’s okay. many people apply for a grant or finance their treatment. There is no judgment on any path you take. you know what works best for your life and will get you closer to your goal of starting a family.