If you’re set on trying to have a family, but your health care plan doesn’t offer IVF coverage, what can you do? Your homework. There are a few options for accessing insurance, but it’s not an easy process. The additional work may seem overwhelming when you’re already feeling discouraged and drained, but the effort could make all the difference on your conception journey.
It was worth it for me. I struggled with female- and male-factor infertility and recurrent miscarriages for more than a decade. I learned how to access IVF benefits not offered by my employer. My efforts resulted in two IVF babies out of ten pregnancies. I was able to overcome feelings of helplessness by taking some control over my benefits and ability to pay for what I felt was so critical to my life—having a family.
Professionally, I focused my attentions on conducting research with legislators, employers, and insurers to learn what they needed to know to support IVF benefits. All of the desired information is available in a resource I created, the Policymaker’s Guide to Fertility Health Benefits.
My advice is to consider all of your options and start with the one that connects with your strengths and comfort level.
Here are five key ways to secure IVF coverage.
1. Ask Your Employer for 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 can ask brokers to add coverage for fertility treatment. They can ask their broker to:
- Search for an IVF rider benefit to add to their existing plan.
- Provide two health plans to their employees. One that offers IVF benefits and one that doesn’t.
- Replace a current plan with one providing IVF benefits.
Employers need to hear from their employees. Why?
- You are how the employer learns there is a need for IVF coverage.
- The more employees who contact their Human Resource Departments, the better employers understand there should be no limitation to the scope of coverage provided.
- Employers want to be competitive so they want to know which companies are offering coverage and what benefit packages they offer.
- Employers are either self-insured (insurance companies manage benefits, but the employer pays the claims) or fully insured (insurance companies manage benefits and pay the claims). Self-insured employers are motivated to offer IVF coverage once they learn the cost savings associated with providing benefits.
With reasonable infertility benefits, patients tend to transfer fewer embryos in an IVF cycle. The estimated healthcare cost associated with a singleton pregnancy (through birth) is $21,458 while twins is $104,831 and triplets is $407,199. There is also savings in mental health benefits. When employers are informed that this could apply to 1 in 6 employees, they consider it more seriously.
2. Ask Your Insurer for Coverage
When requesting coverage, your personal story will make your request for additional benefits (called an Exemption of Benefits or Predetermination of Coverage) memorable. With a letter from your doctor and additional research, you should try to convince the insurance company that you are a good investment with a good chance of success (you have greater than a 5% chance of live birth), have a medical need (IVF is your only option), and can save them money (patients with IVF benefits have more singleton births). These reasons will help justify creating a win-win solution for everyone.
You can remind the insurer that IVF benefits provide access to affordable health care, which enables patients to make treatment decisions based on medical recommendations, rather than financial concerns.
Many people believe that the insurance coverage they’re offered is finite. But, you can request special consideration.
The goal is to make the insurance medical director’s job easy to override the company’s policy and provide you with benefits. You can remind the insurer that IVF benefits provide access to affordable health care, which enables patients to make treatment decisions based on medical recommendations, 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 facts are a Google search away or within The Policymaker’s Guide to Fertility Health Benefits.
3. Purchase Non-Group Insurance
I purchased non-group insurance to have my IVF cycles covered. I found a non-group plan (or 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’re offered is finite. But, you can request special consideration.These plans exist. States either have designated organizations and/or an insurance department to help consumers navigate through the available insurance plans to determine which one will work best. To find your state resources you can do a search for “organization to find a health insurance plan (name of state)” and/or “(name of state) insurance department.” The nonprofit that I run, Fertility Within Reach, also has a direct link to list the insurance department of each state. Typically, you can apply for these plans if there has been a change in your life (employment, family, etc.) or during a yearly open enrollment period.
4. Participate in Clinical Research Trials
Applying for a fertility clinic research spot is another option for paying for treatment. Fertility centers often seek patients for clinical trials. The treatments and discounts offered by clinics can vary. You can search online or visit specific websites such as centerwatch.com or clinicaltrials.gov to find trials by condition and location. Once you have located a research trial that interests you, you have to apply.
If you’re selected to participate, read the fine print of the agreement. You want to make sure you clearly understand what your responsibilities are and what the clinic is offering before signing. Those participating receive a significant benefit while helping advance 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 requiring fully insured employers to provide IVF coverage, self-insured employers can decide not to offer this benefit. What matters is the state where the employer’s headquarters is located and which companies provided insurance benefits.
For example, let’s say you live in Arizona, a state without mandated benefits, and work for CVS. CVS has headquarters in a state with a law requiring IVF benefits, which means you will have benefits even though 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 skill set in a company offering benefits.
Not all companies offer the same breadth of benefits. One company may voluntarily provide $15,000 in coverage to use toward IVF while others may contribute $4,000 or up to six IVF cycles. Often you can collect substantial information on which benefits different employers offer by participating in online forums and surveying your personal community. Forums can be found on Facebook or other online communities.
If you aren’t able to find a full-time job with IVF coverage, you can consider a part-time job where it is offered. Pregnantish has featured the story of Christian Borrero-Colon, a US serviceman who took a job with Starbucks specifically to obtain infertility insurance coverage.
Keep in mind that seeking or adding employment with an employer providing IVF benefits does not need 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 or don’t work for you, that’s OK. 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 bring you closer to your goal of building a family.