Fertility insurance is an element of health insurance that covers issues with conception and carrying a child to term. Many parents rely on fertility insurance for expensive procedures such as in vitro fertilization, but this isn’t its only role. It helps would-be parents pay for tests, procedures and treatments involved with a wide range of issues related to having a child. This can include fertility tests for people who struggle to conceive, ongoing procedures to ensure a healthy pregnancy and, in some cases, artificial insemination.
If you’re thinking of starting a family, consider working with a financial advisor.
Fertility Insurance Rules by State
At time of writing, 18 states have passed laws related to fertility insurance coverage. Of these, 16 states require insurance companies to include some form of fertility coverage in their health plans. However the exact nature of those laws, and what coverage they require, ranges widely. As the Kaiser Family Foundation writes, “in states with ‘mandate to cover’ laws, these only apply to certain insurers, for certain treatment services and for certain patients, and in some states have monetary caps on costs they must cover …”
The remaining two (California and Texas) require insurance companies to offer fertility coverage as an option. You can find the full list of states at the Kaiser Family Foundation here.
In the remaining states, insurance companies can approach this as they see fit. This means that, for some consumers, fertility insurance can be an option if they can afford to pay for it.
At time of writing, only New York’s Medicaid program offers any kind of coverage for fertility treatments. No state Medicaid programs cover artificial insemination or in vitro fertilization.
Because insurance options are limited to a relative handful of states, most patients pay out of pocket for fertility-related medical costs. This can run in excess of $10,000 for parents who are struggling to conceive or keep a pregnancy. Patients who get treatments like in vitro fertilization can often pay $60,000 or more.
However, if you do have the option to seek fertility insurance, here are the top three you might want to look at.
Best for High-End Treatments: Cigna
Even among companies that offer fertility insurance, most avoid paying for particularly expensive procedures like in vitro fertilization unless the state requires them to. (A very few, like Arkansas, require this coverage.) This makes Cigna stand out. As with all insurance companies, Cigna is likely to consider services like IVF as not medically necessary. Yet they are more likely to offer and approve coverage for this procedure than other major insurers. The same is true for related procedures like freezing a would-be parent’s eggs or sperm.
In addition, Cigna is known as one of the more cost-effective health insurance options on the market and they are often available through ACA marketplaces. Not only does this make them a good choice for an insurance company in general, but it particularly helps when paired with unusually high-cost treatments like IVF.
However, it’s important to note that Cigna’s low costs come for a reason. Individuals may not always be able to get comprehensive health insurance through Cigna in other areas, meaning that they may have fewer coverage options or pay higher out of pocket costs when it comes to other parts of health care. Too, Cigna is only available in 12 states at time of writing.
Best for Broad Access: United Healthcare
United Healthcare is one of the largest providers in the country. It is available in all 50 states and offers insurance plans on most (if not all) ACA marketplaces. If you are looking for a particular type of health insurance, you can almost certainly find it through United Healthcare. What’s more, that reach also gives United Healthcare one of the widest networks of providers in the country. That network is particularly useful when dealing with specialists like a fertility doctor, since it means you’re much more likely to find someone convenient and close to home.
United Healthcare also offers some form of fertility treatment in many of its insurance plans. This often includes particularly high-end procedures such as artificial insemination.
However there are two challenges with United Healthcare. First, this can often be a more expensive option. While United Healthcare is known for offering good insurance plans, they are not known for offering cheap insurance plans. Second, in some ways United Healthcare’s size works against it. The exact fertility treatments that this company offers range widely from state to state. This all makes United Healthcare well worth shopping for when it comes to fertility insurance and other high end coverage, but be certain to read your policy carefully before enrolling. You can’t know what you can get until you actually apply for coverage.
Best for General Treatment: Blue Cross Blue Shield
Blue Cross Blue Shield (BC/BS) is one of the largest health insurance companies in America. It offers policies in all 50 states and is accepted by most mainstream healthcare providers. (That doesn’t mean that your specific policy will be accepted by a specific doctor, just that there’s a very good chance that you can buy a BC/BS policy that your local doctor will accept.)
They are also generally known as one of the most cost effective insurance companies. In part this is because Blue Cross Blue Shield is a nonprofit organization. This helps it to provide better coverage at lower prices than many of its competitors in the market, and it often does so.
At the same time, Blue Cross Blue Shield offers some form of fertility treatment in most, if not all, states. The details vary depending on the location, but individuals looking for fertility coverage can find it in some format with this insurance company.
This makes Blue Cross Blue Shield a very strong general option. It isn’t necessarily the best for someone who wants specialist care (like with Cigna) or the most available treatment options (like with United Healthcare). However if you are looking for a very good health insurance plan that also offers fertility treatment, Blue Cross Blue Shield might be a good fit.
Bottom Line
Fertility insurance is an element of health insurance. It covers treatments related to conception and maintaining a pregnancy. If you are interested in this coverage, we particularly recommend considering Cigna, United Healthcare and Blue Cross Blue Shield.
Family Financial Planning Tips
- Conceiving a child can be expensive, at least if doctors have to get involved. But it’s nothing compared to the costs of raising a child to age 18.
- A financial advisor can help you get ready for the financial realities of raising a family. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three financial advisors who serve your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
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