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Does Insurance Cover Fertility Testing?


Infertility is a common problem for women ages 15 to 49. In fact, the Center for Disease Control and Prevention says that about one in five (19%) are unable to conceive after one year of trying. To combat infertility issues, many couples seek fertility care to help them build the family of their dreams. Unfortunately, fertility care costs are prohibitive. For example, fertility testing can cost thousands of dollars depending on how invasive the testing is. But, depending on your insurance plan, you may get testing covered but have to pay for treatment. Here’s a breakdown of what’s covered and your best options.

If you’re planning a family, a financial advisor could help you create a financial plan for your needs and goals.

Does Insurance Cover Fertility Testing?

Depending on your specific health insurance policy and the state mandates, your insurance may cover fertility testing and treatments. For example, your plan may cover in vitro fertilization (IVF). However, it may exclude coverage for the medication that coincides with the treatment. Other plans may cover both the medication and treatment for IVF, and some may not.

Some employers may offer supplemental fertility coverage. You can speak with your employer to see if supplement coverage is available through companies like Carrot and Progyny. Supplement coverage helps bridge the fertility care coverage gap, so starting a new family won’t be as big of a financial burden. In addition, these plans help families achieve better outcomes since they remove some of the barriers that often come with traditional healthcare coverage.

Which Fertility Tests Could Be Covered?

While many plans exclude coverage for fertility treatment, they will cover diagnostic testing. If you are 35 or younger and have been trying to conceive for an entire year or are over age 35 and have been trying for six months, connecting with a fertility specialist is an excellent next step. These specialists can order fertility testing that examines factors like the health of your reproductive system, your hormone levels, and reproductive health. They can also examine the reproductive health of the male partner. In addition, undergoing fertility testing helps a couple determine if there are underlying medical issues that may prevent conception.

Diagnostic covered under your plan may include:

  • Physical exams
  • Imaging tests
  • Bloodwork
  • Specialized diagnostic testing

What States Mandate Fertility Coverage?

SmartAsset: Does Insurance Cover Fertility Testing?

In the last 30 years, 17 states have passed laws that require insurance companies to offer coverage for fertility testing and treatment or offer it. These states include:

  • Arkansas
  • California
  • Connecticut
  • Delaware
  • Hawaii
  • Illinois
  • Louisiana
  • Maryland
  • Massachusetts
  • Montana
  • New Hampshire
  • New Jersey
  • Ohio
  • New York
  • Rhode Island
  • Texas
  • West Virginia

While 15 of these states must cover fertility care, California and Texas require insurers only to offer fertility care. Keep in mind that the details of each law can vary by state. For example, Utah law requires that insurance companies provide indemnity benefits for adoption or infertility treatments and maternity benefits.

How to Identify If Your Insurance Covers Fertility Testing

The best way to determine if your insurance covers fertility care is to get a copy of the terms and details of your plan. You can visit your health insurance company’s website, speak to your HR department, or call the insurance company directly. If you already have a fertility specialist, you can reach out to them to break down your policy details.

If your spouse’s employer offers a different healthcare plan, you may also want to explore available options. In some cases, switching healthcare providers might be the best solution to get your fertility testing and treatment costs covered.

But, keep in mind that even if your plan does cover testing or treatment, it may come with limits.

How to Take Advantage of Fertility Care Benefits

If you discover your healthcare plan does cover fertility care and testing, your first step is to contact a fertility specialist known as a reproductive endocrinologist (REI) for an initial consultation. Typically, they will provide a comprehensive health examination and determine the best course of action for your fertility needs.

You may also meet with the financial counselor, explain your benefits and outline the out-of-pocket costs you’re responsible for. Then, depending on your financial situation, they may suggest different financing solutions to ease the cost burden.

Low-Cost Insurance Alternatives

SmartAsset: Does Insurance Cover Fertility Testing?

But what if your insurance company doesn’t cover fertility testing or treatment? The infertility journey can be very long and costly. Depending on your state and healthcare providers, it could cost upwards of tens of thousands of dollars or more, which could be a significant obstacle for most families. In fact, the average cost of one round of IVF in the U.S. is $12,400. So, if the first time doesn’t work, you will have to do it again.

So, if you don’t have a suitcase of money stuffed under your bed, there are still alternative options for paying for fertility testing and treatment. First, a low-interest personal loan is worth considering. Many lenders will let you prequalify for a personal loan so you can compare your options. Then, when shopping around, check for origination fees, or early payment penalties, so you don’t spend more than you need to on a financing option.

Some fertility clinics have financing options available such as point-of-sale loans. Partnering clinics may also offer a loan product called Bundl, which offers a financing option for those who may need multiple rounds of IVF. Families put a deposit down and then choose a flexible repayment plan based on their financial situation. Bundl also offers full or partial refunds if you don’t conceive in a certain amount of time.

So, explore your financing options to uncover a more affordable solution for your needs.

Bottom Line

Some health insurance plans will cover fertility testing and treatments. Verifying your policy’s coverage details will help you determine if fertility care is included in your plan. If it’s not a part of your coverage, you will likely have other financing options available. Comparing each financing option can help you find the most suitable solution for your budget and needs, so you can start growing your family.

Tips on Funding Fertility Care

  • The host of options for paying for fertility care means this decision is best made with the help of an experienced and qualified financial advisor. Finding a qualified financial advisor doesn’t have to be difficult. SmartAsset’s free tool matches you with up to three financial advisors in 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.
  • Use our free retirement calculator to get a quick estimate of how you’re doing preparing for life after work.

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