Does Medicare Cover IVF

Original Medicare does not cover In vitro fertilization (IVF). However, there are specific cases when deemed medically necessary that Medicare will allow coverage. Over the years, the demand for fertility treatments, including IVF, has gone up. As women wait longer to start a family, unfortunately, their chances of a successful pregnancy decreases.  Yet, modern medical advances continue to open the doors of fertility for many women, providing a higher chance of successful conception.

Below we explore Medicare coverage for IVF and other fertility treatments.

Does Medicare Pay for Fertility Treatments?

Each year, more and more women are finding themselves needing fertility treatment due to the difficulty of getting or staying pregnant. For many, fertility treatments are the best option for a healthy pregnancy.

Fertility treatments include:

• Intrauterine insemination
• In vitro fertilization
• Fertility drugs
• Intracytoplasmic sperm injection
• Zygote intrafallopian transfer
• Gamete intrafallopian transfer

While these methods of fertility are proven to work, the cost of fertility treatments can become an extreme burden on the average American.

It is rare to receive Medicare coverage for fertility treatments. However, it is not impossible. If your doctor deems a fertility treatment to be medically necessary, Medicare Part B coverage may apply.

All situations are unique and individual rules, costs, and coverage will vary by case.  To be deemed medically necessary, your doctor must first go through the proper screenings and tests to prove infertility in someone who would be otherwise fertile.

Once this has been found, your doctor may submit his claim to Medicare. Then, they will decide whether your case warrants Medicare coverage or not. Approval for Medicare coverage is based on several factors. Thus, one case may be approved while a similar case is not.

Does Medicare Cover IVF as a Fertility Treatment?

While Medicare does cover some fertility treatments, unfortunately, in vitro fertilization (IVF) is not a covered option.

Understandably, IVF may be a necessary treatment for certain conditions and situations. However, it is almost never covered by any form of insurance, including Medicare. This is due to the medical necessity of the treatment.

Because IVF is such an extensive process, insurance companies require you to try other routes before they cover IVF. This means you must exhaust all other fertility treatments before your insurance company will consider covering IVF.

Thus, many women either experience burnout or, in the best cases, a successful pregnancy before IVF is considered by the insurance company.

How Does Medicare Diagnose Infertility?

The processes of diagnosing infertility can be extensive. A diagnosis may include hormone analysis, testicular biopsies, genetic testing, CAT or MRI scans, semen analysis, or testosterone level testing. Women may also have several hormone tests, thyroid tests, and postcoital screenings to better understand their reproductive system.

Based on the results of your screenings, tests, and imaging, a decision will be made on your fertility. The first step to receiving Medicare coverage for fertility treatment is receiving an infertility diagnosis.

Does Medicare Cover Sperm Analysis?

To correctly diagnose male infertility, a sperm analysis plays an essential role. Medicare often covers a semen analysis if your doctor refers you to a pathology laboratory.

Specialized labs running IVF programs may require more thorough testing, which may become more expensive. Sperm analysis can be difficult to deem medically necessary. So, consult with your doctor to see if Medicare will cover it beforehand.

Does Medicare Cover Fertility Treatment Drugs?

Medicare Part D Prescription Drug plans or Medicare Advantage plans with prescription coverage do not provide coverage for fertility medications.

You may also be wondering if Medicare covers Clomid. Unfortunately, since Clomid is a fertility drug, it is not covered by Medicare Part D.

Common fertility drugs that are excluded from Medicare Part D formularies with an infertility diagnosis include:

• Follicle-stimulating hormone (FSH)
• Human menopausal gonadotropin (hMG)
• Metformin, Letrozole
• Bromocriptine
• Gonadotropin-releasing hormone (Gn-RH)
• And more

However, Medicare Part D formularies are continuously changing, and our agents will keep you up to date about newly available medications under your plan when you enroll with us.

How to Get Help Covering Fertility Treatments with Medicare

If you are approved for or believe you may require Medicare fertility coverage, having a Medicare Supplement plan will help drastically reduce your out-of-pocket costs. Whichever treatment option is best for you and your needs, we can help lead the way in finding adequate coverage.

Give us a call at the number above, and we can point you in the right direction. Our licensed insurance agents can help you find and compare plans available in your area. You can also explore plans that may help cover the costs of fertility treatments online by using our online rate comparison form.