Medicare covers fertility treatments for qualifying individuals. Over the years, the demand for fertility treatments has gone up.
Times are changing, and women are waiting longer to start a family. Unfortunately, the older a woman gets – the less fertile she becomes.
Modern medical advances continue to open the doors of fertility for many women, providing a higher chance of successfully conceiving.
Does Medicare Cover IVF
Coverage for In Vitro Fertilization (IVF) treatment largely depends on where you live or your employers’ location.
Part A doesn’t apply because that’s your hospital insurance, covering services while an inpatient in a Medicare hospital setting.
Yet Part B pays for most medically necessary fertility treatments; unfortunately, IVF isn’t one of them.
Medigap and advantage plans are both sold by private insurance companies and may help with IVF costs. However, the road to success may require some costly commitment.
Does Medicare Cover Fertility Treatments
If your doctor deems a fertility treatment to be medically necessary, Part B coverage may apply. All conditions are unique and, individual rules and costs often vary by case.
Treatments for infertility must be reasonable for Medicare coverage to apply. Your doctor must first go through the screenings to prove infertility in someone who should be otherwise fertile.
A good rule of thumb is if Part B will pay for it, your Part C insurance likely covers the costs.
How is Infertility Diagnosed
A couple has a 20-25% chance of conceiving during any given month, no matter how infertile or fertile.
Women have more than 50% of a chance to get pregnant within six months of actively trying. Typically, if attempts are unsuccessful after this time, infertility is a concern.
Some women go for more specific tests, including outpatient surgical options. About 7.4 million women in the US consider treatment for their infertility diagnoses.
Only 12% of married women are unable to remain or get pregnant altogether. Although fertility issues are 1/3 because of the man, the other 1/3 is due to the woman.
Yet the remaining, 1/3 of cases happen for reasons that are still unknown. Men and Women may both undergo fertility tests to determine or evaluate fertility.
The processes may include testicular biopsies, genetic testing, CAT or MRI scans, semen analysis, or testosterone level testing. Infertility diagnosis for a woman consists of a different series of tests.
Women may have several hormone tests, a thyroid test, and postcoital screenings to better understand your reproductive system.
Medicare and Infertility Treatments
Fertility treatments aren’t typically under Medicare coverage due to the lack of necessity. Meaning, advantage plans don’t have to include them.
Going beyond the basic coverage of Parts A and B, many Advantage plans offer extra benefits. Routine vision, hearing, dental, and drug coverage are some perks among MA plan benefits.
Enrolling in alternative coverage when battling infertility is a smart idea. Infertility is a widespread issue with many treatment options.
Sadly, many don’t qualify for insurance coverage.
Endocrine specialists, however, may be part of your plan’s benefits. Providing the doctors in your area accept Medicare assignment, office visits may cost $200-$400 per visit.
What are the Costs of Fertility Treatment
As many couples struggle with infertility, the costs of treatment are often a notable cause of concern. Many therapies are self-pay and costly.
Be sure to check with your plan and doctor about your costs before getting any services. Currently, in the US, the average IVF cost is about $11,000 – $12,000.
Some more complex donor egg transplants can cost up to $28,000, and Medicare doesn’t offer any coverage for this procedure.
It’s becoming more common or women to freeze their eggs for future use. This option allows the conservation of fertile eggs until you’re ready to have a family. Expenses are roughly $7,500 for each freezing cycle.
Options include ovarian stimulation and intrauterine insemination (IUI). Expenses start at $300 for some procedures, and others cost $4,000.
Treatment and testing may vary depending on the facility. Costs of other fertility treatments include medications; prices range from $10 to $100.
Does Medicare Cover a 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 cost more. Always ask your doctor about out-of-pocket costs for IVF sperm analysis.
Medicare Fertility Treatment Coverage
Part B pays your outpatient services and necessary treatments. Coverage may include parts of fertility treatment.
Everyone has a unique case, and fertility coverage is almost nonexistent without proper supplement insurance.
There are 17 states nationwide that have laws requiring fertility coverage.
Coverage isn’t free; if you have private coverage, you may still have copay costs. If you meet the infertility criteria, you may qualify for coverage.
Infertility requirements include:
- If you’re 35 years of age or older, unable to carry, or for six months and pregnancy results in a live birth after one year
- If you’re unable to get pregnant after trying for one year, with unprotected sex
- Make sure to check your state and talk to your local agent for fertility coverage options.
Does Medicare Insurance Cover Fertility Treatment Drugs
Part D drug plans don’t pay for fertility drugs. However, Part D formularies are continuously changing, try to stay up to date about newly available medications under your plan.
Insurance plans cover fertility drug costs when you use a specific pharmacy. Look online or call your insurance plan and talk to an agent.
Remember always to write down the name of who you spoke to and the time and date you spoke to someone.
Having this information may be helpful if you need assistance in the future. You won’t know until you ask.
Supplement Insurance for IVF
Coverage for in vitro fertilization can be complicated and confusing. Supplement insurance costs vary for IVF and artificial inseminations.
Some companies have no coverage, others may pay for all the costs, and many companies are a mix of the two. Supplement insurance for IVF can be impossible unless you live in one of the states listed above.
Although these states offer some coverage, the terms are different per state laws. Always contact a local agent to make sure; your plan may cover testing but not a treatment for IVF.
How to Pay for Medicare Fertility Treatments
If you’re struggling to have a baby, you’re not alone. Many couples stress ways to afford the high costs of fertility treatments and care.
No, all hope isn’t lost just yet, you may be able to start still the family you’ve always wanted. Thankfully, many fertility clinics are willing to help with the financial burden of treatments.
More extensive facilities typically have staff ready to assist you in ways to cover costs. Financial assistance is often an option for lower-income families, and others may have payment plans.
Personal loans are an option for those with a good line of credit. Some lenders allow you to borrow up to $50,000 or more. Whichever option is best for you and your needs, we can help lead the way.
Just give us a call at the number above, and we can point you in the right direction. Our agents compare local ratings and benefits, so you don’t.
If you can’t call right now, fill out an online rate comparison form and let our agents contact you about the best options!