Close close icon

Does Medicare Cover Fertility Treatments


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.

Guidelines on Medicare Coverage for 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 deemed medically necessary for Medicare to cover it. Your doctor must first go through the screenings to prove infertility in someone who should be otherwise fertile.

Does Medicare Cover IVF?

Medicare does cover some fertility treatments. Unfortunately In vitro fertilization (IVF) is not one of those treatments. Part D also excludes coverage for any fertility medications your doctor prescribes.

How Does Medicare Diagnose Infertility?

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.

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 cost more. Sperm analysis can be difficult to deem medically necessary, consult with your doctor to see if Medicare will cover it.

Does Medicare Cover Clomid?

Unfortunately, since Clomid is considered a fertility medication, Medicare won’t cover it.

Does Medicare Cover Fertility Treatment Drugs?

Part D drug plans or Medicare Advantage plans with prescription coverage, don’t pay for fertility drugs. Excluded medications include follicle-stimulating hormone (FSH), human menopausal gonadotropin (hMG), Metformin, Letrozole, Bromocriptine, and gonadotropin-releasing hormone (Gn-RH). However, Part D formularies are continuously changing, 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

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 see what supplemental options are available in your area now that may help cover the costs of fertility treatments.

Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

4 thoughts on “Does Medicare Cover Fertility Treatments

    1. Hi Tawanda! Not normally, the only way Medicare would cover it is if your doctor deemed the procedure medically necessary.

  1. Thank you Lindsay for the information you provided. I’m on Medicare due to brain damage. My husband and I are trying to conceive. It’s to the point where fertility treatment is our next step. The initial testings alone are more than we can afford. If Medicare can help at all, this will be a true blessing. I hope to find more information.

    1. Hi Amy! I’m so happy you found this article helpful. You’re not alone in regard to affording the many different costs associated with fertility treatments. I wish you the best of luck with your fertility journey!

Comment

Your email address will not be published. Required fields are marked *