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Affording Treatment

Is My Fertility Treatment Covered? 3 Essential Open Enrollment Tips

November 16th, 2022 | 8 min. read

By Sierra Dehmler

Let’s say you work for a company that offers you insurance. Great! And then you find out there is no fertility coverage under the plan. Not so great.

Finding out that the care you need isn't covered by insurance is beyond frustrating. In fact, it's heartbreaking. Especially if you know you’ll be needing fertility treatments in the next year. The thought of not being able to achieve your biggest hopes and dreams because of a lack of insurance coverage is incredibly upsetting. So, what should you do?

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Is your fertility treatment covered for 2023?

With IVF costing anywhere between $12,850 and $24,250 out-of-pocket, affording treatment with funds straight from your bank account is not an option for most people. So how can you pay for treatment? Your first thought might be that you have two options: take out a large personal loan or indefinitely postpone any fertility testing and treatment until you can afford it or it’s covered by a future plan.

But before you resign yourself to another year of not having the fertility coverage you need, paying for all your IVF or IUI expenses out-of-pocket, or just delaying treatment altogether, keep reading. We'll share our expert tips for what to do during open enrollment so you can make a plan and get the care you need. 

We won't sugar coat it: the below suggestions may require several phone calls to your provider or employer, some number crunching, and following up, but I assure you, your thorough research will pay off in getting you one step closer to success on your family-building journey. Plus, it could save you major cash, which is often a huge hurdle to achieving your bigger goals.

💡 Did you know? Illume Fertility provides an Insurance & Billing Advocate to each patient to help guide them through the process of evaluating their insurance and getting the most out of their coverage. 

What is open enrollment?

Open enrollment is the time period each year where you can enroll, change, or drop your health insurance plans for the upcoming year (whether it’s Medicare, employer-based, or from the health marketplace).

There are varying degrees of coverage, ranging in cost from hundreds of dollars a month for a single-person plan to well over a thousand dollars for a family plan. And that doesn’t include deductibles. That price can go up even higher for more all-inclusive coverage.

The open enrollment period for 2023 lasts from November 1 to December 15 in most states. However, due to individual state preferences, some states have elected to extend that and have longer open enrollment windows. Always check to see to see if your state has an extension.

What should I do next?

If you are tapping into employer-provided health insurance, you’ll need to ask your human resources department what their particular policy is. Companies set their own dates for open enrollment (it typically falls around the same time as general open enrollment, but you should check with your HR department - just to be safe).

During this time, you can choose to stay on your employer-based health insurance or switch to another provider in the marketplace. You might decide to do this for infertility coverage reasons, which we’ll help you dig through below.

It goes without saying, but if you are planning for (or already in the midst of) fertility testing or treatments, it makes sense to have an insurance plan that covers the most services at the lowest possible out-of-pocket cost.

Our advice? Tackle this open enrollment season with confidence by doing your research! Here’s where to start…

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3 Things to Do During Open Enrollment

We know it can be tempting to put off overwhelming responsibilities like researching your insurance coverage.

That's why we recommend breaking it up into more manageable tasks. If you're feeling stressed or unsure of what to do next or where to look for answers, reach out to your HR department, talk to your fertility clinic team, or ask for support from loved ones. You've got this!

1. Start Your Research Now 

While the official deadline is usually December 15th, don’t wait until the night before to start your research and risk losing your chance to make needed adjustments. As anyone who has dealt with insurance coverage and fertility can be pretty time-consuming to figure out! 

You will want to read and understand your current policy as thoroughly as possible, and let's be honest: it’s not necessarily easy to understand. You may need to call the insurance company or talk to your employer’s human resources department to get accurate and clear answers.

Then, compare against the other available policies. Look for treatments covered by each policy, lifetime limits on infertility treatment and how to get treatments approved for coverage.

Examine the formulary. That's the list of fertility medicines that will be covered. (A big, important part of most fertility treatment protocols!) And make sure you are familiar with the annual deductible and additional payments that must be paid for each visit, procedure or prescription. Balance those expenses against the annual premium to determine which is likely to cost less over the year.

Ask your provider the right questions. Need help with what questions to ask? We list them all out here.

💡Pro Tip: Your blood work and fertility diagnostics should always be covered by insurance. Otherwise, you can end up paying thousands when you don’t need to. Keep this in mind throughout the process!

2. Use Up Your Remaining 2022 Coverage

Congratulations! You have chosen the right policy to help you cover fertility costs next year. Now it's time to determine how much of your annual deductible you have spent for this year. If you have gone through the entire amount, ask your doctors what tests you can do now (while they are more fully covered) to prepare for fertility procedures in 2023.

The results from many tests are reliable for up to six months and your insurance will pay for the bulk of them until the end of the policy year. Your Flexible Spending Account (FSA) or other medical spending plans are also valuable because you can use those savings to pay for any additional costs.

💡 Pro Tip: Learn how different medical spending accounts work, such as FSAs and HSAs.

3. Explore Insurance Riders

If none of the policies offered by your employer provide adequate coverage for fertility treatment, it may be possible for you to purchase a rider. This can help defray the costs of treatment and make a big difference.

While strides are being made to push for more equitable coverage for all, there is unfortunately still a long way to go. For hopeful parents who are part of the LGBTQ+ community, purchasing an insurance rider can sometimes be the best option for getting the family-building assistance needed to move forward.

💡 What is a rider? A rider adds coverage at additional cost, but this option could be less expensive than paying out-of-pocket or getting a different carrier. If you're planning one or more treatments for intrauterine insemination (IUI) or in vitro fertilization (IVF), for example, the higher premium might be worth it.

Now is the Best Time to Act

Here's a quick recap of the next steps you should take to ensure you have the right insurance coverage to make your dreams of a family a reality:

  • Research all of your possible options
  • Use the coverage you currently have to its full extent
  • Explore whether adding an insurance rider is right for you

Doing all of this now is the best gift you can give yourself so that you can get the best medical coverage available to you within your means. It also means you can check off a big, important task before the holidays hit!

Read the fine print and understand what your options are, because if you wait too long, you might miss your 2023 coverage window. Again, all of this takes time, but think of how boss you’ll feel when you figure out this major piece of the infertility puzzle.

While insurance is never a fun thing to talk about and waiting to speak to an insurance customer representative on the phone can really test a person’s patience, remember the end game: your future family.

The work you're doing now will all be worth it. 

Get started on your research today!

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Sierra Dehmler

Sierra Dehmler is Illume Fertility’s Content Marketing Manager - and also a fertility patient herself. Combining empathy gained on her personal journey with her professional experience in marketing and content creation, she aims to empower and support other fertility patients by demystifying the fertility treatment process.