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.
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Is my fertility treatment covered for 2024?
The thought of not being able to achieve your biggest hopes and dreams because of a lack of insurance coverage is incredibly upsetting. With IVF costing anywhere between $12,850 and $24,250 out-of-pocket, affording treatment with existing funds 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 insurance plan.
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 putting your family-building dreams on hold, keep reading so you can explore your options.
How to Take Action
In this guide, we share our expert tips for what to do during open enrollment so you can make a plan and find ways to get the fertility care you need to grow your family.
We won't sugar coat it: these suggestions may require several phone calls to your insurance provider or HR department, some number crunching, and following up, but your thorough research will pay off in getting you one step closer to success on your family-building journey.
Plus, it could save you some major cash, which is often a huge hurdle to achieving your bigger goals.
💡 Did you know? Illume Fertility assigns 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 be Medicare, employer-based, or a plan from the healthcare marketplace).
There are varying degrees of coverage, with insurance premiums ranging in cost from hundreds of dollars a month for a single-person plan to well over a thousand dollars for a family plan. That doesn’t include deductibles, and the price can go up even higher for all-inclusive coverage.
Did you know? The open enrollment period for 2024 lasts from November 1 to December 15 in most states. Some states have elected to extend, and may 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. Why? Companies set their own dates for open enrollment! It typically falls around the same time as the general open enrollment period, but you should always check with your HR department - just to be safe.
During this time, you can elect to stay on your employer-based health insurance or switch to another provider in the marketplace. You might decide to do this for fertility coverage reasons, which we’ll help you learn more about below.
It goes without saying, but if you are planning for (or already in the midst of) fertility testing or treatment, it makes sense to have an insurance plan that covers the most services at the lowest possible out-of-pocket cost.
We know this can all feel quite daunting, but as you do your research and learn more about your options, you'll be able to tackle this open enrollment season feeling more empowered and prepared to achieve your goals.
3 Things to Do During Open Enrollment
We know it can be tempting to put off overwhelming responsibilities like researching your insurance coverage - it's hard to know where to start. 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.
Here are the three big next steps you should take!
1. Start Your Research Now
While the official deadline for choosing an insurance plan is usually December 15th, you shouldn't wait until the night before to start your research and risk losing your chance to make much-needed adjustments.
As anyone who has dealt with insurance knows...it can be pretty time-consuming to figure out! Take a nice, deep breath and then tackle each of the following actions one at a time:
Understand Your Current Policy
Even if you think you have a pretty good handle on your current policy, you should always read through it as thoroughly as possible before taking the next step. Let's be honest: it’s not necessarily easy to understand insurance and medical lingo!
If you're feeling confused, you can always call the insurance company or talk to your employer’s human resources department to ensure you get accurate and clear answers.
Compare Available Insurance Plans
Your next step is to do some research and compare your current policy against any other available policies.
Look to see which fertility tests and treatment pathways are covered by each policy, what the lifetime limits are for fertility treatment, and what you're required to do to get approved for treatment.
Examine the Formulary
A formulary will list out all of the fertility medications that will be covered. Medications are an integral part of most fertility treatment protocols - so this is exceptionally important to know.
Know Your Deductible
Make sure you are familiar with the annual deductible, monthly premium, and any additional payments (such as co-pays) that must be paid for each visit, procedure or prescription. Then, balance those expenses against the annual premium to determine which is likely to cost less over the year.
Talk to Your Insurance Provider
Another essential part of this process is spending time talking with the insurance provider - and knowing how to ask the right questions. Need help? Check out our helpful list.
Did you know? Blood work and fertility tests should always be covered by insurance. Keep this in mind so you don't end up paying thousands when you don’t need to!
2. Use Up Remaining 2023 Coverage
After choosing the right policy to help you cover any needed fertility care in the new year,it's time to determine how much of your annual deductible you have spent for this year.
If you have reached your deductible, ask your doctors what tests you can check off your list now (while insurance covers more of the costs) to prepare for fertility treatment in 2024.
Did you know? Many fertility test results are reliable for up to six months - so if your insurance will pay for the bulk of them until the end of the policy year, take advantage!
If you have a Flexible Spending Account (FSA) or other medical spending plan, you can also use those savings to pay for any additional costs. 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 an insurance rider. This can help defray the cost of treatment and make a big difference.
In October 2023, the American Society for Reproductive Medicine (ASRM) announced a new, updated definition of infertility which experts expect will push insurance companies to expand fertility coverage - making it accessible to many more hopeful parents. This is BIG news!
While strides are being made to push for more equitable coverage for all, there is still a long way to go. For those in the LGBTQ+ community, purchasing an insurance rider can sometimes be the best option for getting the family-building assistance they need to move forward.
What is a rider? An insurance rider adds coverage at an additional cost. This option may be less expensive than paying out-of-pocket or getting a different provider. If you're planning one or more treatments like 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 plan to make your dreams of expanding your 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 work now is the best gift you can give to future you. By learning more about insurance, 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!
Remember to read all the fine print and understand what your options are, because if you wait too long, you might miss your 2024 coverage window. All of this takes time, but will bolster your confidence and help 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 goal: your future family. The work you're doing now will all be worth it!
Dr. Spencer Richlin is Surgical Director and Partner in reproductive endocrinology at Illume Fertility. In addition, he is Division Chief of Reproductive Endocrinology at Norwalk Hospital. Dr. Richlin is board certified in both Reproductive Endocrinology and Obstetrics & Gynecology. He joined the team at Illume Fertility in 2004.