Bear in mind that you may be covered to diagnose but not treat infertility. Even if there is IVF coverage, it may not include cryopreservation and storage for the embryos.
Most policies, independent of location, exclude services that involve sperm or egg donors, surrogacy, and treatment to reverse voluntary sterilization. The Affordable Care Act states that people cannot be denied coverage for pre-existing health conditions. Therefore, if you buy a Marketplace ACA-mandated health insurance plan, you cannot be denied coverage for health reasons.
This does not apply to short-term health insurance or other non-ACA policies, which have different rules. With these policies, you may be denied coverage or charged more for a policy if you have certain health conditions. Insurance policies in the 19 mandated states must cover three cycles of IVF. This includes medications to prepare the ovaries for egg collection if the intent is to use a fresh embryo for transfer.
If the plan is to use a frozen embryo for IVF, insurance must cover medication for endometrial preparation. If you opt for intrauterine insemination, your coverage limits may be different.
Check with your insurance provider for limits and coverage options. To compile our roundup, we evaluated 11 companies that offer fertility insurance before selecting the category leaders. Companies that offered a range of fertility diagnostics and treatments carried more weight in our analysis.
We also looked at industry rankings from AM Best regarding financial stability, the Better Business Bureau for client satisfaction, and consumer intelligence data from JD Power to establish their industry standing. Get diet and wellness tips to help your kids stay healthy and happy. Natl Health Stat Report.
AM Best. AM Best affirms credit ratings of UnitedHealth Group and most subsidiaries; upgrades credit ratings of certain subsidiaries. Updated December 18, National Committee for Quality Assurance.
Updated Sept. Discover Infertility Treatment Coverage by U. Updated August, Nation Conference of State Legislatures. Coverage and Use of Fertility Services in the U. Planned Parenthood. What Is IUI? Your Privacy Rights. To change or withdraw your consent choices for VerywellFamily.
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I Accept Show Purposes. Fertility Challenges. By Zia Sherrell. Fact checked by Sean Blackburn. Sean is a fact-checker and researcher with experience in sociology and field research.
Learn about our editorial process. Our editors independently research, test, and recommend the best products; you can learn more about our review process here. We may receive commissions on purchases made from our chosen links. Best Fertility Insurance Companies. Final Verdict. Compare Providers. Best Overall : United Healthcare.
Get a Quote. Pros Available in all 50 states Telehealth available Online quotations Good reputation Extensive provider network A smartphone app that integrates with medical records. Cons Infertility treatments likely limited to 19 mandated states IVF may not be covered Not available in some counties More expensive than some competitors.
Best for Budget Coverage : Cigna. Cons Only available in 12 states May not be able to combine al riders with each policy type. Cons May not be able to buy online Navigating the various company websites can be confusing. Best for Additional Resources : Aetna. Pros IOE providers Simple search to find endocrinologists and specialists Helpful hotline and information resources Nationwide availability.
Cons No individual health plans. Final Verdict Undergoing fertility treatment can be emotionally and financially draining, and suitable fertility insurance can remove some of the stress. An individual or group policy of accident and health insurance must provide coverage for medically necessary expenses for standard fertility preservation services when a necessary medical treatment may directly or indirectly cause iatrogenic infertility to an enrollee.
Exceptions Employers with fewer than 25 employees do not have to provide coverage. Does not require religious employers to cover infertility treatment.
If HHS requires the State, pursuant to the ACA, to defray the cost of fertility preservation coverage, then fertility preservation coverage is no longer operative. Exceptions The law does not require insurers to cover fertility drugs, IVF or other assisted reproductive techniques, reversal of a tubal ligation, a vasectomy, or any other method of sterilization. The patient is the policyholder or a covered dependent of the policyholder. Iatrogenic infertility means an impairment of fertility caused directly or indirectly by surgery, chemotherapy, radiation, or other medical treatment affecting the reproductive organs or processes.
Exceptions Does not require religious employers to cover infertility treatment or fertility preservation procedures. Employers with fewer than 50 employees do not have to provide coverage.
Does not include the storage of sperm or oocytes. For purposes of meeting the criteria for infertility in this section, if a person conceives but is unable to carry that pregnancy to live birth, the period of time she attempted to conceive prior to achieving that pregnancy shall be included in the calculation of the 1-year or 6-month period. Conceiving but having a miscarriage does not restart the 1-year or 6-month clock to qualify as having infertility.
Insurers shall not impose any exclusions, limitations or other restrictions on coverage of infertility drugs that are different from those imposed on any other prescription drugs, nor shall they impose deductibles, copayments, coinsurance, benefit maximums, waiting periods or any other limitations on coverage for required infertility benefits which are different from those imposed upon benefits for services not related to infertility.
The law does not limit the number of treatment cycles and does not have a dollar lifetime cap. Exceptions Insurers are not required to cover but are not prohibited from covering experimental infertility procedures, surrogacy, or reversal of voluntary sterilization. Code Ann. Coverage Requires HMOs to cover infertility services as part of basic health care services. New Hampshire. Coverage Each health carrier that issues or renews any group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide coverage for the following: Diagnosis of the cause of infertility.
Medically necessary fertility treatment. This includes coverage for evaluations, laboratory assessments, medications, and treatments associated with the procurement of donor eggs, sperm, and embryos. Fertility preservation when a person is expected to undergo surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment of fertility.
This includes coverage for standard fertility preservation services, including the procurement and cryopreservation of embryos, eggs, sperm, and reproductive material determined not to be an experimental infertility procedure.
Storage shall be covered from the time of cryopreservation for the duration of the policy term. Storage offered for a longer period of time, as approved by the health carrier, shall be an optional benefit. No health insurance carrier may: Impose deductibles, copayments, coinsurance, benefit maximums, waiting periods or any other limitations on coverage which are different from those imposed upon benefits for services not related to infertility or any limitations on coverage of fertility medications that are different from those imposed on any other prescription medications.
Impose pre-existing condition exclusions or pre-existing condition waiting periods on coverage for required benefits or use any prior diagnosis of or prior treatment for infertility as a basis for excluding, limiting or otherwise restricting the availability of coverage for required benefits.
Impose limitations on coverage based solely on arbitrary factors including, but not limited to, number of attempts or dollar amounts or age, or provide different benefits to, or impose different requirements upon, a class protected under RSA A than that provided to, or required of, other patients.
New Jersey. Infertility resulting from voluntary sterilization procedures are excluded from coverage. Must be less than 46 years of age. COVERAGE Group insurers, HMOs, State Health Benefits Program, and School Employees Health Benefits Program that provide pregnancy related coverage must provide infertility treatment including, but not limited to: artificial insemination; assisted hatching; diagnosis and diagnostic testing; fresh and frozen embryo transfers; 4 completed egg retrievals per lifetime; IVF, including IVF using donor eggs and IVF where the embryo is transferred to a gestational carrier or surrogate; ICSI; GIFT; ZIFT; medications; ovulation induction; and surgery, including microsurgical sperm aspiration; and standard fertility preservation services when a medically necessary treatment may directly or indirectly cause iatrogenic infertility.
Exceptions Employers with fewer than 50 employees do not have to provide coverage. Cryoperservation is not covered except for those at risk of iatrogenic infertility. Nonmedical costs of egg or sperm donor are not covered. Infertility treatments that are experimental or investigational are not covered. New York. Infertility means a disease or condition characterized by the incapacity to impregnate another person or to conceive, defined by the failure to establish a clinical pregnancy after twelve months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after six months of regular, unprotected sexual intercourse or therapeutic donor insemination for a female thirty-five years of age or older.
Standard fertility preservation procedures are covered but not defined by law. Coverage Group policies must provide diagnostic tests and procedures that include: hysterosalpingogram; hysteroscopy; endometrial biopsy; laparoscopy; sono-hysterogram; post coital tests; testis biopsy; semen analysis; blood tests and ultrasound Provides up to 3 IVF cycles fresh embryo transfer or frozen embryo transfer to patients in the large group insurance market or more employees.
Provides medically necessary fertility preservation medical treatments for people facing iatrogenic infertility caused by a medical intervention, such as radiation, medication, or surgery, in all commercial markets individual, small and large groups. Every policy that provides for prescription drug coverage, shall also include drugs approved by the FDA for use in the diagnosis and treatment of infertility. Prohibits delivery of insurance coverage from discriminating based on age, sex, sexual orientation, marital status, or gender identity.
Rhode Island. Iatrogenic infertility means an impairment of fertility by surgery, radiation, chemotherapy or other medical treatment affecting reproductive organs or processes. Coverage Insurers and HMOs that cover pregnancy benefits, must provide coverage for medically necessary expenses of diagnosis and treatment of infertility and for standard fertility preservation services when a medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a covered person.
Coverage is provided to women between the ages of 25 and 42 for diagnosis and treatment of infertility does not apply to fertility preservation. Insurance Code Ann. Section 3. Coverage No coverage is required. Insurers are only required to offer IVF. Exceptions Does not require religious employers to cover infertility treatment. To change or withdraw your consent choices for Investopedia.
At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. These choices will be signaled globally to our partners and will not affect browsing data. We and our partners process data to: Actively scan device characteristics for identification. I Accept Show Purposes. Your Money. Personal Finance. Your Practice. Popular Courses. Best Fertility Insurance Expand. Best Fertility Insurance. Final Verdict. Compare Providers. How to Choose. Best Overall : UnitedHealthcare.
Learn More. Why We Chose It. Pros Offers coverage for egg and sperm retrieval for surrogacy Covers ovulation induction Reimburses some assisted reproductive technologies. Cons Does not state how many fertility specialists are in the network Does not cover long-term storage of sperm, eggs, or embryos Does not cover preservation of reproductive materials prior to cancer treatment.
Pros Covers IVF and other rarely covered procedures Covers a significant number of diagnostic tests Offers some cryogenic coverage in certain states.
Cons Does not cover experimental procedures like vaginal microbiome testing Does not cover reversal of voluntary sterilization Surrogacy costs are excluded.
Best Additional Resources : Aetna. Pros Rates infertility providers to help you find one that has a good track record Helps you find a provider and facility that is a good fit for your needs Has extensive online FAQs about infertility treatment. Cons No online quotes or estimates Does not offer plans through the individual and family health care marketplace Excludes some treatments for those over 40 years of age.
Best Affordable Policies : Wellcare. Pros Offers infertility coverage between ages 21 and 44 Covers diagnostic fertility tests Includes artificial insemination. Best for Assistive Reproductive Technologies : Progyny. Pros Covers the most effective treatments first Access to excellent fertility providers All-inclusive coverage focused on outcome rather than cost.
Cons Does not offer other forms of health coverage Is only available through employee group plans Premium coverage, but at a premium price. Final Verdict The fertility insurance companies that made our list have different types and qualities of coverage for fertility treatment and diagnostics.
Be sure to ask your insurer what treatments are covered before purchasing a policy. Providers in-network: You want to be able to see providers near you who have a good track record around fertility care. Make sure to ask an insurer what providers are in your area before purchasing coverage. Make sure to ask your provider how many rounds of treatment they cover before signing up for a plan. Co-pays, limits, and deductibles: Fertility treatments are expensive.
Before you decide whether to purchase fertility insurance, figure out how much you would be paying out of pocket for treatments through that plan. Is Fertility Insurance Expensive? Methodology We evaluated a dozen health insurance companies that offered fertility insurance and evaluated them based on things like treatments offered, diagnostics covered, resources provided, and the focus of the plans on fertility treatment and care.
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