Figuring out what your insurance covers can be a tricky and confusing situation. Insurance Pro AZ is here to help you on this journey. This becomes more true when you are navigating an emotional situation such as research for which insurance covers IVF (In vitro fertilization).
Insurance plans can vary widely from state to state and it’s important to take this into consideration. Arizona is not a state that mandates that companies offer infertility coverage. Because of this, finding out what you might be responsible for in co-pays or a deductible and what you can get covered through your insurance is a must!
Insurance Pro AZ is here to help you on this journey. If you are working through which plan covers infertility services, read on for a helpful roadmap to insurance plans that cover infertility in Arizona.
What is infertility and infertility care?
A diagnosis of “infertility” is often necessary in order to qualify for infertility services. This means there are likely many steps you need to take before you are able to begin a cycle of IVF. So, what does this entail? Often there are quite a few hoops to jump through including the many diagnostic tests needed to determine whether or not you are a candidate. A lot of insurance plans cover these, but some might stop there.
If you are thinking about IVF, this likely means you have likely already tried to get pregnant using other methods. For women trying to conceive for the first time who are under the age of 35, this usually means 1 year of actively trying to conceive (CDC). If you are over the age of 35, this time period can be shortened to 6 months. At this point, it is recommended that you should consult a fertility specialist.
3 Signs of infertility in females
For many women who are ready to start a family, they might not even know whether or not they will struggle with infertility. Some women might assume they will be able to get pregnant easily, only to find out they need a specialists help. Other women might have had trouble their entires lives with certain aspects of their reproductive organs and know that they will need help once they are ready.
For this reason, it’s a good idea to educate yourself well before you think you might need infertility services. That way, you will be prepared during what can be an emotionally difficult journey for many.
According to WebMD, You might know you will have some trouble getting pregnant naturally if throughout your life you’ve had:
- abnormal or irregular periods
- an absence of periods (you’ve never had a period or your period stops)
- a history of painful periods
What is involved in infertility services?
So, you have arrived at the point of knowing you need infertility services for one or more reasons. Now, you need to be sure you know which insurance covers IVF, or as much of this potentially expensive process as possible. In Arizona, plans can vary a lot and might depend on what your employer offers for coverage. Arizona state laws do not require that employers offer benefits for infertility treatment.
Because of this, you should call your insurance company, or call several companies, to see which plans offer the most coverage. Many will cover all or most of the diagnostic portion of your journey. But when it comes to the IVF procedure, you will be forced to pay out-of-pocket for much of the cost.
You should be in the know as much as possible about all the aspects of which insurance covers IVF from the beginning. Keep reading to discover the details of what each plan covers so you can find your best approach.
A glance at 4 insurance plans that cover IVF
UnitedHealthcare seems to be the best overall choice. There are 1.3 million providers in their network across all 50 states. Your copay, deductible, and out-of-pocket expenses will depend on what plan you choose and what state you live in. Here are some pros and cons of their infertility services and coverage which do include surrogacy and insemination:
- A wide network of doctors and providers in 50 states
- Telehealth is widely available
- Coverage for ovulation Induction
- Coverage for sperm and egg retrieval for surrogacy
- Can be more expensive than other companies
- Not transparent about how many fertility specialists are in the network in what states
- IVF might not be covered
- They do not pay for donor eggs and sperm and
- No coverage for long term storage of these reproductive materials
The cons for UnitedHealthCare might look like a lot. But depending on who you are and what you need, and given the other benefits they offer, it’s always worth calling to talk to someone about your specific situation.
Cigna made the list because several of its plans offer coverage for IVF at a budget price. They also cover many of the diagnostic tests needed for this procedure.
- Infertility care with the reasonable monthly payment
- Covers elective egg freezing
- Covers IVF
- Does not cover some common experimental procedures
- Surrogacy costs not covered
- only available in 12 states
Cigna has an equal number of pros and cons. Some of these might be weighted differently for you than for someone else. If you know you want to move forward specifically with IVF or that you need other fertility tests like an ovarian reserve analysis, and need it to be covered, this might be the right choice for you.
Aetna made the list because they offer a wide variety of helpful resources for someone looking to learn about infertility services and providers. Their large library of videos and lists of rated providers are helpful for someone just beginning the journey who needs a lot of information in one place. Like other companies, there are good things and not-so-good things.
- Expansive library of infertility care information
- Rated network of providers to help you find a good fit
- Doesn’t offer online quotes
- Aetna doesn’t offer plans on the individual marketplace
- Excludes coverage for some infertility services for those over 40
Depending on your age and what your needs are, Aetna might not be the right fit for you. For example, they only offer plans through Medicare, Medicaid, and employers. So if you are an individual looking for insurance on the marketplace, this will not be available to you.
Blue Cross Blue Shield:
Blue Cross Blue Shield is a widely available insurance company and could be a great choice if you know you might need more than one round of infertility treatments. It is a well-known company across all 50 states and for that reason can feel more accessible.
- Covers at least 3 rounds of IVF and may cover more if needed
- Well known and available in all 50 states
- Could be confusing navigating the system with so many local companies within the larger company
- You might not always be able to buy insurance online
If you are willing to spend time online or figuring out who your local Blue Cross Blue Shield agent is, this could be a great choice for you. Even more so if you are unsure whether or not IVF is going to be a quick, single-round procedure for you.
Take-aways about which insurance covers IVF
There is a lot of information here. You are likely someone that is considering infertility care and looking for which insurance plans cover IVF in a way that fits your lifestyle, your physical and emotional needs, and your budget. Hopefully rounding up this information about the most widely accessible insurance companies and what they offer is a helpful jumping-off point for you. Let’s look at some big takeaways.
If you are just starting on this journey, it’s important that you take the time to thoroughly research each company and what they can offer you. Arizona is one of 43 states that doesn’t require companies to offer insurance plans that cover infertility treatments. Because of this, asking the right questions and making sure you get well-informed, complete answers could make a huge difference in what you end up having to pay out of your own pocket.
An example of this might be that some plans will offer full coverage for the diagnostic testing, but stop short of covering any of the actual treatments. Maybe another plan covers some of your treatment but only after you’ve paid a pricey deductible, which could add up to thousands of dollars. If you look hard, there are plans that largely cover IVF; and not just your first round, but multiple rounds if needed.
You can see the importance of taking the time to learn the ins and outs about which insurance covers IVF in order to be able to make the best decisions for you and your growing family.
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