How will you afford fertility treatment?

You may have heard that insurance doesn’t usually cover infertility treatments, but that’s beginning to change. Many companies are starting to recognize the importance of fertility assistance and choosing plans that include treatment benefits. Where you live can also impact coverage—19 US states currently have certain insurance requirements in place for some infertility treatments^*:

• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• Hawaii
• Illinois
• Louisiana
• Maryland
• Massachusetts
• Montana
• New Hampshire
• New Jersey
• New York
• Ohio
• Rhode Island
• Texas
• Utah
• West Virginia

^*Coverage may vary by state. Please check with your insurance provider for details.

If your employer’s health plan doesn’t cover fertility treatments, you can talk to them about making a change. Read more about the Coverage at Work Initiative at resolve.org.

Know your plan 

If you live in a state with infertility coverage laws, it’s still important to verify the type of plan your employer has. In some cases, your plan may not provide coverage. For example, some factors that may impact coverage include:

• The policy was written and/or resides in your state
  Some out-of-state plans may not provide infertility treatment benefits
• You have a fully insured or self-insured plan
  Some self-insured plans may be exempt from state laws
• Your company has enough employees to be required to provide coverage
  Some states may allow exemptions for smaller companies      

More information on fertility treatment coverage by state can be found at resolve.org. 

Assess your coverage

Once you’ve verified that coverage exists, your insurance provider can help you understand your plan’s benefits and limitations, referral requirements, and whether preauthorization is necessary. It’s also important to confirm drug coverage for infertility medications.

Submitting a predetermination of benefit letter to your insurance company before treatment can give you a better idea of the costs you’ll be responsible for.

If you have questions about insurance coverage for fertility treatment, assistance is available. Call 1-866-LETS-TRY for support.

Some fertility drug manufacturers offer savings programs to help make treatment more affordable. Many people can benefit, including:

• Military personnel and their spouses
• Patients with no insurance coverage

Your fertility clinic can answer questions about the types of drugs they’ll prescribe for treatment. Program information can usually be found on the drug manufacturer’s website.

If you’re eligible for medication savings, you may only be able to have prescriptions filled at certain pharmacies. Because the same medication can vary in price dramatically, it’s important to verify participating pharmacies before having medication filled.

Learn about programs that can help make several common fertility drugs more affordable at FertilitySavings.com.

Treatment clinics understand the financial hardships you are facing. Many offer affordable payment plans, have relationships with financing companies, and offer medication discounts.

Some clinics offer package pricing. These allow you to pay a discounted price upfront for a certain number of treatment cycles. You usually won’t receive money back if you’re successful on your first try, but some programs will offer a refund if you reach the end of your package without success.

RESOLVE: The National Infertility Association has compiled a comprehensive list of infertility financing programs. Some are now offering shared risk refunds and bundling options at reduced costs.

View RESOLVE’s list of infertility financing programs.

For people who need help paying for infertility treatment, grants and scholarships are available from nonprofit organizations. Eligibility requirements and application deadlines must be met.

View a comprehensive list of grants and scholarships on resolve.org. 

Your employer may offer special accounts to help you save on medical costs. These include:

• Flexible spending arrangement (FSA)
  FSAs are arranged by your employer and can be used for certain out-of-pocket healthcare costs, including copays, deductibles, and some medications. You opt to have a certain amount withheld from your salary and placed in the FSA. No federal or employment taxes are deducted from your contribution to an FSA. Your employer may also contribute, but is not required to. As of 2020, you may only defer $2,750 to your account each year.
   
• Health savings account (HSA)
  An HSA is a tax-exempt account you establish to pay or reimburse for qualifying medical expenses. HSAs can only be used with a high deductible health plan. You, your employer, and/or family members can all contribute to an HSA. Account contributions for 2021 are capped at $3,600 for an individual, and $7,200 for a family. Funds in these accounts generally roll over each year.
   
• Health reimbursement account (HRA)
  HRAs are funded by your employer only. Qualifying medical expenses and reimbursement limits are determined by your employer-provided insurance plan. There is no cap on the amount your employer can contribute to the HRA in a year. Money in these accounts may generally be rolled over each year.

The money you defer to these accounts isn’t taxable, making them great cost-saving tools for treatment expenses. 

 Visit IRS.gov to learn more.  

If there’s a good amount of equity in your home, using a home equity loan or a home equity line of credit may offer a way to fund treatment. Talk to a professional to have a clear understanding of the terms and timeline.

As of 2022, you can deduct only the amount of unreimbursed allowable medical care expenses paid during the year for yourself, your spouse, and/or dependents that exceeds 7.5% of your adjusted gross income. Ask your tax professional for details and keep accurate records of your paid expenses throughout the year.

Visit IRS.gov to learn more.