Because infertility is a health problem it should be covered by your employer's group health plan. Well, it probably isn't - so you better check your policy details. Insurer's classify it as optional treatment, like liposuction or breast reduction surgery. If you're feeling the fears, anxiety, and mental weight of going month after month without becoming pregnant, you know it's a real and serious health problem.
Infertility Insurance - It's the Law in 15 States
Before you panic, check for mandated infertility treatment in your state. Fifteen states have laws specifically requiring insurers to provide some coverage - most likely limited coverage - for infertility treatment. Here's the list: California, New York, Texas, Massachusetts, Illinois, Ohio, Connecticut, Georgia, Hawaii, Arkansas, Maryland, Montana, New Mexico, West Virginia and Rhode Island.
But if you're in one of these states, check the details about coverage limits because they vary greatly - some really generous and some ridiculously limited. More advanced treatments such as IVF and egg donation may not be covered. And even if you live in a state mandating liberal coverage, your group health plan may be excluded under the law because your employer is a small company. Or the definition of infertility may exclude your case - really, check the law.
No Mandated Coverage in Other States
In the 35 states without laws requiring infertility insurance coverage, you're dependent on the generosity of your employer's health plan. But only about one in four plans cover infertility treatment. Those plans impose limits on specific types of treatment or extent of treatment or dollar limits on treatments or drugs. So your out-of-pocket costs will probably be significant even if you have some coverage.
New Federal Health Care Law - ObamaCare
President Obama's health care initiative has been highly touted as a big improvement, a broad overhaul that will bring expanded coverage and fairness across the board. Maybe it will, but don't count on it to provide comprehensive infertility insurance coverage. Consider:
- If you need help now, or even next year, it won't help you. Some benefits in the law are in effect now, but the vast majority of changes to insurance coverage won't be implemented until 2013.
- Nothing in the new law's 2,000+ pages specifically addresses coverage for infertility treatment or implies mandated coverage for infertility. There may or may not be some coverage, we won't know until full details are worked out.
What to Do
Be realistic - you can only deal with the here and now. If the reality of infertility treatment cost is overwhelming and you are committed as a couple to having children, consider these steps:
- Get a realistic estimate of the likely costs for the full course treatment you will need.
- Carefully examine details of the insurance plans covering each of you to determine exactly what costs will be covered.
- If one partner's plan is more generous than the other's, consider shifting to the plan with better infertility coverage.
- Otherwise, you might consider changing jobs, if you have the opportunity to work for a company with especially generous insurance benefits.
- Finally, consider relocating to a state with better mandated coverage.
If none of those options are available, you will probably have to pay for infertility treatments from resources available to you. With the cost established, consider these possible sources:
- Your infertility clinic may offer payment plans or guarantees to cap your costs at a certain level. Carefully evaluate those plans before agreeing.
- If you have a flexible-spending account for health costs, it can be used to pay for infertility treatment.
- You can withdraw from your 401-K account, but beware of the tax bite you may incur.
- If you have lived in your home for a few years, you may have enough equity to get a home equity loan at a very favorable rate.
- Your parents (eager future grandparents) may be able and willing to help.
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