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    Will My Insurance Cover Fertility Treatment?

    2 December, 2019

    Typically, insurance coverage for fertility needs has been widely unavailable. 

    In fact, research shows that only 56% of women have fertility coverage with their insurance plans, whereas 44% of them pay for in-vitro fertilization (IVF) and other fertility treatments out-of-pocket. Despite there being 16 states with current laws to provide coverage for fertility treatments, it doesn't necessarily mean that insurance providers have to follow suit. 

    With that in mind, if you have questions about whether or not your insurance provider will cover fertility treatments, here's what you need to know: 

    Considerations When Seeking Fertility Coverage

    A worthwhile insurance plan that offers fertility coverage should include various procedures that pertain to fertility treatment. 

    For instance, you don't want a plan that only covers a consultation with a fertility expert, and then excludes things like physical exams, blood tests, and actual procedures. Overall, your fertility coverage should include the following parameters to ensure that you're protected from the moment you realize you have fertility issues:

    • Physical exams, blood tests, ultrasounds
    • Hormones/medications
    • Actual procedures (like IVF and IUI treatments)
    • Any necessary surgical procedures

    Of course, relying on an employer to make sure that all of these things are covered may result in incomplete information, so it's important to check with individual insurance companies before selecting a plan. Once again, there are limitations as to what’s actually covered in different states/with different insurance companies, which means it's easy to sign off on a plan that doesn't provide good coverage. 

    Take our Fertility Mandate Quiz to find out if you qualify for coverage!

    If you need some additional help with research, click here to explore the full list of states and what's included regarding fertility coverage from providers. 

    What Else You Should Know

    Finally, before finalizing your insurance coverage, correspond with your employer to find out if their insurance plan is written in the governed state.

    Quite often, a state may impose fertility coverage guidelines, but an employer chooses to partner with an insurance plan that is governed by a different state. The result is that your state's guidelines are bypassed, which may mean only partial or no fertility coverage whatsoever for you as an employee. Along with that challenge, some insurance providers may abide by a state's regulations, but only provide partial coverage for a procedure or treatment, leaving you to make up the additional cost. 

    Ideally, you want to choose a provider with a fertility plan that works in your favor. This means an arrangement that pays out between 50%-100% of a fertility treatment or procedure. However, keep in mind that fertility treatments can be expensive, and having an arrangement where you need to invest some of your own funds is certainly not unheard of—in most cases, it can be expected. 

    Find the Fertility Coverage You Need with Kofinas

    Any time insurance gets involved, understanding the process can be a real challenge. 

    On the other hand, Kofinas Fertility Group makes finding the insurance coverage you need simple with fertility experts to help navigate the waters. Not to mention, with New York's new "FAFTA" fertility mandate that went into effect January 1st, 2020, you can rest assured that any issues you face regarding fertility will be covered.

    Learn more about NY State’s Fertility Mandate


    George Kofinas

    Read about the treatment philosophy of founder and medical director of Kofinas Fertility Group in New York, Dr. George Kofinas.


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