There's no sugarcoating it: Fertility treatments are expensive. The current economy and rising unemployment rates have made it so that starting a family may not be a feasible choice for some people.
To mark National Infertility Awareness Week, we connected with Dr. Alexander Kucherov, a fertility specialist at Illume Fertility, about the current financial struggles he's seen among his patients and asked him for advice on how to make fertility treatments more affordable for those struggling to pay for it.
Dr. Kucherov is board-certified in obstetrics and gynecology, and fellowship-trained in reproductive endocrinology and infertility. He began his fellowship in reproductive endocrinology and infertility in 2017 and completed it in 2020. Since then, he has been practicing as a reproductive endocrinologist.
The main financial challenges that Dr. Kucherov has seen in his patients involve a lack of insurance coverage. Without that coverage, patients have to pay out of pocket, and the price can be steep. According to Dr. Kucherov: "Fertility is among the most expensive health benefits, with one cycle of IVF costing anywhere from $12,850 to $24,250."
And for those who have insurance, it may not cover what they need. As he explains, "[S]ome of these plans may cover some aspects of fertility treatment but not all. For some patients, this is fine, but for other patients, their insurance coverage may not include the necessary treatments for them to achieve their goals … certain types of fertility preservation (such as egg freezing) are most commonly not covered by insurance."
Those who are unemployed or underpaid need to get very creative and resourceful in finding ways to successfully pay for fertility treatments. In his practice, Dr. Kucherov has seen patients use crowdfunding, self-pay options, and loans from companies that charge minimal interest.
"State-run insurance exchanges may have commercial insurance plans available with fertility coverage if the patient is able to purchase one of these," he tells us. "There are also many companies that provide loans for fertility care, often at a low or 0% interest rate. Many fertility practices have self-pay options, which may be discounted under certain circumstances. Finally, I have seen patients use crowdfunding approaches to raise money for fertility treatment."
With that in mind, here are five ways that Dr. Kucherov suggests those with limited funds or no insurance coverage try to help make fertility treatments more affordable:
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1. Supplement the Cost With Grants
Grants can help supplement the cost of fertility treatment, with some that cover costs top-to-bottom and medicine-to-procedure.
Be mindful that grants typically have stipulations that differ depending on who is issuing the grant. For example, one grant might require that recipients use a specific fertility clinic or live in a certain state.
2. Get Medical Loans
Although you still need to pay the loan back plus interest, medical loans can be an option for some.
This might be a better option than just swiping your credit card for every bill because you can negotiate a predetermined interest rate and payback period.
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3. Ask the Fertility Clinic About Opportunity Plans
Some fertility clinics offer financial options or assist in paying over a particular amount of time. Before diving into treatment, be sure to ask your fertility clinic team about these types of plans.
4. Purchase an Insurance Rider
For those who can buy health insurance on their own but don't have options that cover fertility treatments, purchasing a rider may be something to explore. This can make a big difference.
Although an insurance rider requires an additional cost, it can be less expensive than getting a different carrier or paying out-of-pocket when taking everything into consideration.
If you're planning on one or more treatments for intrauterine insemination, or IUI, or in vitro fertilization, or IVF, for example, the higher premium might be worth it.
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5. Buy Health Insurance and Fertility Coverage
For those who are able to purchase health insurance through the ACA marketplace, some insurance companies will cover partial or full costs for fertility treatment. Some of these plans include a stipend for medication, and others offer a lifetime monetary allotment. Coverage options can vary.
To confirm whether an insurance company covers fertility care, start by calling the number on the back of your insurance card.
If your insurance policy does not cover infertility, find out:
Is there another plan I can switch to that does cover infertility treatments?
Make sure to understand the grace period before using the fertility benefits. Some insurance companies require a certain amount of time to pass before dipping into benefits such as infertility.
Is there another plan you can choose that covers the drugs and procedures you need?
Although there may be a higher deductible, in the long run, these plans may save you money.
If your insurance policy does cover infertility, ask the following:
Do I need to use a particular clinic?
Some insurance companies will only cover your treatment if it's administered by certain clinics. Typically, preferred clinics are ones that report to SART, or Society for Reproductive Technologies, or another third-party information source with clinic statistics.
How do you define infertility in order to grant coverage?
Some plans require a particular amount of time trying to conceive or other health issues before allowing access to extended coverage.
Is all the fertility testing covered?
Fertility testing must be done before any treatments are started. Is your HSG, saline sonogram, and genetic testing covered? Ask about those specifically.
What specific fertility treatments does the company cover?
Some insurance will not cover anything more than ovulation-inducing medication. Some will cover the entire gamut of procedures. Be sure to get a detailed list.
Do you cover fertility medications?
This category might include specialty pharmacies or at-home delivery and might require using a specific pharmacy.
Do I have any yearly or lifetime maximums on procedures or spending?
Some plans place a cap on treatments in a given amount of time. For example, your lifetime allotment might be three IUIs and one IVF cycle, or one IVF cycle per year. Some plans will not put a cap on the type of procedures but will instead grant you a certain monetary stipend to be used on fertility needs in a given amount of time. For example, you could be given a $25,000 lifetime allotment.
Other important costs to consider:
Will I have a co-pay for office visits? Will all visits have the same co-pay, regardless of the purpose?
You'll be in the office quite a bit between having bloodwork done, an ultrasound or diagnostic testing, or simply a chat with your doctor.
Do you cover pre-implantation genetic testing?
Most insurances will not cover this, but some may, particularly where there are existing genetic concerns.
Should I need ICSI in an IVF cycle, is that covered?
ICSI is a more focused fertilization method (manually placing a single sperm inside one egg) that requires more intensive work by the embryologist.
Do you cover cryopreservation?
You might need to freeze your eggs or embryos, and you'll want to budget for those costs if they're not covered. A good follow-up question to ask: Is there any coverage or reimbursement for the costs of keeping those specimens frozen year over year?
If I exhaust a predetermined coverage allotment, is there an additional package I can purchase?
Do I have a deductible to work through before my fertility coverage is paid for?
Ask about all the office visits you'll have and if those payments can apply to your deductible if you have one.
You can also request insurance codes for specific procedures (like IUI and IVF) from your fertility clinic in order to run them by your insurance company.
Make sure that by the time you get off the phone with your insurance representative that you are feeling comfortable and understand everything that has been said. You can also request to get the policy in writing.
It can be quite overwhelming trying to figure out how to pay for fertility testing and treatment in the year ahead. As you work to find answers and search for the best options, always remember why you are doing this. This may not be the easiest path to parenthood, but all your hard work, persistence, and courage will give you the very best shot at building your own family.
