By Alexander Kucherov, M.D., fertility specialist at Illume Fertility
Before the calendar could flip to February, 2023 had already become a brutal year for unemployment. On Jan. 4, Amazon announced it would lay off 18,000 employees. On Jan. 2spending0, Google announced 12,000 employees would lose their jobs. Microsoft announced it was cutting 10,000 jobs on Jan. 18. Salesforce, IBM, SAP, Wayfair, Vacasa and Coinbase all jumped on the trend, too, expanding on the 20-year high in tech layoffs recorded in 2022.
With tens of thousands of workers potentially in-between jobs, the question of how to pay for benefits usually sponsored by employers is on the minds of many. While not all companies cover fertility testing and treatment, those who are losing access to fertility coverage will be searching for alternative options to fund the care they need. Fertility is among the most expensive health benefits, with one cycle of IVF costing anywhere from $12,850 to $24,250.
For men and women who are struggling to grow their family and struggling to remain employed, wondering how to afford fertility testing and treatment is an additional source of stress. Even as hopeful new legislation like the Right to Build Families Act is introduced in Congress, it’s clear we have a long way to go before all people have the ability to access the fertility and family-building care they need.
Despite the wave of unemployment and fears of a recession, aspiring parents have several options for affording fertility treatments and finding the resources needed to take control of their futures. Other than paying out-of-pocket, here are five ways the unemployed can offset the cost of fertility treatment:
Grants are a great way to help supplement the cost of fertility treatment. Some might even cover all costs top-to-bottom, 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.
Medical loans are another option. These are essentially out-of-pocket, as you’ll ultimately end up having to pay the loan back, plus interest. This might be a better option than just swiping your credit card for every bill, since you can negotiate a predetermined interest rate and payback period.
Oftentimes, a fertility clinic will have financial options that either discount their services or assist in paying over a particular amount of time. Ask your fertility clinic team to see what plans they might offer before diving into treatment.
If you are able to buy health insurance on your own, but it doesn’t cover fertility treatment, it may be possible for you to purchase a rider. This can help defray the cost of treatment and make a big difference.
An insurance rider adds coverage at an additional cost. This option could be less expensive than paying out-of-pocket or getting a different carrier. If you're planning on one or more treatments for intrauterine insemination (IUI) or in vitro fertilization (IVF), for example, the higher premium might be worth it.
While strides are being made to push for more equitable coverage for all, there is still a long way to go. For hopeful parents who are part of the LGBTQ+ community, purchasing an insurance rider can sometimes be the best option for getting the family-building assistance needed to move forward.
Health Insurance & Fertility Coverage
For those who are able to purchase healthcare 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, while 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 like infertility.
Is there another plan you can choose that does cover 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, below are questions you can ask to better understand the parameters of the coverage:
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 (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 of trying to conceive, or other health issues, before allowing access to the 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 do you cover? Some insurances will not cover anything more than ovulation-inducing medication. Some will cover the entire gamut of procedures. Make 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 3 IUIs and 1 IVF cycle, or 1 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? And 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, should you have one.
In addition to the questions above, 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 they’ve 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 option for you, 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.
Alexander Kucherov, M.D. is a fertility specialist at Illume Fertility, board certified in obstetrics and gynecology, and fellowship-trained in reproductive endocrinology and infertility.