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Does your insurance cover IVF? Open enrollment is the time to switch.

open enrollment, fertility coverage

Looking to start fertility treatment but worried about the financial commitment? Have limited insurance benefits that won’t cover much of the cost? As we enter open enrollment season for private employers – and New Jersey’s insurance marketplace begins open enrollment from November 1 to December 15 – it might a good time to look into your options.

Keep in mind that while you probably want the best insurance coverage you can get, you also want to know what kind of coverage you need. It could be a good idea to make an appointment with a fertility doctor for a first consultation before you switch out of your current insurance plan. Some fertility clinics, like RMANJ, will try to collect health information (previous testing) before your first visit so doctors can prepare you as best as possible on that first visit about what type of treatment might be right for you. Bloodwork and ultrasound done at that first appointment will also help doctors understand what type of care you’ll need. But don’t wait too long, open enrollment only goes until December 15.

At that point, you’ll know more about what type of benefits make sense for you, and can begin the hunt for a new plan during open enrollment.

Things to keep in mind when looking for a new insurance plan for IVF:

  • Most people will sign up for an employer-based plan. Although patients are limited to what insurance is offered by your employer, different plans have different benefits, and you’ll want to make sure you know what is offered.
  • Whether you are choosing between a Health Savings Account (HSA) or a traditional Preferred Provider Organization (PPO) plan, you should be seeking the infertility section of the policy. Plans sometimes have separate sections for infertility and IVF, and other times the section is called ‘Family Planning.’
  • If you can’t find the relevant section, you may have the opportunity to request benefits for particular codes. Ask your HR coordinator for help finding these: an Intrauterine Insemination (IUI) is 58322, an egg retrieval necessary for IVF and egg freezing is 58970, and Intracytoplasmic Sperm Injection (ICSI) is 89280.
  • If you’re looking to purchase a plan through the New Jersey marketplace (also called an exchange), you may want to look into NJ Horizon Blue Cross Blue Shield Omnia plans, which often cover IUI.
  • Don’t equate a good plan with a good insurance brand. For example, there are Aetna plans with great infertility benefits, and Aetna plans with no infertility benefits.
  • Likewise with state infertility mandates. Even if your state has a strong infertility mandate (like NJ,) meaning insurance companies are required to either cover or offer coverage for infertility diagnosis and treatment, your employer may not be required to follow the state mandate. It’s best to find out.
  • If you decide to switch insurance, talk to your family first – changes to out of pocket expenses should be a decision you make with the entire family in mind.
  • Finally, if you don’t have benefits at all, you should look into ‘shared risk programs’ offered by some clinics. Even if your initial out of pocket expense is higher, these programs, like RMANJ’s CareShare program, which is available for patients that meet program criteria, can reduce the per cycle cost of treatment, leading to big savings.