Are Fertility Services Covered or Not?

The Rise of Fertility Treatments

Fertility treatments have become increasingly common. In fact, according to one study, one in three adults either used fertility treatments or know someone who has. If you are considering infertility services, knowing your options for paying for services can help you make informed decisions.

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Fertility Coverage by Health Insurance Companies. Covered? or Not?

Does Health Insurance Cover Fertility Services?

In general, health insurance companies cover services that your doctor deems to be medically necessary. If you have an ACA-compliant health insurance policy, then there are 10 essential benefits that your health insurance company is legally required to cover.

While this coverage is fairly robust, it does not cover everything. If you seek treatments that are not considered to be medically necessary, meaning that they are not necessary for your health or evaluating, diagnosing or treating an illness, injury or disease, then you should speak with a health insurance agent that can look into the individual plan benefits thoroughly for you to see what services might be covered. Services that are not usually covered include cosmetic surgery, weight loss programs, adult vision or dental services (you can, however, get coverage for vision/dental separately).

Where You Live Matters

As of April 2021, the majority of states do not require private health insurance companies to cover fertility services. In California and Texas, health insurance companies have to offer at least one plan that includes this coverage. In 15 states, health insurance companies have to cover at least some fertility services.

While Nevada currently does not require health insurance companies to cover fertility services, it has a benchmark plan that does cover some fertility treatments.

Limitations on Fertility Treatment Coverage

Even if you live in a state that requires health insurance coverage for fertility treatments, there may be certain requirements that you have to meet to have services covered. For example, if you have unexplained infertility, you might only qualify for in vitro fertilization after a period of time or a specified number of in-vitro cycles.

Some states with required coverage for fertility treatments do not cover IVF, or they may only cover treatment up to a certain dollar amount. Other states only cover cryopreservation for someone whose fertility is expected to be compromised due to a medical diagnosis or treatment.

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How You Get Health Insurance Matters

If you are one of the 61% of workers who are enrolled in a self-funded health insurance employer plan, then your plan may or may not cover fertility treatments, regardless of the state you live in. If you get your employer-based health insurance through a company with fewer than 50 employees, then your plan is exempt from state laws related to fertility coverage. Additionally, religious employers can file for exemptions that allow them to not offer this coverage based on ethical or philosophical beliefs.

Find Fertility Treatment Coverage with Nevada Insurance Enrollment

Health insurance can be confusing, especially when it comes to issues such as fertility treatments. At Nevada Insurance Enrollment, health insurance agents can help you determine whether there is a policy available to you that includes the coverage you are looking for.

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