According to a study by Prosper Marketplace, 84% of women surveyed said that the cost of fertility treatments was their most significant concern. Their worries aren’t unfounded — the average cost of fertility treatments ranges from $1,182 to $38,015, depending on the treatment you receive. While the costs associated with fertility treatments are high, the hope for success is still higher. Having a working knowledge of the potential costs, insurance laws, and options for treatment can help you alleviate stress and plan for the future.
Does insurance cover fertility treatments?
As the POTUS attempts to repeal the Affordable Care Act, conversations and concerns about health insurance coverage have been at an all-time high. But even with the Affordable Care Act mandates for essential healthcare coverage — such as maternity and newborn care, pediatric care, prescriptions drugs, and emergency services — insurers aren’t required to pay for fertility treatments. They just aren’t considered “essential.” As disheartening as this is, there is good news: infertility is considered a pre-existing condition, which means that no insurance company can deny you coverage because you’ve been diagnosed.
The 2015 Prosper Marketplace study found that 21.6% of women who received fertility treatments were not covered at all by insurance, while 38% had about 50% of the costs covered. Less than 30% of women had most or all of their fertility treatment costs covered by insurance. This range of numbers shows that insurance coverage is largely dependent on your insurance plan and the state you live in.
State laws impact the cost of fertility treatments
According to the National Conference of State Legislatures (NCSL), “15 states—Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia—have passed laws that require insurers to either cover or offer coverage for infertility diagnosis and treatment.
Thirteen states have laws that require insurance companies to cover infertility treatment. Here are some other laws worth noting:
- Louisiana and New York prohibit the exclusion of coverage for a medical condition otherwise covered solely because the condition results in infertility.
- Two states—California and Texas—have laws that require insurance companies to offer coverage for infertility treatment.
- Utah requires insurers providing coverage for maternity benefits to also provide an indemnity benefit for adoption or infertility treatments.
- While most states with laws requiring insurance companies to offer or provide coverage for infertility treatment include coverage for in vitro fertilization, California, Louisiana, and New York have laws that specifically exclude coverage for the procedure.”
You can find more information on fertility treatment coverage in your state in this article by Attain IVF. The final answer, however, will come from your insurance company. You can call and ask questions about what is covered, what the lifetime maximums are, and whether you need prior approval to see a fertility specialist.
What are my fertility treatment options, and how much do they cost?
There are many different options for fertility treatments. The one you choose will depend on your personal situation — and what you can afford. Here’s a look at the average estimated cost of fertility treatments in the United States.
Clomiphene and gonadotropins are two of the most commonly prescribed fertility drugs. The goal of both is to cause ovulation, either by stimulating your hormones or your ovaries. The success rate is what makes them so popular. 30 to 40% of women taking clomiphene conceive by their third treatment cycle. The rate for pregnancy on gonadotropins in 15% each cycle.
Cost estimates for fertility drugs:
- Gonadotropins — ranges from $155 to $6,446 per cycle.
- Clomiphene — the average cost is $97.23 for a 30-day prescription
These prices can fluctuate based on whether the prescription is the brand name or generic, as well as whether your insurance covers them. It’s always best to ask your insurance provider directly which, if any, prescription fertility drugs are covered. In addition, you may want to consider the other costs you’ll incur like doctors visits, ultrasounds, and testing.
Intrauterine insemination (IUI)
Commonly used by women with unexplained infertility, intrauterine insemination is done by placing your partner’s or a donor’s sperm directly into your uterus. The pregnancy rate falls between 7 and 16% per cycle. This can be one of the more affordable options, though you’re still looking at between $700 and $2,000 per cycle.
A similar method of fertility treatment — cervical cap insemination — can also be done at home, for a much lower cost, around $80 per attempt.
In vitro fertilization (IVF)
In vitro fertilization is a costly option and one that many women don’t choose until they’ve exhausted other, less invasive fertility treatment options. IVF is a process that removes your eggs from your ovaries and combines them with your partner’s or a donor’s sperm. If successful fertilization occurs, the embryo will be implanted into your uterus. Success rates tend to be high with IVF for women under age 40.
- 40% for women under age 35
- 21% to 31% for women age 35 to 40
- 11% for women aged 41 to 42
- 5% for women 43 and older
While the success rates make IVF a great option, the costs are often prohibitive. Using your partner’s sperm can cost an average of $14,000 but can be as high as $38,015 if you use donor eggs.
If you have a specific health problem that impacts your fertility, your doctor may recommend a corrective surgical procedure. These surgeries can help open blocked fallopian tubes, remove excess tissue from endometriosis, or treat polycystic ovarian syndrome (PCOS) through ovarian drilling. The success rates of these surgeries depend on many factors including your overall health and the type of surgery. However, the chances of conception do range from 21 to 50%, making them a good option.
The cost of surgery for fertility can range from $2,000 to $10,000, depending on a variety of factors:
- what your insurance covers
- the hospital you go to
- whether the hospital and doctors are in- or out-of-network
- the type of anesthesia used
This can make it hard to pin down exact costs. You should always check with your doctor and your insurance company.
How can I afford the cost of fertility treatments?
According to the Prosper Marketplace survey, more than 70% of women who had fertility treatments incurred some amount of debt. 82% of respondents decided to delay fertility treatments due to cost. The cost of fertility treatments can be a burden on many families.
Not being able to afford fertility treatments can be heartbreaking. Thankfully, there are several programs that exist for this very reason. Check them out to see if you qualify:
Glow Fertility Program — offers cost-saving opportunities for women in Northern and Southern California and New York City (though they plan to expand to more cities)
Grants and Scholarships — Resolve.org has compiled a list of nonprofit organizations that award money for fertility treatments to qualifying women