Fertility treatment costs/insurance cover (specially in the NYC/NJ area)

posted 3 years ago in TTC
Post # 3
Member
661 posts
Busy bee
  • Wedding: May 2012

@proudcatlady:  Massachusetts based employers are required to cover fertility treatments… My company is MA based and if I wanted IVF or IUI I would have to pay my max deductible ($1500) and then it would be 100% covered… That does not include medication which I believe my max medication deductible is $2500… The medicine can get expensive…

New York based employers are required to cover testing for infertility and treatment for medical  causes of infertility but not IVF or IUI… Like if you want a Semen Analysis then that would be covered, but if you have super low count and could only conceive via IVF that would not be covered… DH’s employer is NY based so that’s how I know…

there are only a few (<10) states that mandate infertility coverage but most are worse than NY and MA is the best ….

Here in Utah we have a clinic that will guarantee you a live baby via IVF for $20k or you get your money back… That doesn’t include the cost of medications, but I’m sure you’ll find out its still one of the best deals in the country!

Good Luck!!!

Post # 4
Member
4153 posts
Honey bee
  • Wedding: November 1999

@proudcatlady:  Hey lady, sorry to see that you’re struggling with possible unexplained infertility.  About the NY/NJ area, we just moved from there so I can offer some help.  Currently 15 states mandate that insurance cover some portion of infertility treatment, and both NY and NJ are on that list.  The coverage in NJ is even better than that in NY because the state of NJ is one of only 2 or 3 states that covers multiple rounds of IVF, which is an amazing benefit.  You can read about the specific coverages mandated in each state here.  http://www.resolve.org/family-building-options/insurance_coverage/state-coverage.html

 

Turns out we moved from one of the best states in the nationfor infertility coverage  (NJ) right before we learned we most likely need IVF.  Womp womp.  I hope you get a pleasant natural surprise in the very near future and you don’t need any of this info!! 🙂

Post # 5
Member
3153 posts
Sugar bee
  • Wedding: September 2011

@proudcatlady:  Both of the previous posters have offered great info, so I won’t add to that. I will add that my insurance (VA) only covers 50%, and at that I’m pretty lucky, as most don’t offer any infertility coverage.

We did three rounds of IUI (was not a combined package, never heard of such). If I had to guestimate, I would say in total I spent 3K+. My second cycle cost us more because I wasn’t responding to the meds as I should, and in that cycle I paid probably $1,200 for the entire cycle. At our clinic, they also offer a “money back guarantee” type program for IVF. They will do unlimited IVF cycles until you bring a baby home from the hospital or your money back. I have not looked into the price of this yet, as I’m hoping we won’t need it. Good luck!

Post # 6
Member
1212 posts
Bumble bee
  • Wedding: May 2011

Hi there — my guess would be that it will be cheaper in the UK because almost everything health care related is sooo much more expensive in the U.S. than it is anywhere else, unless you have good insurance!  

As the previous posters said, insurance cover for infertility varies state by state.  I live in NY… some insurances here will cover IVF and IUI, others won’t…it really depends a lot by the insurance.  My insurance covers it up to a $10,000 lifetime maximum (enough to cover about 1 cycle), but I do still need to pay a 10-20% co-pay for the IVF procedures so it’s not totally free.  After the $10,000 lifetime max it will be out of pocket for everything that is specific to IVF.  

In general you could figure around $15,000 for an IVF cycle in NYC including ICSI, freezing of extra embryos, and most of the medications.  I lived in Connecticut previously and the cost was around the same.  Some clinics have better deals than others.  Some clinics (though I don’t know of any in NYC offhand) will offer a “guarantee” package costing around $20,000 for up to 3 rounds of IVF to make a baby (and your money back if they don’t).   

Post # 8
Member
1015 posts
Bumble bee
  • Wedding: June 2012

@proudcatlady:  There is something in the US called the Attain program where you pay for 3 rounds, and you can get a partial refund if you don’t get a baby.  Of course if you get pregnant right away, you overpaid.  But some think it’s worth it for the peace of mind.  I’m in NY, and I’m one of the lucky ones who has insurance coverage.  My IUI would be covered 100% (not sure about the injectable drugs though, if it got to that point).  We have severe MFI, so we went straight to IVF.  If we did IUI, it would be with DS, and I’d have to pay for the DS.  For IVF, my insurance covers a lifetime max of 3 rounds, with me paying a 25% co-insurance.  My meds were covered too.  For my first round of IVF, I paid less than $4k.  I want to say even less than $3k, so that’s pretty amazing.  I was anticipating spending much more.  As you’ll hear me rave about on the 1+ board, I love my RE.  NYCkitten started seeing him too.  So if you do end up in NYC, we could be the WB TTC 1+ trifecta (well, trifecta of patients who were on the board, as I’m hoping NYCkitten and I will graduate very shortly!).

Post # 11
Member
3989 posts
Honey bee
  • Wedding: October 2011

I have friends who went through treatment in Virginia.  Their insurance didn’t cover any of it.  They could purchase “one try” for $10,000 or “five tries” for $25,000.  They bought the five tries just in case but of course got pregnant after the first.

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