Does Medicare Cover IVF?
IVF – in vitro fertilization – is an assisted reproductive technology procedure that may help people become pregnant if they have fertility or genetic issues. It begins by retrieving eggs from ovaries, fertilizing them in a lab, and implanting the embryo(s) into a uterus.
Your physician might suggest undergoing IVF treatment if you are having trouble conceiving and have tried other infertility treatments without success. It is also commonly used as the primary fertility treatment for women older than 40, or if you or your partner have any of the following health conditions:
- Blocked or damaged fallopian tube(s)
- Anomalies regarding ovulation
- Endometriosis
- Fibroids
- Issues with sperm production or function
- Infertility without a known cause
- An illness like cancer that might hinder fertility and you want to freeze embryos to use after recovery
- Genetic disorders that risk a child’s health
Because IVF treatments are expensive, you might be wondering if you have insurance coverage to help with the costs. Unfortunately, even if IVF is a necessary treatment for your condition, most insurance companies, including Medicare, don’t cover it unless you’ve tried other fertility treatments first.
Does Medicare cover IVF?
If you are planning to start IVF treatment, you’re probably not the typical age of most Medicare enrollees who are 65 and over. However, you might be eligible for Medicare at a younger age if you have a qualifying disability certified by your physician or another health condition like end-stage renal disease or amyotrophic lateral sclerosis (ALS).
If you’re receiving Social Security disability benefits (SSDI), you become eligible for automatic enrollment in Medicare at the beginning of the 25th month of receiving benefits. At that time, the Social Security Administration automatically enrolls you in Original Medicare Part A (hospital insurance) and Part B (medical insurance). If you have ALS, your Medicare coverage automatically begins on the first month that you begin receiving Social Security benefits.
Although Medicare rarely covers fertility treatments, you may be able to get coverage for one of the following procedures to help you conceive:
- Intrauterine insemination
- Fertility drugs
- Intrafallopian transfer of a zygote or a gamete
- Intracytoplasmic sperm injection
You might be able to get coverage through Original Medicare Part B if your physician certifies that the fertility treatment is medically necessary. For this to happen, your physician (who accepts Medicare assignment) must carry out all applicable screenings and examinations, and she must certify that you are a person experiencing infertility, but you would have the ability to become pregnant in other circumstances.
After coming to this conclusion, your physician must submit a claim to Medicare certifying your medical condition and reasons why fertility treatments are medically necessary. Medicare reviews your case and decides whether you can get coverage for the treatment.
How much do IVF treatments cost without Medicare coverage?
In the United States, if you get IVF treatments at a clinic that specializes in fertility issues, you might be charged anywhere between $12,000 and $14,000 for one cycle of IVF that includes only the required parts. If you get optional care and services in addition to basic care, you might pay up to $30,000 for one cycle of IVF.
In most instances, the prices listed above don’t include the cost of injectable hormones. These can run between $3000 and $6000 per cycle, which you typically pay directly to your pharmacy.