Does My Health Insurance Plan Cover Fertility Treatments
Maternity and newborn care are considered essential benefits under most health plans, but infertility care often is not. Coverage runs the gamut: Some insurance plans cover in vitro fertilization but not the accompanying injections that women may also require. Other plans cover both. Some plans cover limited attempts at certain treatments. And some plans do not cover IVF at all.
Men will want to check what their plan covers for semen analysis and male infertility care. Remember that infertility is a couples disease, says Joanne Armstrong, MD, senior medical director and head of Aetnas Womens Health. “There are risk factors that involve the female and the male, so make sure both partners are evaluated.”
If you have a choice of health care plans, you’ll want to pick one that offers as much coverage as possible. But heres an important caveat: Just because a doctor tells you that you are a candidate for infertility care doesnt mean you will automatically be eligible for services covered by your plan. Aetna members can learn more by checking out its Infertility Treatment FAQs.
What About Open Enrollment
The month for Employer plan Open Enrollment may vary based on the employer. The national Open enrollment for an Affordable Care Act plans takes place once per year beginning on November 1st and ending on December 15th few states allow an extension of this enrollment timeline until January 15th. Unless there is a qualifying event, such as a job change, this open enrollment period is the only time your surrogate can sign up for a new health insurance plan. While it is definitely important to take your time in finding the right surrogate, it is necessary to keep this timeframe in mind, as you may need to wait to cycle until she can secure a plan under the ACA.
Who Else Is Involved In The Gestational Surrogacy Process
- Attorneys: The surrogate and the intended parent must be represented by separate legal counsel who are licensed in New York State and have expertise in surrogacy matters. The attorneys draft and review legal documents to make sure their client’ ) interests are protected. They also help their client understand their rights and responsibilities included in the surrogacy agreement.
- Surrogacy matching programs: Some intended parents may go through a surrogacy matching program, also called a surrogacy agency. These programs:
- coordinate the many services that are part of the surrogacy process
- work to make sure that everyone’s interests are protected
- can refer the surrogate and intended parent to attorneys who can help them with the legal aspects of surrogacy
- can refer the intended parents and surrogates to qualified health care providers.
In New York State, surrogacy programs must be licensed by the New York State Department of Health and follow the Department’s guidelines.
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Does Medical Insurance Cover Surrogacy
When women are carrying their own pregnancy, theyre able to use their own insurance. However, using a surrogate can make this process a bit trickier, as policies and coverage vary across insurance providers.
To cover your surrogate’s pregnancy with insurance, check that her insurance provider doesnt exclude surrogate pregnancies from their coverage plans. Certain clauses would mean its possible that your surrogates insurance provider wont cover costs associated with surrogacy.
Reach out to an insurance specialist referred to you by your surrogacy agency as a first step to determine your surrogates insurance coverage. Together, you can assess how much insurance coverage you or your surrogate will receive based on your unique case. You can also determine if you need to pursue additional coverage and how to manage out-of-pocket payments.
Lets review how these considerations will factor into your total insurance and financial plan.
How Does Insurance Coverage Work For Our Surrogate And Baby
Again, it would be nice if you could just provide surrogate insurance coverage through your own policy to take care of your gestational carriers surrogacy-related costs. But because shes the one who is pregnant, not you, this isnt how insurance providers usually handle it.
Your surrogate will typically have her own surrogacy insurance, separate from yours. If her policy doesnt have exclusions for surrogate pregnancies, shell usually go through her own medical insurance provider. Even if there are exclusions for surrogate pregnancies, shell often be able to get at least some coverage from her own health insurance.
Remember that any out-of-pocket costs will be your responsibility, as the intended parent. All this will be detailed within your contracts before you even begin the medical process, to ensure everyone involved is protected and has a good idea of whose insurance will cover what.
Your American Surrogacy specialist will help you get your child on your insurance policy, usually before he or she is even born. The pre-birth or post-birth orders that youll complete with your attorney can be helpful in this process, but adding a baby born via surrogacy to your policy is typically the same as it is for any new parent. Surrogates are never financially responsible for the medical costs of the intended parents newborn baby.
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Someone Had Recommended A Backup Plan Is This A Good Idea
We recommend backup policies be purchased when there is not a full guarantee that the surrogates current insurance carrier would cover a surrogate pregnancy. The backup policy then serves as a safety net. If the primary insurance carrier chooses to deny a members maternity claims, the back-up policy would then come into effect to cover those costs. The back-up policy would only be activated if the claims were denied. We do NOT recommend that surrogates use ACA plans as secondary insurances, as primary ACA plans can deny claims for up to two years after the claims have been submitted, but secondary ACA plans can only backtrack a few months, potentially leaving the Intended Parents/Surrogate liable for the full amount of the maternity fees.
Hopefully this has answered a few of your questions, but we are always available to discuss any further concerns you may have. You can reach us at or by calling us at 888.799.7077.
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Help Where Do I Start
First and foremost, understand that health insurance for the pregnancy is very different from health insurance for the baby/babies. The insurance for the baby goes on the intended parents insurance, while surrogate health insurance is for the pregnancy. This post will mostly cover the insurance for the pregnancy.
Each time a surrogate enters the program, ConceiveAbilities has their insurance reviewed by our insurance partners, ART Risk Solutions. They are the industry experts at surrogacy insurance. If the Intended Parents choose to work with the surrogates insurance, they will give us a determination on the likelihood that the surrogates insurance will accept the claim.
Id say less than 5% of surrogate healthcare plans, state exclusively that they will cover a surrogate pregnancy. said Deb Levy, Clinical Director and Surrogacy Specialist at ConceiveAbilities, About 30% state clearly that they will exclude a surrogate pregnancy. And then everything else is somewhere in the middle: either its silent on surrogacy, the language is ambiguous, or the healthcare plan is self funded, which is most risky.
Can A Surrogate Choose To Use Her Own Insurance Plan
In some cases, the surrogate is able to choose her own health insurance plan. Its important that the surrogate looks over the policy with a qualified insurance specialist whos familiar with the fertility industry. The insurance specialist can determine whether a policy is acceptable to use during the surrogates maternity policy. Keep in mind there are several variables to consider, such as the Employer Open Enrollment period, fully funded policies, loss of employment, or self-funded policies.
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So Whats The Best Option For My Surrogates Insurance
The best solution for you will depend on when your surrogacy pregnancy starts. A lot of couples try to time their surrogacy journey to start between December 1 and January 1 this is a super busy time for U.S. surrogacy agencies Thats not always possible, so you should be aware of how the timing of your pregnancy will effect your insurance options .
To know for sure, you need to do some math
8. If you surrogate has her own insurance and it will cover the pregnancy, congratulations! You dont need to do anything . But in the likely event that she does NOT have insurance, the path forward depends on your timing
a. If you become pregnant around November, you are in luck! Its Open Enrollment time, and you can sign up for an ACA plan right away. Youll get the best deal on insurance for your surrogate, and the options are pretty clear on the ACA website.
b. If you get pregnant in September, you will need to buy Gap insurance for 3 months until your ACA plan can begin paying your expenses.
c. If you get pregnant in July, youll probably need Gap insurance for 6 months .
d. If you get pregnant in March, your entire pregnancy will conclude before the ACA open enrollment period so Gap Insurance makes no sense. You should consider a Private Insurance policy. But depending on the deductibles required, that may also be expensive.
Why Do I Need Health Insurance For My Surrogate
Health insurance requires a financial commitment, so why is it so vital?
Surrogacy health insurance is one of the most important parts of a surrogacy arrangement. It ensures that the surrogate and the pregnancy are protected in case any complications should arise.
In a surrogacy arrangement, there are a lot of moving parts and various parties involved. Even with the greatest experts, state-of-the-art technology, and meticulous financial planning, medical bills can accumulate quickly.
Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute as the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs. According to The New York Times, The cumulative costs of approximately four million annual births is well over $50 billion.
ConceiveAbilities does not allow Intended Parents to leave their surrogate uninsured.
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Can My Surrogate Just Use Her Own Insurance Plan
It may be possible. Only careful evaluation of your surrogates personal policy by a qualified insurance specialist with knowledge of the fertility industry can determine whether your surrogates personal policy is suitable for use for a surrogate maternity cycle. There are many variables to consider and pay attention to throughout a surrogate journey. It is important to work with someone who understands the challenges, changes, special qualifications requirements as well as the timeline of enrollment requirements. Self funded, vs. fully funded policies, Employer Open Enrollment, or loss of employment are a few variables that may affect your cycle.
Will The Surrogacy Insurance Cover Infertility Treatments Too
Depending on your insurance, your infertility treatments may be covered up to a certain amount. Typically, this insurance covers the IVF costs to create an embryo.
As of August 2020, 19 states have laws that require insurance companies to either offer or cover coverage for infertility diagnosis and treatment. In California, health insurance companies must offer infertility insurance coverage for diagnosis and treatment of infertility, but they arent required to cover IVF.
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Here Are Some Examples To Explain The Reasoning
Lets assume your Gap insurance costs $1,200/month with $1000 in enrollment fees. Also assume your ACA plan would be $500/month . Finally, lets assume that a Private Insurance program is available for $1,000/month for a 12 month term.
a. If you need Gap Insurance for 3 months, thats $4,600 additional to your surrogacy budget.
b. If you need to buy that Gap insurance for 6 months, thats about $8,200 in total. Depending on the plan , your Gap insurance may start to become as expensive as just buying a Private Insurance policy.
c. If you need Gap insurance for 9 months well, thats not really Gap Insurance at all because the policy will have to run the entire duration of your surrogacy journey. It would definitely be cheaper to buy a Private Insurance policy.
Are Surrogates Covered By Insurance
It depends. So its important that we expand and look at this issue from several angles.
First of all, when we say health insurance in this context, were referring to just a regular insurance policy that you use to cover your general health expenses. Were not referring to a specific surrogacy policy, which well discuss below.
Second of all, its important that we differentiate between the surrogates insurance policy and the intended parents insurance policy.
Finally, the surrogacy process includes multiple steps, so its important that we specify which procedures are covered and which arent.
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How Do I Get Started
The gestational surrogacy cost and medical insurance can be overwhelming to navigate. Thats why its so important to work with an agency like Simple Surrogacy. If you want to build a family through surrogacy, our helpful representatives can help you find the perfect surrogate mother.
Our friendly and knowledgeable representatives can also help you determine your current health plan or if you need a new one. This allows you to focus on more important things, such as getting to know your surrogate mother. When youre embarking on the surrogate journey, its easy to forget about the costs and medical insurance, but its a crucial step.
Contact Simple Surrogacy today by reaching out to us online or calling us at 1-866-41-SURRO for more information on gestational surrogacy.
What Does Health Insurance For A Gestational Surrogacy Cost
Health insurance plans have a wide variety of costs. Insurance plans can cost between $550-$850/month on the Affordable Care Act. In addition to the monthly cost, there will be co-pays and deductibles, typically with an out of pocket max of around $6,000-$9,500. The range of costs there depends on the plan selected. Some plans have lower cap amounts but higher monthly costs.
Another option is Prime Insurance which partners with select insurance carriers to protect surrogate mothers and intended parents. The upside to these plans is that you can purchase them anytime of the year. While they cost more than the ACA plans, theyre still cheaper than most pregnancy plans.
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How Much Does Insurance Cost For Surrogacy Maternity Coverage
If you have done the math and your surrogates insurance plan doesnt cover surrogacy, fear not! You can choose to purchase comprehensive surrogacy-specific coverage. Although this is a great fallback, the cost-effectiveness of this option will vary depending on your unique circumstances.
For instance, while the thought of paying out-of-pocket for surrogacy sounds difficult, surrogacy insurance plans also tend to be expensive. Although, the benefit of surrogacy coverage insurance plans is that they cover surrogate medical costs, which may make these plans a great remedy if your health insurance plan doesnt offer much coverage. Its not recommended to cash pay without placing some kind of stop loss policy, but there are backup plans for cash paying to limit your financial liability and add a safety net.
If youre choosing to purchase a new insurance policy for your surrogate or opting for a completely new insurance plan, its important to consider if this plan will be accepted at your surrogates preferred OB/GYN and delivery hospital for her comfort. It may require a little back-and-forth to discover facilities that are within your surrogates defined preferences for all prenatal visits and the delivery that also takes your insurance. This will ensure that you are paying minimal out-of-pocket costs, and do not become responsible for the full amount of medical services or your babys hospital care.
Is Surrogacy Covered By Insurance Provider X Y Or Z
There are some insurance providers that are known to be more surrogacy-friendly than others, but as always, you should check with your American Surrogacy specialist to review your policy in greater detail.
Some common questions about frequently used providers have included:
Does Tricare cover surrogacy?
No. Many of the women who choose to become gestational surrogates are military wives, so they have Tricare insurance. However, this is the one provider we recommend both surrogates and intended parents stay away from, as theyre strict about the exclusion of surrogate pregnancies and wont offer coverage for either party.
Will Blue Cross pay for surrogate mother?
Potentially, yes, Blue Cross Blue Shield will usually pay for the surrogates maternity expenses, at least. There are no exclusions for surrogate pregnancies. However, insurance policies are subject to change. As always, check with your surrogacy specialist and your insurance representative for more information about what is covered by your specific policy.
Does Aetna insurance cover surrogacy?
Again, its important to always check with your surrogacy specialist and your personal insurance representative for more information about what is and is not covered by your individual policy. Youll usually be at least partially covered for some of your IVF costs, and your surrogates maternity costs may be covered if she has Aetna, as there is no surrogate exclusion clause.
Does Cigna insurance cover surrogacy?
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