Understanding Fertility Insurance & IVF Cost in Long Island
Every patient’s financial situation is as unique as their infertility journey - and treatment costs range just as dramatically. While most patients will have some coverage for an evaluation and even IUI, IVF coverage will depend on the benefits offered by your employer. Currently only 17 US states have fertility insurance coverage laws. Another seven states have fertility preservation legislation on the books. Understanding insurance and treatment costs starts with understanding your employer’s plan to confirm if they are one of the following types:
- Fully Insured or Self-Insured: Fully insured plans follow state law. Self-insured plans follow federal law and are exempt from state law.
- Greater Than Plan: A “greater than 25” plan, “greater than 50” plan, often do not have to provide coverage.
- Governed State. The insurance policy must be written and/or reside in the state that has an infertility coverage law.
Out of pocket expenses can range from a few hundred dollars to a few thousand dollars or more. While the most expensive treatment paradigm is IVF with embryonic testing it is also the most effective and may shorten the overall time in care and reduce the total amount of money spent. Speak with your NYRW financial care team to talk about cost and insurance options and see what might be best for you.
While there are plenty of exceptions, group policies offered in New York state must provide infertility diagnostic tests and procedures that include:
- Hysterosalpingogram
- Hysteroscopy
- Endometrial biopsy
- Laparoscopy
- Sono-hysterogram
- Semen analysis
- Blood tests and ultrasound
- Provides up to 3 IVF cycles (fresh embryo transfer or frozen embryo transfer) to patients in the large group insurance market (100 or more employees).
- Provides medically necessary fertility preservation medical treatments for people facing iatrogenic infertility caused by a medical intervention, such as radiation, medication, or surgery, in all commercial markets (individual, small and large groups).
- Every policy that provides for prescription drug coverage, shall also include drugs (approved by the FDA) for use in the diagnosis and treatment of infertility.
- Prohibits delivery of insurance coverage from discriminating based on age, sex, sexual orientation, marital status, or gender identity.
New York State Infertility Insurance Mandate
For several years New York State has offered a grant program for qualifying NY residents who have health insurance that does not cover IVF called the NYS Infertility Demonstration Program (IDP). While helpful to some the IDP was limited to a handful of patients and providers.
However, On March 31, 2019, the legislature in Albany passed the 2020 NYS budget and Governor Cuomo signed a new bill that expanded infertility insurance coverage into law on April 12, 2019. The three main components of the new laws offer the following:
- Provides up to 3 IVF cycles (fresh embryo transfer or frozen embryo transfer) to people who get their health insurance from a fully insured employer who has coverage on the Large Group market. These are companies with 100 or more employees.
- Provides medically necessary fertility preservation medical treatments for people facing iatrogenic infertility, that is, infertility caused by a medical intervention, such as radiation, medication, or surgery, in all commercial markets, including those getting insurance from the Individual market, as well as the fully insured Small Group and Large Group markets.
- Prohibits delivery of insurance coverage from discriminating based on age, sex, sexual orientation, marital status, or gender identity.
