Does Medicaid Cover IVF Insurance?

Does Medicaid Cover IVF Insurance?

Last Updated on July 7, 2022 by Anne-Sophie Reinhardt

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Ironic, the question is not “Does Medicaid Cover IVF?” but “Why people do not use Medicaid Coverage for IVF?”.

The NSFG (National Survey on Family Growth) has shown that women with Medicaid coverage don’t use their plans to help get pregnant as much as those without private insurance. This is because the majority of US states don’t provide fertility treatment.

Other studies have shown that New York was the only state where policies required Medicaid to cover fertility treatment. As of April 2021, however, 19 States had passed laws that covered fertility treatment. Furthermore, 13 of these laws also include IVF coverage. Other States may require Medicaid to pay for IVF procedures and treatments that could hinder pregnancy.

These treatments may include thyroid drugs, fibroids, abnormal bleeding, IVF procedures, and other gynecologic problems that can cause pelvic pain.

IVF Insurance Coverage – What is IVF?

The series of complex procedures that corrects genetic problems or increases fertility is In-Vitro Fertilization (IVF). It allows patients to conceive and deliver babies. To be exact, the most efficient form of assisted reproductive technology (ART) is IVF.

Firstly, the eggs are taken from the ovaries and then fertilised with sperms in a clean area during the IVF procedure. Secondly, doctors will fertilise the eggs and transfer them to the uterus. In conclusion, a complete IVF cycle can take approximately three weeks.

You can use the eggs of a patient and the sperm from their spouse to perform IVF. The process can also use anonymous donors’ eggs and sperm if necessary. Furthermore, a surrogate (gestation carriers) may be recommended if the patient cannot carry fertilised eggs.

What Are the Eligibility Requirements for Medicaid to cover IVF?

The insurance mandate mentions that a State’s Medicaid program should cover pregnancy-related benefits, like IVF and Infertility treatment. This law also requires that health plans for teachers and state employees include the same infertility coverage.

Besides, the mandate has also been updated to clarify that infertility can be defined as a condition that affects the functioning of the reproductive system. The new law aligns the requirements to the medical definition of infertility. As a result, it allows women without partners or women with same-sex partners to apply for Medicaid infertility coverage.

In some states, Medicaid may cover infertility treatments by those who meet the criteria. So, these criteria are:

  1. The man cannot impregnate the woman.
  2. A woman over 35 with a male partner cannot conceive after one-year of unprotected sexual sex.
  3. After 12 unsuccessful attempts at intrauterine fertilization under medical supervision, a woman who is over 35 years of age still cannot conceive.
  4. A woman over 35 without a male partner wasn’t able to conceive after six attempts at intrauterine insemination.
  5. Involuntary medical sterilization is the reason why partners are unable to conceive.
  6. If the woman is unable to carry the pregnancy to live birth.
  7. If the law states that the woman was infertile in the past.

What Does Medicaid Cover with Regard to IVF Procedures?

If the plan provides pregnancy benefits, Medicaid must pay for three IVF cycles, these procedures are:

  1. Treatment that commences when preparative drugs are given to excite the ovaries for oocyte retrieval with the intent of IVF with a fresh and frozen embryo transfer.
  2. IVF procedures where the embryo is implanted in a surrogate using donor eggs.
  3. ICSI (Intracytoplasmic sperm injection).
  4. Assisted hatching.
  5. Fertility examinations and diagnostics.
  6. Infertility medications.
  7. Infertility surgery (when deemed necessary).
  8. ZIFT (Zygote intrafallopian transfer).
  9. GIFT (Gamete intrafallopian transfer).
  10. Ovulation induction.

Does Medicaid Cover IVF Require Services Before A Procedure?

Medicaid will pay for services that are necessary before an IVF procedure. These services include:

Physician Clinic Visits

A visit to a physician clinic involves an appointment with a certified fertility specialist, a reproductive endocrinologist. You can discuss any concerns with the doctor during the visit.

Hysterosalpingogram

The Hysterosalpingogram, an x-ray procedure to check the health of your fallopian tubes or uterus. A blocked fallopian tube or an abnormal uterine cavity can cause infertility.

Blood Testing

Before undergoing an IVF procedure, doctors have to do a blood test to assess the level of FSH (follicle-stimulating hormone) in your body. This will allow the reproductive endocrinologist to determine the quality and quantity of eggs that you might have.

Pelvic Ultrasound

An ultrasound of your pelvic region can give you valuable information about the uterus and endometrial lining. A specialised ultrasound can also be used to evaluate your ovarian reserve and uterine shape.

Which Infertility Prescription Drugs Does Medicaid Cover?

Medicaid will also cover medically required ovulation stimulation medication and medical services related to monitoring and prescribing these drugs. This applies only to Medicaid enrollees 21-44 who are experiencing infertility.

Medicaid will cover the following ovulation stimulation medications for a maximum of three treatment cycles per lifetime: Clomiphene citrate, Bromocriptine, Tamoxifen, Letrozole.

What Can Fertility Clinics Do to Make IVF Procedures as Cost Effective as Possible?

Fertility clinics are able to make infertility treatments as affordable as possible for patients. They Involve the patient in IVF treatment grant programs. It is estimated that the total value of all the services provided for one Gift of Hope IVF grant will be around 15,000 USD.

Clinics can help you create a customized treatment plan for each patient to maximize their success and reduce costs. They make sure you take advantage of every benefit available to your Medicaid plan.

The Fertility Clinics can help you access the best 3rd-party financing for IVF treatments to get the treatment you need. They also guide in maximising the discounts on prescription medication offered by a partnership between the clinic and pharmaceutical manufacturers.

What more?

In case your Medicaid does not cover IVF, or for any reason, you don’t have this coverage, you can apply for IVF Loans or IVF Grants.

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