Infertility is a devastating blow. You may grieve your fertility just as you would grieve any other loss, or grieve for the child you wish you could have had long ago. Infertility treatment is highly effective, yet about half of infertile couples do not seek treatment. For many, fears of exorbitant costs are a major deterrent.
Most people have heard that insurance does not cover infertility treatment. The truth is more complicated. Texas has an insurance coverage mandate that requires insurance plans to offer IVF coverage. Even if you don’t have IVF coverage, however, you may have some level of infertility coverage available to you.
Fertility Insurance Rules in Texas
Fortunately, Texas has infertility insurance laws in place. Unfortunately, these laws don't always make coverage mandatory. Texas requires insurers to offer coverage for in vitro fertilization (IVF). It does not require employers to pay for this coverage or insured people to buy it.
This means that you have the option to buy a plan that covers IVF, but that plan will likely cost more. For people who do not struggle with infertility, this cost can be a deterrent. Or maybe you didn’t opt for IVF coverage when you first purchased your plan, and are having trouble getting it now.
Consumer choice and individual plans are not required to cover IVF. Texans are also increasingly investing in non-insurance plans, such as Christian cost-sharing plans. These plans are not required to cover IVF and rarely do.
Additionally, religious employers -- such as Christian universities, closely held religious corporations, and churches -- are not required to offer plans that provide coverage for IVF. They are not prohibited from doing so either, though, so the fact that you work for a religious employer does not necessarily mean you don’t have coverage. Self-insured employers are also not required to offer IVF.
Plans that do cover IVF are not required to cover first-line infertility treatments. These treatments tend to be more affordable and work well for many conditions. First-line treatments directly treat a specific fertility issue. For example, ovulation induction is a treatment for PCOS and some other ovulatory disorders.
If you are planning to have a baby in the next few years, or if you have already begun trying for a baby, consider investing in a plan that covers IVF. IVF can cost several thousand dollars, and many couples need to try multiple cycles. So the small additional premium will still offer significant cost savings beyond the significant expense of IVF infertility treatment.
With that being said, we accept most insurance types (private and commercial health insurance coverage), including:
- Blue Cross Blue Shield
- First Health
- Great West
- Tricare/Tricare West
- United Healthcare
Insurance Coverage in Other States
Some examples of laws in other states include:
- California requires insurers to offer the chance to buy infertility coverage. This coverage must cover most infertility treatments, but not IVF.
- Rhode Island requires plans that offer maternity coverage to also cover medically necessary fertility procedures.
- Ohio requires coverage for most diagnostic and exploratory infertility services.
- Louisiana prohibits exclusion of coverage for a correctable medical condition solely because that condition also causes infertility.
Most states, however, do not mandate any coverage at all.
Employers increasingly understand that fertility can be key to worker happiness, and therefore to productivity. So some large employers now offer health insurance packages that feature some form of infertility coverage even when and where state laws do not require it.
Examples of employers that cover some infertility treatments include:
Qualifying for IVF Insurance Coverage
If you have a plan that covers IVF, you still have to qualify for treatment. Each plan sets its own standards. If you have an out-of-state plan or you receive coverage above and beyond that required by the law, the legal mandate in Texas may not apply to you. Instead, you’ll need to review your policy to qualify. Your fertility specialist can help you with this.
If you’re in Texas and have purchased a plan that meets the state’s minimum requirements for IVF coverage, here are the qualifying criteria:
- You must have had infertility for at least five continuous years. Seeking treatment as early as possible can help you document this history.
- You must have tried less costly treatments such as ovulation induction.
In certain cases, couples with any of the following conditions are eligible for treatment without the five-year waiting period:
- Diethylstilbestrol (DES) exposure
- Removal or blockage of one or both fallopian tubes
- A man who does not produce sperm
Note that the diagnostic procedures for some of these conditions are likely to be covered by insurance. Endometriosis, for example, is a serious and chronic medical condition, and insurers typically cover both diagnostic testing and treatment.
CAPEXMD specializes in providing patient financing services for all fertility treatment options. Our easy, convenient loan process and competitive rates ensures that the financial aspects of treatment are not an obstacle to achieving your dream of a family. CAPEXMD offers a wide variety of fertility loan options, allowing you to attain the necessary financing required to make your infertility treatment affordable. Each loan program is designed to fit your individual circumstances and once approved, our Fertility Loan Specialists will work closely with our fertility center partners to ensure the funds are secured prior to the commencement of your treatment.
Prosper Healthcare Lending is the premier financing company in the fertility and surrogacy industry.
With over 1,500 patients empowered by over $21,000,000 in funded Prosper fertility loans, this is a name and financing program you can trust.
Some of the benefits of using Prosper Healthcare Lending for financing your fertility treatment include:
- Financing ANY fertility or surrogacy treatment related expenses, including medication
- Loan amounts go up to $100,000 and terms out to 84 months
- Instant decision without affecting your credit on loans under $35,000*
- Anyone can submit- family members or friends can inquire about a loan on your behalf
- Convenient- you can apply through your provider’s website in less than 2 minutes
Center of Reproductive Medicine - Provider #004466
*Only for fertility loan inquiries submitted through the Standard Credit Program
The ReUnite Assist program provides discounts off of specific fertility drugs for eligible patients. Patients will receive an email after completing their online application with instructions on their discount savings and additional program details.