One of the most frustrating aspects of infertility treatment is the sheer cost of the enterprise. The intensive monitoring, advanced technology, and volume of medication can create enormous bills. To compound the situation, very few people have insurance coverage for infertility treatment. So, does your dream of becoming a parent have to suffer just because you aren't independently wealthy? No. There are alternatives and solutions. You can make it work.
By way of apology, this article will focus on infertility treatment in the United States. It's what I know. Many other countries are more advanced in recognizing infertility as a disease. I do know that there are expanded opportunities for insurance coverage in Canada, for example, depending on diagnosis. In addition, advanced techniques such as IVF can be much cheaper in other countries; cheap enough to offset the cost of travel.
Also, I'm not an accountant, just an infertile woman without a wealthy relative. Please don't rely too heavily on anything I say. If you have questions, contact a financial advisor or accountant.
Location, Location, Location
The best way to have your infertility treatment paid for is to live in a state which mandates insurance coverage. These states may be broken down into categories.
Mandate to Offer States
These laws require insurance companies to offer insurance coverage to employers. However, the law does not require companies to pay for the coverage. The Mandate to Offer states are: California (excluding IVF, including GIFT); Connecticut (only to group policyholders); and Texas.
Mandate to Cover States
These laws require that insurers provide infertility coverage for every policy. The Mandate to Cover States are: Arkansas (IVF only); Hawaii (one cycle of IVF only); Illinois; Louisiana; Maryland (IVF only); Massachusetts; Montana (only applies to HMOs and only as a "preventative service"); New Jersey; New York; Ohio (similar to Montana); Rhode Island; and West Virginia (similar to Montana and Ohio).
If you live in a mandate state, you've got it made. If not, you do have the option of moving to a mandate state. This works particularly well for people who live in cities which border mandate states. Could you find a job in a mandate state? Could your partner? One word of caution is needed, however. The mandates do not apply to companies which self-insure their employees. This can be a crucial distinction, and it is something that must be investigated before a new job is obtained.
Get a Little Help From Your Friends
There are employers who are well-known for providing infertility benefits, regardless of mandate. One trick is to explore companies who have corporate headquarters in mandate states. Often, they will extend the infertility benefits to all employees, even those employees do not work in the mandate state. There are several national clothing retailers who offer excellent infertility benefits, as well as several financial institutions.
However, in this time of corporate belt-tightening, several companies in non-mandate states are discontinuing their infertility benefits. Also, as a warning, companies in non-mandate states are making it increasingly difficult to qualify for infertility coverage. For example, they may require you to work a certain number of hours, gain a certain amount of seniority, or put similar conditions on your receipt of the benefits. Still, this is a viable option for women who are not under a pressing time crunch.
Use What You've Got
You or your partner's company may offer a 125(c) program (also called a cafeteria plan, a medical savings account, or a health slush fund) as part of its employee benefits package. A 125(c) plan allows you to place pre-tax dollars into a savings account. The money from the account reimburses you after you pay up-front for medical expenses. The IRS considers infertility treatment to be a medical expense. This means that you may reimburse yourself with tax free dollars after you pay out of pocket for infertility expenses.
The savings opportunities with a 125(c) plan arise because you don't pay taxes on the money that goes into the account. The savings aren't enough to cover major expenditures like an IVF cycle, but it can help with things like medication. Every penny helps. It is important to remember that 125(c) plans do not roll over from year to year. You must use your money within a given calendar year or it's gone. This is important to consider when you are deciding how much money to withhold. For more advice, visit with a Human Resources person at your job or at your partner's job.
The IRS allows a deduction for out of pocket health care expenditures as long as those medical expenses exceed 7.5% of your adjusted gross income. This can get tricky, and it's best to consult a tax advisor. The IRS does allow deductions for expenses related to infertility treatment, so if you've had a lot of out of pocket expenses this year, you might want to consider using this route.
Fight For Your Rights
Resolve, the national support group for infertility, has introduced the Family Building Act of 2003 (H.R. 3014). This legislation would require insurance coverage for infertility treatment (up to four IVF attempts) by all group health plans that also provide OB benefits. The legislation would also apply to self-funded plans. Concurrently, H.R. 3026 would require the federal government to provide infertility benefits to its employees, including military personnel.
Call your representative in Congress and urge him or her to support this legislation. While it might not be passed in time for some of us to benefit, this legislation would be a giant step forward towards the recognition of infertility as a disease. For more information, go to Resolve's Insurance Coverage Information.
Beg, Borrow, and Steal
Unless you are blessed with a benefactor, at some point it may be that you have to borrow money in order to pursue your family building options. You can go a traditional route and use a home equity loan or another type of secured loan. There are a couple of lenders who cater to infertility patients. One, IntegraMed, is currently offering unsecured loans at 5.9% interest rates. The company works with certain clinics throughout the country, so this won't work if your currently clinic does not participate in the program. You can visit the company at www.integramed.com and learn more about the program. Most, if not all, lenders that cater to the infertility crowd have certain eligibility criteria which must be met before a loan is issued. It's important to remember that this isn't a judgment about your chance of success with IVF. It's just the company's way of protecting itself and its assets. Realistically, if you are under 37 you should be able to qualify for one of these loans.
Learn to Share
If you are at a point where IVF looks like your best option, consider participating in a shared cycle, also called egg sharing or split cycling. In this case, one woman goes through IVF as normal. However, she shares half of the retrieved eggs with another woman. The recipient woman pays the bulk of the costs of the cycle. In fact, the cost to the donor woman can be as little as $200, depending on the structure of the program. This won't work for everyone, since some clinics have strict physical guidelines for admission into an egg share program. In addition, sharing eggs isn't for everyone. But, if you think you could get comfortable with donation, egg share cycles are a wonderful way to make IVF a financial reality.
One Word of Caution
We're all looking for ways to cut corners, and an easy way to save a few dollars is to buy your medications from somewhere other than a licensed pharmacy. There are several on-line sites that facilitate the swapping or selling of medication. Please, don't do this. It's not safe. You don't know where the medication has been, whether it's been stored properly, whether it's expired, and whether you're actually getting the medication that you have agreed to purchase.
Your RE may have a program that could allow you to get some medication for free. In addition, at least one drug manufacturer offers a discount based on income qualification. It may be that you can round up some free or discounted medication from your doctor. But don't try to do it another way.
Financing infertility treatment is incredibly difficult. In addition, the stress of trying to come up with the money can cause friction within your relationship. Hopefully, one of these ideas will spark something that allows you to pursue your dream of becoming a mother.
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