Open Enrollment Tips – Is Your Infertility Treatment Covered in 2021?
Let’s say you work for a company that offers you insurance. Great!
And then you find out there is no fertility coverage under the plan. Not great.
In fact, that’s heartbreaking. Especially if you know you’ll be needing fertility treatments in the next year. The thought of not being able to achieve your biggest hopes because of a lack of insurance coverage is incredibly upsetting.
With IVF costing anywhere between $12,850 and $24,250 out-of-pocket, affording treatment straight from your bank account is not an option for most people. Therefore, your first response might be that you have two options: take out a large personal loan or indefinitely postpone any fertility testing and treatment until you can afford it or it’s covered by a future plan.
Before you accept another year of not having fertility coverage, paying for all your IVF or IUI expenses out-of-pocket, or just postponing treatment altogether, check out these three tips for open enrollment.
I'm not going to sugar coat this: the below suggestions will take honest effort from you, maybe several phone calls to your provider or employer, and some number crunching, but I assure you, your thorough research could pay off in getting you another step closer to success in family-building. Plus, it could save you major cash, which is often a huge hurdle in achieving your bigger goals.
What is Open Enrollment?
First, let’s briefly define “Open Enrollment.”
This is the time period where you can enroll, change, or drop your health insurance plans for the upcoming year (whether it’s Medicare, employer-based, or the health marketplace). There are varying degrees of coverage, ranging in prices from hundreds of dollars a month for a single-person plan, to well over a thousand for a family plan. And that doesn’t include deductibles. That price can go up for more all-inclusive coverage.
Open Enrollment for 2020 lasts from November 1 to December 15 for most states. Although, due to state preferences and the COVID-19 pandemic, a handful of states have elected to extend that (see if your state has an extension).
If you are tapping into employer-provided health insurance, you’ll need to ask your human resources department what their particular policy is. Employers set their own dates for open enrollment (it typically falls around the same time, but you should check just to be safe).
During this time, you can choose to stay on your employer-based health insurance or switch to another provider in the marketplace. You might decide to do this for infertility-coverage reasons, which we’ll help you dig through below.
And, it goes without saying, if you are planning for – or are engaged in – fertility testing or treatments, it makes sense to have the plan that does the most at the lowest possible out of pocket costs.
Tackle this Open Enrollment season with confidence, and do. your. research. Here’s where you can start…
Want the ultimate health insurance and fertility coverage breakdown?
3 Things to Do During Open Enrollment to Ensure Fertility Coverage in 2021
1. The deadline is Dec. 15 - but don’t wait until Dec. 14 to start your research.
You will want to read and understand your current policy as thoroughly as possible, and it’s not necessarily easy to understand. You may need to call the insurance company or talk to your employer’s human resources department to get correct and appropriate answers.
Then, compare against the other available policies. Look for treatments covered by each policy, lifetime limits on infertility treatment and how to get treatments approved for coverage.
Examine the formulary – the list of fertility medicines that will be covered. And make sure you are familiar with the annual deductible and additional payments that must be paid for each visit, procedure or prescription. Balance those expenses against the annual premium to determine which is likely to cost less over the year.
Ask the right questions to your provider. Need help with what questions to ask? We list them all out here.
Patient S.H. recommends, “Here’s something to keep an eye on: Blood work and fertility diagnostics should always be covered by insurance. Otherwise, you can end up paying thousands when you don’t need to.”
2. Use up your remaining 2020 coverage now!
Congratulations, you have chosen the right policy to help you cover fertility costs next year. Now determine how much of your annual deductible you have spent for this year. If you have gone through the entire amount, ask your doctors what tests you can do now to prepare for procedures in 2021.
The results from many tests are reliable for up to six months and your insurance will pay for the bulk of them until the end of the policy year. Your Flexible Spending Account (FSA), or other medical spending plans, are also valuable because you can use those savings to pay for any additional costs.
3. Look into insurance riders.
If none of the policies offered by your employer provide adequate coverage for infertility treatment, it may be possible for you to purchase a rider. A rider adds coverage at additional cost, but this option could be less expensive than paying out-of-pocket or getting a different carrier. If you are planning one or more treatments for intrauterine insemination (IUI) or in vitro fertilization (IVF), for example, the higher premium might be worth it.
Bonus tip: Reproductive Medicine Associates of Connecticut guides patients through the process of evaluating insurance and getting the most out of your coverage.
Now is the Time to Act
- Research all your options.
- Use the coverage you currently have to its full extent.
- Look into all possible riders.
Doing all of this now is the best gift you can give yourself, so that you can get the best medical coverage available to you within your means.
Read the fine print and understand what your options are, because if you wait too long, you might miss your 2020 coverage window. Again, I know that this all takes time, but think of how boss you’ll feel when you figure out this major piece of the infertility puzzle!
I understand that insurance is never a fun thing to talk about and waiting to speak to an insurance customer representative on the phone can really test a person’s patience, but remember the end game: your future family. The work you're doing now will all be worth it. You've got this!
How do I make sure my coverage includes infertility? How will I afford IVF Treatment out-of-pocket if it doesn't?
About Virginia Hamilton Furnari
Virginia Hamilton Furnari is RMA of Connecticut’s Brand Specialist and has a background in writing, marketing, and content production. In addition to helping mold the RMA of CT brand through blogs, videos, and events, she is also a patient and has undergone many fertility treatments. Given her professional and personal involvement in the fertility community, she has immersed her mind, body, and soul in family-building education.