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.
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.
While most of our patients have insurance coverage in Texas, some travel to Texas from other states. Additionally some Texas residents may be insured in other states. This can happen if you work remotely for a large company, if your company bought insurance coverage in another state, or if you’ve recently moved. So it’s important not to assume that your insurance coverage is in Texas. Check your policy. The state law that governs your policy may influence which services you are eligible for.
Most states, however, do not mandate any coverage at all.
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: