Does Medicare Cover IVF? – Overview
According to the United States NLM (National Library of Medicine), roughly 10% of couples in America are considered infertile based on their inability to conceive after one year of unprotected sex. Such couples can pursue fertility treatments to help them conceive.
Over the years’ demand for fertility treatments has been on the rise.
However, Medicare will only cover fertility treatment if a physician deems the procedure to be medically necessary. This means some people wait longer to get help, or they get no help at all.
Unfortunately for Medicare enrollees, the more a person grows old, the less fertile they become.
Even though advancements in the Medical field make it easy for companies to cover fertility treatments, Medicare might turn them down due to their age.
Millions of Americans struggle to conceive and keep their pregnancies up to live birth.
Based on exam results and the diagnosis, the fertility specialist; reproductive endocrinologist may recommend various fertility treatment options to help you conceive.
What Is IVF?
IVF (in vitro fertilization) is a complex succession of procedures meant to prevent genetic issues or improve fertility so that a patient can conceive and give birth. IVF is perhaps the most effective form of ART or assistive reproductive technology.
Eggs are retrieved from the ovaries and fertilized by sperms in a lab during the IVF process. The fertilized eggs are then relocated to the uterus. One entire IVF cycle takes about three weeks.
IVF can be done using a patient’s eggs and the sperm of their partner. The procedure can also be done using the eggs and sperms of anonymous donors if need be.
In some cases, if the patient cannot carry the fertilized egg, a surrogate (gestation carrier) will be used.
Does Medicare Pay for Fertility Treatments?
If your physician deems a fertility procedure to be medically necessary, then Medicare Part B can apply. All situations are unique, so individual guidelines and even expenses will vary case by case.
Your physician must first go through the screenings to prove you’re infertile if you happen not to be getting any success conceiving.
Being that Medicare won’t pay for your IVF procedure, some other fertility treatments that physicians can recommend include:
1. ICSI (Intracytoplasmic sperm injection).
2. Intrauterine insemination (IUI).
3. Infertility medications.
4. Assisted hatching
5. Ovulation induction
6. Infertility surgery (when deemed necessary).
Which Parts of Medicare Pay for IVF Procedures?
Medicare Part A
Medicare Part A covers your accommodation in hospitals and nursing facilities. Therefore, if you have Part A coverage, then any reasonable and necessary services you will receive in hospitals about fertility treatment will be paid for by Medicare.
Since most people don’t pay premiums for Part A cover, Medicare will charge your coinsurance based on the type of facility you received treatment in and the length of your stay in the facility.
Medicare Part B
Medicare Part B will be for specific physician services, medical supplies, and some medically necessary treatment about fertility. So if your doctor deems fertility treatment to be a necessity for you, Medicare Part B will pay for it. However, this doesn’t include IVF procedures.
Medicare Part C
Medicare Part C is also known as the Medicare Advantage plan, and its provided by private insurance companies under the authority of Medicare.
Although Medicare Part C covers all benefits included in original Medicare (Part A and B) and benefits such as prescription drugs, Part C won’t pay for your IVF or fertility treatment because it’s not required to cover them.
Note that the types of benefits and costs in Medicare Advantage vary depending on the program you are subscribed to. So ensure that you carefully compare various Part C plans before choosing one to see which caters to your needs best.
Medicare Part D
Medicare Part D is an elective plan that includes prescription drug coverage like Part C. Medicare Part D is also similar to Part C because private insurance companies provide it under the authority of Medicare.
Most Medicare Part D plans don’t cover prescription drugs meant to treat infertility and IVF, such as clomiphene citrate (Clomid).
However, Part D plans are constantly changing, and your insurance provider will let you know about any newly included drugs when changes occur.
FAQs Allied to Medicare’s IVF Coverage
How Does Medicare Detect Infertility?
Infertility is often considered a problem in women alone, which is incorrect because men experience infertility issues as well. The process of diagnosing infertility in women includes
1. Post-coital screenings.
2. Hormone tests.
3. Thyroid tests.
4. Hysterosalpingogram (X-rays of the uterus and fallopian tubes).
5. Pelvic ultrasound.
On the other hand, testing for infertility in men is a little bit different, and it includes:
1. Genetic testing.
2. Testicular biopsy.
3. MRI or CAT scans.
4. Semen analysis.
5. Testosterone level testing.
Does Medicare Pay for Sperm Analysis?
To correctly diagnose infertility in men, a semen analysis plays a key role. Medicare will pay for your semen analysis if your physician recommends that you visit a pathology lab.
Specialized facilities that have IVF procedures may need more thorough analysis, which could cost more. It’s rare for a physician to recommend that you get a semen analysis, so consult your local Medicare office to see if it’s covered.
Does Medicare Pay for Fertility Treatment Medication?
Even though Medicare Advantage Plans (Medicare Part C) are meant to cover prescription medication, they won’t pay for fertility prescription medication.
Some of the excluded prescription medications are:
1. FSH (follicle-stimulating hormone)
2. HMG (human menopausal gonadotropin)
3. Gn-RH (gonadotropin-releasing hormone)
All in all, fertility treatments such as IVF procedures can be very effective. Research shows that roughly 1.7% of all infants born in the US each year are conceived through ART (assistive reproductive treatment).
But, unfortunately, if you need an IVF procedure, you will be disappointed because Medicare won’t pay for it since these procedures cost thousands of dollars, and Medicare is designed to pay for the least expensive treatment option.