November 15, 2013

PCOS to Pregnancy: Infertitlity Coverage and the Affordable Care Act

I'm not here to debate politics. I honestly think there are some good and some not so good changes coming with the Affordable Care Act in 2014. We have health insurance through my husband's work and I consider our coverage to be pretty good. He called me last week when he received his open enrollment benefit package. There was a notice included that said there would be changes to infertility coverage. A quick call to our insurance company and I have answers as to what that means.

Currently, our insurance covers "diagnosis and treatment" of infertility. However, that doesn't mean they will cover any treatment plan my doctor recommends. IVF and IUI are off the table because my insurance won't cover any type of insemination or transfers. My insurance will cover up to $5000 per year in treatment for things that are covered.

This year, that has left us with prescribed medication that would be used in an IUI or an IVF cycle, but we are timing our intercourse. Our doctor has recommended IUI, but since insurance won't cover the procedure or the medication, this is not a path we are taking. IVF has also been mentioned as a next step, but once again...not covered.

Starting in January, the $5000 yearly limit will be lifted. IUI and IVF will be covered. There will be a lifetime limit of three cycles of treatment and lifetime limits on the amount of medication that can be prescribed.

While that all sounds great, it's important to note that while the procedures will be covered under insurance, until our deductible is met, these procedures will be very expensive for us for our portion. I also think that three cycles is very limiting. Many times it takes three cycles or more. So basically, if you can get pregnant within the three cycles, that's the only child my insurance will help you to conceive. No future children through insurance. If the treatments fail after three cycles, there will be no more second chances in my lifetime.

I met a woman in my doctor's office this week that had done three failed cycles of IVF last year. She took some time off and was back for more. Financially, this will be off the table for many people.

I'm really hoping that none of this will matter. I'm still mid cycle and praying that this new treatment plan will work. Hopefully, by January I will be pregnant and no longer need fertility treatment.

If you are struggling with infertility, I encourage you to call your insurance company to find out what changes will come in your plan in the new year. I can only speak for myself. Below are some resources that explain a little more how the Affordable Care Act influences insurance coverage.

What the Affordable Care Act does wrong when it comes to infertility treatment {Resolve}
The Affordable Care Act Part 1: Understanding how the ACA impacts insurance in the United States {Fertility Within Reach} - Keep an eye on this blog because part 2 will focus on infertility coverage

I'm Jenny, the mama behind the blog Cloth Diaper Revival.   I'm a stay at home mom to Noah and a wife to Chas, the cloth diapering dad.  I used to be a 3rd grade teacher until I was blessed with the birth of my first child, Noah. I'm currently trying to conceive my second child while struggling with infertility due to PCOS. This series covers my journey and my experiences along the way.


Thank you for sharing this information. We're in the same situation. We've had to pay out of pocket for everything. For us, the clomid, follicle ultrasound and trigger shot cost $250. Then there is progesterone supplements if I happen to run out that cycle (another $30) and we've also done estrogen patches in the past (another $40). It adds up quick and we also probably need an IUI, but just can't. We've also been referred to follistim, which we cannot afford either. It's all so frustrating! Thankfully, we finally found a level of Clomid I respond to (after many failed rounds of Femara, as in zero follicles) so we're just pushing forward as is... 20 months later.

Good luck Jessi! We were only able to afford the Follistem (and Ganorelix) after we met our deductible, but even then it was really expensive. This round of meds was about $400, but if we hadn't of met our deductible it would have been $1500. It's all so expensive!