Finance Guides

IVF Cost with insurance - how much is IVF with insurance?

How much will you pay for IVF? Here is how to calculate your cost for infertility treatment when using your insurance coverage.
How much does IVF cost with insurance coverage?
How much does IVF cost with insurance coverage?
You found out that your health insurance covers IVF, yay!

You’ve called your insurance and they confirmed that both your fertility doctor and your infertility treatment are covered.

Ok, great. So your insurance will pay for your IVF cycle, but how much will they pay for? 

Spoiler alert: Probably not all of it.

Don’t make the common mistake of having to call your insurance months after your IVF cycle is completed saying:

"If it was covered then why do I have a bill to pay?!"

A lot of people can get tripped up by insurance jargon and the word covered is probably the most notorious. And when it involves a treatment as expensive as IVF, it's important to understand what your personal costs will be.

If you understand what "covered" actually means in the insurance world, then you can set your expectations correctly. 

When a service is covered by your health plan, that means your plan is prepared to pay for the charges of your treatment. But you've got some money to pay too! 

In health insurance, there's usually a "cost-share" between the insurance company and you.

Ever heard of a deductible?

This is a dollar amount that you have to pay to your insurance plan when they cover treatment for you.

Ever heard of co-insurance?

You may have that to pay too.

If you learn what these words mean and what these numbers are on your insurance plan, you can calculate how much you will have to pay for IVF based on your insurance coverage.

For most insurances plans, there are three terms you need to know: 
  • deductible
  • co-insurance
  • max out-of-pocket

Some people might have copays but it’s less common for infertility procedures.

Keep in mind that if a treatment is "not covered" by insurance, then you pay the entire bill yourself. Your insurance won't be involved at all.

"Covered" treatments get applied to your deductible, co-insurance, and max out-of-pocket. Non-covered treatments do not.

Let's figure out your cost of IVF when using insurance!

How much does IVF Cost With Insurance?


You first need to know these three words and what the numbers are under your insurance plan.

Deductible 


Your medical plan likely has a deductible and it's important to know what the dollar amount is, because you pay that. 

Deductible: The amount of money you have to pay for "covered" services before your insurance plan starts to pay anything. 

Your deductible could be $200 or even $2,000 depending on your plan. 

If you have an HDHP plan or a family plan with multiple people (spouse, partner, children) added as dependents, your deductible is likely higher.

If you're doing IVF, be prepared to pay your deductible pretty quickly. 

The deductible has to be paid each plan year in which insurance covers treatment. You only pay your deductible once a year. 

After that, you move on to co-insurance. 

Co-insurance


Once you've paid your entire deductible, insurance starts to pay a part of your bills! 🎉 

This is where a 'cost-share' between you and insurance comes in, known as co-insurance.

This part always looks tricky on plans but it's really not!

Keep in mind that this is not a copay in which there's a flat fee like $20 each visit. This is actually a percentage of the IVF cost that you pay. 

Co-Insurance: The percentage of each bill that you pay for after your deductible has been paid. Usually you pay a small portion of the bill (e.g. 20%) and your insurance pays the rest (e.g. 80%).
 

The percent of the bill that you pay depends on your insurance. It could be 10% or 20% of the bill. 

Ask your insurance plan what your coinsurnace is for infertility coverage.  

Do I have to pay co-insurance forever? 😩

Usually no, but it depends on the plan! For most plans, you pay co-insurance for each bill that your insurance covers until you've paid a certain amount of the bills. This amount is called the max out-of-pocket.

Max out-of-pocket


The light at the end of the tunnel! 

This is the limit for the amount of money you will pay for covered treatment.

The amounts you paid to your deductible and co-insurance all eventually add up to you meeting your max out-of-pocket. 

Max Out-of-pocket: The maximum amount of money that you will pay for covered treatment in a plan year. Once you have paid up to your max out-of-pocket on your plan, then insurance starts to pay 100% of the bill for your covered services.

If you're still confused by insurance and numbers aren't your thing, then the only number you should pay attention to is the max out-of-pocket. 

Once you've hit this number, you're done paying!

Keep in mind that you need to ask your insurance plan whether your IVF coverage has a max out-of-pocket and what that dollar amount is. Some insurance plans have special rules where certain types of medical coverage doesn't have a cap for when you'd stop paying part of the bill.

Let's say you have a $3,000 max out-of-pocket for IVF coverage.

Once all your payments for deductible and coinsurance total $3,000 then you've met your max out-of-pocket! After that, you won't pay any more bills for anything your insurance covers. You'll just get statements showing that you owe $0.

Some people hit their max out-of-pocket in their first treatment while others may meet it gradually over the course of the year.

Copays


You're not likely to have very many copays when undergoing IVF or IUI but it's good to be aware of these anyway. Some plans do work through copays instead of co-insurance. These are flat fees instead of you paying a percentage of each bill. You've probably paid one of these after a doctor's visit.

Copays: Copays are set dollar amounts that you pay for a service, like how you might have a $20 copay when you go in for an office visit with your doctor.

How to calculate your IVF cost with insurance


Let's do some examples!

These examples are for someone who is using an in-network clinic with their insurance plan and has coverage for IVF. 

You can sub your own numbers for your insurance plan to get an idea of what you would pay!

You'll need these three numbers from your IVF coverage details:
  1. deductible
  2. co-insurance
  3. max out-of-pocket

In this example, we'll use estimated of treatment costs but your fertility clinic may charge a different amount.

Example IVF insurance coverage:
Deductible: $500
Co-insurance: 20%
Max out-of-pocket: $2,000

Calculating your IVF bill


Let’s reset and pretend you haven't used your insurance this year yet.

You do IVF.

IVF cost at clinic is billed to insurance: $20,000

Your Insurance Coverage
Deductible: $500
Co-insurance: 20%
Max out-of-pocket: $2,000

First you'll pay the $500 deductible. Now your deductible has been met for the year!

IUI cost $20,000 - Deductible $500 = Remaining Cost $19,500

But theres still $19,500 left on that bill. Now that applies to your co-insurance.

Remaining Cost $19,500 * 0.2 (20% coinsurance) = $3,900 Coinsurance

So of the remaining $19,500 on the bill, your coinsurance amount would be $3,900. Except it won't be!

Remember, your max out-of-pocket on your plan is $2,000. That means you won't pay more than $2,000 if your insurance plan covers IVF.

Your bill for IVF = Deductible $500 + $1,500 Coinsurance = Total Cost $2,000

Calculating your IUI bill


1st IUI Cycle

You undergo an IUI cycle and your clinic charges your insurance $1,100.

IUI cost at clinic is billed to insurance: $1,100

Your Insurance Coverage
Deductible: $500
Co-insurance: 20%
Max out-of-pocket: $2,000

So first you'll pay the $500 deductible. Now your deductible has been met for the year!

IUI cost $1,100 - Deductible $500 = Remaining Cost $600

But theres still $600 left on that bill. Now that applies to your co-insurance.

Remaining Cost $600 * 0.2 (20% coinsurance) = $120 Coinsurance

So of the remaining $600 on the bill, you have to pay 20% of the amount, which is $120.

Your bill for the IUI = Deductible $500 + $120 Coinsurance = Total Cost $620

In total, your bill for the $1,100 IUI cycle will be $620. 

Your insurance pays the remaining $480 to the fertility clinic.

This may seem like you pay a lot but remember that you are now done paying your deductible for the year, so that $500 you paid was a one-time fee.

Moving forward, you only pay co-insurance (20% of the bill) until you've met your max out-of-pocket ($2,000).

So far, you have paid $620 towards your $2,000 max out-of-pocket. You have $1,380 left for the year on your insurance plan.

2nd IUI Cycle

Let's say you do another IUI the next month.

IUI cost at clinic is billed to insurance: $1,100

You already paid your deductible for the first IUI, so you don't pay that again.

IUI Cost $1,100 * 0.2 (20% coinsurance) = $220 Coinsurance

Your bill for the IUI = $220 Coinsurance = Total Cost $220

Your bill is 20% of the charge, which is $220. 

Insurance pays the rest of the IUI charges, which is $880. 

Overall, you have paid $620 for your first IUI and $220 for your second IUI, so you have $1,160 remaining for your max out-of-pocket to go. 

If you have any further treatment that year, you'll continue to pay co-insurance until you've whittled down your max out-of-pocket to $0. Then your insurance plan will start to pay all of the bill. 

Once your insurance plan starts over for the year, you'll begin this process again from the start with a new deductible and max out-of-pocket.

Most plans reset on January 1. Some plans reset mid-year instead, so make sure you know when your plan resets.

IVF Costs Not Covered By Insurance


You now have the basic understanding how insurance plans apply cost to a patient and how to estimate ahead of time what you might pay. 

But keep in mind that you may need procedures as part of your IVF cycle that aren't covered. That happens sometimes for certain tests or procedures. 

So even if you have IVF coverage, you may still be paying some bills outside of insurance.

Check out our tips on saving for IVF, which is helpful whether you have insurance coverage or not.

IVF Costs not commonly covered by insurance


Health insurance often doesn't cover:
  • ERA
  • Mock Cycle
  • PGT-A

Do keep in mind that if your insurance plan does not cover a specific procedure, like PGT-A, then this charge will have to be paid in full by you. And it doesn't go toward your deductible or your max out-of-pocket.

If you plan on paying for preimplantation genetic testing, check out the cost of PGT-A here. 

How to plan for using IVF insurance

🕵️‍♀️ Ready to get started with a fertility clinic? Head to our fertility clinic search to compare options in your area & learn more about each provider. 

Are you sure?