Federal govt insurance plan for IVF?

[Anonymous]

We've gone through several failed IVFs and my spouse is currently considering applying for a federal government position.

Is anyone on the boards here on a federal govt. health insurance plan that offers IVF coverage? Can you share the name of the plan, how many attempts are covered, etc., and which Dr. (or practice) you go to for IVF under the plan?

Thank you so much.

[Anonymous]

There have been a few posts on this board on this topic, so you may want to search through the archives.

There are a few Federal plans that provide partial coverage for IVF (none that provide full coverage.) I have MD IPA (MD stands for medical doctor, not Maryland and it is available in the whole DC metro area) and it covers up to 3 attempts per live birth at 50% (both fresh and frozen cycles count and they count as an attempt the initiation of injectable drugs, so even if your cycle is canceled, it still counts as an attempt.) For each IVF/ICSI, I paid I think around $4500 out of pocket plus about $150 for the meds. I went to Shady Grove - the plan is a PPO, so you need a referral from a primary care physician and you need to get pre-certification for each cycle, but I never found the pre-certification to be a problem. They cover IVF if you are married, not using donor egg or sperm and have tubal factor, endometriosis, or severe male factor infertility or history of infertility of two years duration

[Anonymous]

to chime in on the post . . . I have Coventry Healthcare of Delaware, here are the stats:

-you have to live in Maryland but can use DC doctors
-you can be single or married
-you can use donor sperm
-you get three attempts
-coverage is 50 percent
-they pay for some meds

my ivf/icsi cycle costs $5400 with GW and I used Dr. Frankfurter.

[Anonymous]

I also have IVF and used them for 3 cycles at Shady Grove--
fresh cycle #1--pregnancy and birth
FET ---negative
fresh cycle #2 --pregnancy, now 22 weeks


They've been great through the entire process. Shady Grove is super familiar with them and got my pre-authorizations for treatment as I needed them. I didn't have to deal with MDIPA at all. As a previous poster mentioned, infertility diagnosis and treatment is covered at 50%. This is different than many plans that cover diagnosis at 100% and treatment at 0%. I got around this somewhat by having my PCP order my initial infertility testing including the cycle day 3 bloodwork and hsg and it was all covered at 100%.

IVF with ICSI at Shady Grove was about $4400 plus another $200 or so in med copays. On my last IVF cycle I responded very poorly to the medications and needed insanely high doses. My meds from freedom pharmacy were >$8K. MDIPA payed without question and I payed a total of $200.

We've had MDIPA for 9 years and have been very happy with them overall. This year alone between IVF and some emergency visits they have payed out an exorbitant amount of $ for us and we've never had any problems with bills getting payed immediately.

[Anonymous]

whoops, previous poster here.
if it wasn't clear from farther along in my post, we have MDIPA.

[Anonymous]

OP here, thanks so much for all the info. This is really helpful!

[Anonymous]

I did a lot of research on this when we enrolled. MDIPA is the best. The med coverage is awesome. I'm at CFA and I paid $3900 for IVF (It's $4500 at SG). Just depends on the clinic.

[Anonymous]

Blue cross blue shield covers fertility testing 100% - I think there were some small copays. I used BCBS when I was undergoing the testing and I planned to move to MDIPA (or possibly an Aetna plan) during open season if we decided to move on to IVF. We got lucky and got pregnant post HSG (which is not uncommon) and so stayed with BCBS.

[Anonymous]

Thank you so much for sharing this info. It's a great help!

[Anonymous]

Blue Cross Blue Shield covered all of my fertility testing, but I switched to MDIPA when I wanted to start IVF. What I did not know was that they will not cover you if you have had a miscarriage within a year prior to starting IVF. I had had a miscarriage a few months before I requested MDIPA coverage for IVF, and they denied it. I really felt burned. Their definition of infertility is one year unprotected intercourse without a pregnancy. I did not fit this definition because I had gotten pregnant, even though my pregnancy was not viable. Even though my doctor wrote MDIPA explaining that IVF is medically indicated for women like me (with repeat miscarriages - - I had three in a row), MDIPA still would not provide coverage.

[Anonymous]

PP--so sorry to hear this happened to you? do you know if this would also be the case if you miscarried following IVF?