Experience with purchasing health insurance off Maryland exchange in order to get some IVF coverage?

[Anonymous]

Hello all! Asking for health insurance experience/advice: have any Maryland residents purchased health insurance off the Maryland healthcare exchange ( https://www.marylandhealthconnection.gov) in order to receive at least some coverage of IUI and/or IVF treatments? Maryland is one of 19 states that have passed fertility insurance coverage laws: https://resolve.org/what-are-my-options/insurance-coverage/infertility-coverage-state/

Background:

My husband and I in the early stages of consulting with doctors and fertility centers to see if IUI or IVF may be a path for us as we TTC.

I am a Federal employee, and have BCBS Federal Employee Program PPO.

As other threads have noted, not a single health insurance plan offered to Federal employees offers any coverage for infertility or fertility treatments (sidenote below re: how this is ridiculous). I have been a Fed for almost a decade, and am working towards Public Service Loan Forgiveness, so leaving Federal service for an employer that does offer fertility coverage or benefits is not currently an option. I am AMA, too, so timing is of importance.

My husband’s health insurance (BCBS South Carolina PPO, through his firm which is based in SC) does not cover anything for infertility or fertility treatments, either. So switching me over to his plan during the upcoming Open Season for such coverage is not an option.

We’re trying to figure out how to afford something like IVF if we need/choose to go that route - ideally in a fiscally responsible way for two individuals in public service/public sector that won’t completely deplete our savings, or resulting in taking from our retirement funds.

We would love to hear from anyone that has switched, or had their partner switch over to Maryland exchange-purchased insurance (apparently the Exchange-purchased insurance could then be a partner’s secondary insurance. It may even be able to be my secondary insurance? Im going to call to check on this). A few more specific questions:

-Which plan(s) did you consider and/or switch to? Why?
-Did IUI/IVF/fertility treatment coverage work out under the plan as expected? If not, how?
-Did you find any negatives or unintended consequences of switching over to Maryland exchange-purchased insurance?

Thank you so much in advance for any insight! I do hope this thread will also help others trying to make similar health insurance decisions, too.

(Sidenote: In 2021, it is just ridiculous for health insurance offered by the Nation’s largest employer to not cover anything for infertility or fertility treatments. I’m making my voice heard to my Congressional representatives, as well as to my Agency, Federal employee unions, and OMB. I encourage others who find this similarly incredulous to please do the same!

Here’s some great info and resources from RESOLVE, the national infertility association, too: https://resolve.org/what-are-my-options/insurance-coverage/coverage-at-work/your-employer-and-your-options/)

[Anonymous]

I bought BCBS and Kaiser for IVF. It worked like I expected. Kaiser was super cheap for drugs, etc , but you have to go to SGF. It is also annoying becuase you need to go thru a work up with kaiser first. BCBS was fine as well. I kept my Fed plan. Everything worked as expected. When I first signed up on the exchange, I was told that if I wanted to keep my work insurance, my husband had to subscribe to the exchange plan, because I could not subscribe to two plans. I later heard this wasn't true, but I'm not sure what is correct.

[Anonymous]

FYI I think some insurance plans which cover IVF won’t pay for it until you have a number of failed IUIs which can take up some valuable time so keep an eye on that.

Also keep an eye on federal Rx benefits which can be good but may require shopping for a different plan

[Anonymous]

Anonymous wrote:I bought BCBS and Kaiser for IVF. It worked like I expected. Kaiser was super cheap for drugs, etc , but you have to go to SGF. It is also annoying becuase you need to go thru a work up with kaiser first. BCBS was fine as well. I kept my Fed plan. Everything worked as expected. When I first signed up on the exchange, I was told that if I wanted to keep my work insurance, my husband had to subscribe to the exchange plan, because I could not subscribe to two plans. I later heard this wasn't true, but I'm not sure what is correct.

There is a FAQ on the MD exchange website saying you can buy a plan if you are covered but you can’t get any premium subsidies

[Anonymous]

I have CareFirst through the exchange and they covered up to 6 IUIs and 3 rounds of IVF if I remember correctly (ended up pregnant on month 12 before starting IUI). I believe they required 3 IUI attempts before IVF.

I am 34 and pay $280/month. My deductible is $6,000 and my max OOP is $12k. One IVF out of pocket was going to be $10k (excluding drugs) so it was actually a decent plan! Good luck.

[Anonymous]

Does anyone know how to access the plan brochures that explain the fertility benefits in detail? I'm looking for the PDFs that are like a hundred pages long, not 2 page-long tables (which never give details about the infertility benefits).

[Anonymous]

If you have not already, use your federal insurance for you initial bloodwork, visits, etc. Your insurance will cover that. Also, unrelated to your question, but since open season is coming up, I’d recommend contributing the max to your FSA. That was so helpful to have those funds to pay for fertility drugs.[twitter]

[Anonymous]

Lol don't get too upset until you realize that if for whatever reason you need to terminate a much-wanted pregnancy you will be out of pocket for the entire cost too. So hopefully your fetus then has no issues!

The feds and military both have these BS rules thanks to congress. I doubt you will get the prolifers to cover either expense because it isn't God's will.

That said, go for it. Use it as secondary insurance.

[Anonymous]

Can someone explain what the plans actually cover? I'm currently on a MD health exchange plan... My nurse failed to do preauthorization for my IUI last cycle so I had to pay out of pocket, doing another this week and will see how much is covered.

I recently got married and my husband's employer plan is actually crappier in general BUT he does have progeny so I if I want the progeny benefits I have to switch to his plan-- but now reading this thread makes me wonder if we should just pay for both plans and use his as secondary but then have progeny access. Though with progeny maybe that's not necessary?

[Anonymous]

Anonymous wrote:Does anyone know how to access the plan brochures that explain the fertility benefits in detail? I'm looking for the PDFs that are like a hundred pages long, not 2 page-long tables (which never give details about the infertility benefits).

As you get closer to open season, the two page plans usually have a link on them to the company's website and you can download the 100 page plan from there.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I bought BCBS and Kaiser for IVF. It worked like I expected. Kaiser was super cheap for drugs, etc , but you have to go to SGF. It is also annoying becuase you need to go thru a work up with kaiser first. BCBS was fine as well. I kept my Fed plan. Everything worked as expected. When I first signed up on the exchange, I was told that if I wanted to keep my work insurance, my husband had to subscribe to the exchange plan, because I could not subscribe to two plans. I later heard this wasn't true, but I'm not sure what is correct.

There is a FAQ on the MD exchange website saying you can buy a plan if you are covered but you can’t get any premium subsidies

The question is whether you can subscribe to two plans, which the FAQ doesn't answer. There used to be some rule against that but I think it changed. There is no point paying for my husband if I don't have to.