MD Mandate and IVF for DE

[Anonymous]

Has anyone successfully used MD insurance purchased through the exchange for IVF for DE/donor egg? We are looking at Carefirst HMO Gold and the plan says IVF is covered. When we called the rep, they said donor sperm was excluded, but didn't mention donor egg. However, the MD mandate says "For patients whose spouse is of the opposite sex, the patient’s eggs must be fertilized with the patient’s spouse’s sperm," For patients whose spouse is of the opposite sex, the patient’s eggs must be fertilized with the patient’s spouse’s sperm" so its unclear to us. We're also following up with SG but wanted to see if anyone has experience navigating this. Thanks so much!

[Anonymous]

Here's a few responses from a semi-recent thread I started on behalf of someone. In the end, my big question for someone considering this is whether the cost of the extra insurance plan actually provides any out of pocket benefit. If the patient does a medicated transfer cycle and has to do multiple of those, then it might be worth it for the drug coverage alone. The exchange CareFirst plan does not cover PGT, freezing, or thawing.
https://www.dcurbanmom.com/jforum/posts/list/1077688.page

[Anonymous]

Anonymous wrote:Has anyone successfully used MD insurance purchased through the exchange for IVF for DE/donor egg? We are looking at Carefirst HMO Gold and the plan says IVF is covered. When we called the rep, they said donor sperm was excluded, but didn't mention donor egg. However, the MD mandate says "For patients whose spouse is of the opposite sex, the patient’s eggs must be fertilized with the patient’s spouse’s sperm," For patients whose spouse is of the opposite sex, the patient’s eggs must be fertilized with the patient’s spouse’s sperm" so its unclear to us. We're also following up with SG but wanted to see if anyone has experience navigating this. Thanks so much!

This insurance won't cover anything associated with a DE cycle. Not even the FET, which I find ridiculous since it's the exact same service at that point.

[Anonymous]

Anonymous wrote:Here's a few responses from a semi-recent thread I started on behalf of someone. In the end, my big question for someone considering this is whether the cost of the extra insurance plan actually provides any out of pocket benefit. If the patient does a medicated transfer cycle and has to do multiple of those, then it might be worth it for the drug coverage alone. The exchange CareFirst plan does not cover PGT, freezing, or thawing.
https://www.dcurbanmom.com/jforum/posts/list/1077688.page

This. Because the exchange plans are designed to support for a retrieval and fresh transfer, some of the more expensive parts of FET aren't even covered. The cost of the plan across a whole year is likely more than just the transfer cost (the parts of an FET that are the same as a fresh transfer). Many of the meds for a medicated transfer are covered by regular insurance, so the cost there can be minimal (mine were free, even when we didn't have IVF coverage). I would say the exchange plan isn't worth it with DE, based on my experience!

[Anonymous]

Insurance does not have to cover IVF when either donor egg or donor sperm are used. It was a concession to Republicans who didn’t want to cover IVF for same sex couples. They couldn’t use sexual orientation as a means of denying medical coverage, so banning coverage for donor cycles regardless of the couple’s sexual orientation was the only way.