MD Exchange Plans with IVF Coverage
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Anonymous
| Does anyone have insight on health care plans with significant coverage for IVF? My employer does not offer coverage. |
Anonymous
|
I came here to post about the same thing! I found the Maryland Health Exchange website helpful as under ‘Plan Information’ they tell you what fertility coverage is available for each plan. Some require you to meet the deductible before the fertility benefit kicks in. Some require a copay versus some that require coinsurance. If you are considering BCBS this chart was helpful for me to compare the different levels of coverage: https://individual.carefirst.com/carefirst-resources/pdf/benefits-comparison-chart-md-2024-cds1217.pdf
I have narrowed down my choices to the CareFirst BlueChoice HMO or the BluePreferred PPO and would love to hear if anyone has experience with either, especially given that the HMO has a cheaper premium. I have already started fertility treatment at sgf and it is in network for both I believe. My financial counselor said the HMO may require a referral but my PCP is in network. I am a federal govt employee and will be using this a secondary insurance to my current govt plan. |
Anonymous
Fed BCBS will offer IVF coverage next year. |
Anonymous
| Thank you! I had looked into it and the premiums (self plus family) are double my current premium and they require a 15% coinsurance whereas I believe I could add the MD Marketplace plan for just myself and have lower overall premiums and a low copay ($40 or less). If I am mistaken, let me know! I have been self pay for fertility treatment up until this point and navigating the insurance options has been confusing- I definitely appreciate any advice or insight! |
Anonymous
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I bought the CareFirst plan and it was *amazing.* It was just me on the plan (we left my husband and daughter on his employer plan), my monthly premium was about $350. We did 4 retrievals and 3 transfers. They consider a full ivf cycle one that ends with a transfer, and you have 3 transfers. The drugs are covered at a co-pay, so they were the cheapest I paid at any point (we had Progyny coverage, and the meds were still cheaper with the CareFirst plan).
Basically, you can do as many retrievals as you can handle and until you do a transfer, it doesn't "count" as an attempt. Because of this, we tried some different protocols that I'm not sure I would have tried if I was paying out of pocket (specifically, a mini-stim, which isn't something my clinic does often) Things not covered: PGT testing, surgical site fees, and HGH (if that's part of your protocol). Bonus: it also covered acupuncture, which was great. Well worth it. Good luck, OP! |
Anonymous
| I had the CareFirst Gold PPO from the exchange as my secondary plan to our family's FEP BCBS Basic. It took some untangling to get the primary and secondary coverage and billing worked out, but it was great coverage for IVF. All of the charges seemed to be exempt from the deductible, which I never understood but I certainly didn't question because that meant I just had to pay the copay. |
Anonymous
| Would you mind sharing why you decided on the PPO plan vs the HMO plan? I was told by BCBS that they have the same coverage and the only difference is the network but with the cost of treatment, I want to be certain I would be covered. |
Anonymous
I guess I didn't want any restrictions on who I could see in network. I wound up switching clinics between the 2 cycles of IVF that I used it for. And in general, I don't like HMOs. |
Anonymous
Which clinics did you end up with? are any clinicis out of Maryland covered by the PPO plan you purchased? |
Anonymous
I'm the PP you're replying to. I used the PPO plan with Dominion and CCRM NoVA. |
Anonymous
I just finished a phone call with a health insurance agent. They mentioned that the waiting period for getting IVF coverage after purchasing any health plan is 1 year. Is it also true with the plans purchased through MD exchange? Also, does the Maryland exchange plan cover IVF treatment in states other than MD? |
Anonymous
I did not have to wait any length of time to use my MD exchange plan at CCRM and I cancelled the plan before the end of the year because I didn't need it anymore. And yes, the MD insurance should cover treatment elsewhere, but you'll want to confirm that before you start. |
Anonymous
| I have one of the MD Exchange Plans (PPO Gold) and was told that they would not cover IVF until I went through 3 IUI procedures first. The clinic also told me that they do not cover IVF if using donor sperm (there may be some exceptions to this). Due to age and Dr. recommendation I will likely not be doing the 3 IUIs. I asked about the self-pay cost for doing IVF during the billing call and the billing specialist indicated that typically if IVF isn't covered, they won't cover the medications either. So really, it sounds like it will be fully out of pocket, despite her mentioning I actually had IVF benefits and if I weren't using donor sperm/did the 3 IUIs, would qualify for IVF coverage. It was hugely disappointing to have this benefit and not be able to actually use it. I would encourage anyone thinking of switching to read the fine print about in which cases the plan will cover IVF and when it will not. FWIW, I've had the same plan for the past 3-4 years. |
Anonymous
how old are you?is boy friend's sperm considered donor sperm? Thanks for sharing. |
Anonymous
I started process when I was in early 40s. IDK about boyfriend. My plan indicated different criteria for spouse and unmarried women. This is the full coverage plan info for 2024 for the MD Exchange Plan I chose which includes the IVF coverage criteria by it may be different by plan: https://content.carefirst.com/sbc/contracts/APPMBN1YRXXMBN3F.pdf |