2025 Federal Insurance for IVF

[Anonymous]

I am a federal employee and looking at options for IVF coverage (not IUI). We need all the things, IVF with ICSI and PGT-A testing. I have looked at the options and it seems the best ones for the most coverage would be either BCBS Standard ($25k annually covered) or Carefirst Bluechoice Standard ($45k annually covered - more coverage but higher premium but still the best "deal"). The 2025 plan brochure for Carefirst has not been put on the website yet.

Does anyone have any other thoughts or understanding? I am looking at the OPM webpage for 2025 infertility coverage (https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/2025-fehb-ivf-information.pdf).

I find this process and looking for details on coverage incredibly confusing. Help if you know, please!

[Anonymous]

GEHA High is another option to consider. There is $25k annual coverage. I’m waiting for additional details to see how it compares to BCBS Standard’s coverage.

[Anonymous]

Anonymous wrote:I am a federal employee and looking at options for IVF coverage (not IUI). We need all the things, IVF with ICSI and PGT-A testing. I have looked at the options and it seems the best ones for the most coverage would be either BCBS Standard ($25k annually covered) or Carefirst Bluechoice Standard ($45k annually covered - more coverage but higher premium but still the best "deal"). The 2025 plan brochure for Carefirst has not been put on the website yet.

Does anyone have any other thoughts or understanding? I am looking at the OPM webpage for 2025 infertility coverage (https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/2025-fehb-ivf-information.pdf).

I find this process and looking for details on coverage incredibly confusing. Help if you know, please!

25k will only cover around 1 IVF cycle. Have you done IVF before or is this your first time?

[Anonymous]

I am aware of the cost. I have done 5 IVF cycles and 8 egg retrievals (4 through the Assure program at SGF), all out of pocket. Anything is better than nothing.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I am a federal employee and looking at options for IVF coverage (not IUI). We need all the things, IVF with ICSI and PGT-A testing. I have looked at the options and it seems the best ones for the most coverage would be either BCBS Standard ($25k annually covered) or Carefirst Bluechoice Standard ($45k annually covered - more coverage but higher premium but still the best "deal"). The 2025 plan brochure for Carefirst has not been put on the website yet.

Does anyone have any other thoughts or understanding? I am looking at the OPM webpage for 2025 infertility coverage (https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/2025-fehb-ivf-information.pdf).

I find this process and looking for details on coverage incredibly confusing. Help if you know, please!

25k will only cover around 1 IVF cycle. Have you done IVF before or is this your first time?

That is incorrect. It depends on the negotiated rate your clinic has with insurance. I’m using BCBS this year at SGF. Only fertility treatments count towards the annual max, so for example, retrieval is around $4k towards the $25k. Monitoring ultrasounds do not count towards the $25k. Meds are also separate.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am a federal employee and looking at options for IVF coverage (not IUI). We need all the things, IVF with ICSI and PGT-A testing. I have looked at the options and it seems the best ones for the most coverage would be either BCBS Standard ($25k annually covered) or Carefirst Bluechoice Standard ($45k annually covered - more coverage but higher premium but still the best "deal"). The 2025 plan brochure for Carefirst has not been put on the website yet.

Does anyone have any other thoughts or understanding? I am looking at the OPM webpage for 2025 infertility coverage (https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/2025-fehb-ivf-information.pdf).

I find this process and looking for details on coverage incredibly confusing. Help if you know, please!

25k will only cover around 1 IVF cycle. Have you done IVF before or is this your first time?

That is incorrect. It depends on the negotiated rate your clinic has with insurance. I’m using BCBS this year at SGF. Only fertility treatments count towards the annual max, so for example, retrieval is around $4k towards the $25k. Monitoring ultrasounds do not count towards the $25k. Meds are also separate.

Seconding this. I also had BCBS and used Shady Grove was pleasantly surprised at how "cheap" (lol, but it's all relative) the actual fertility treatments ended up being after the negotiated rate. We also ended up with well over $100k worth of drugs that we only paid a few thousand out of pocket for -- which is not included in the 25k max. We got VERY lucky and only needed one round but I have no doubt we would have been covered for two more rounds if needed.

[Anonymous]

Thank you so much for this response. I think we will go with bcbs standard given your response and my other research. Congrats on your outcome!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am a federal employee and looking at options for IVF coverage (not IUI). We need all the things, IVF with ICSI and PGT-A testing. I have looked at the options and it seems the best ones for the most coverage would be either BCBS Standard ($25k annually covered) or Carefirst Bluechoice Standard ($45k annually covered - more coverage but higher premium but still the best "deal"). The 2025 plan brochure for Carefirst has not been put on the website yet.

Does anyone have any other thoughts or understanding? I am looking at the OPM webpage for 2025 infertility coverage (https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/2025-fehb-ivf-information.pdf).

I find this process and looking for details on coverage incredibly confusing. Help if you know, please!

25k will only cover around 1 IVF cycle. Have you done IVF before or is this your first time?

That is incorrect. It depends on the negotiated rate your clinic has with insurance. I’m using BCBS this year at SGF. Only fertility treatments count towards the annual max, so for example, retrieval is around $4k towards the $25k. Monitoring ultrasounds do not count towards the $25k. Meds are also separate.

Seconding this. I also had BCBS and used Shady Grove was pleasantly surprised at how "cheap" (lol, but it's all relative) the actual fertility treatments ended up being after the negotiated rate. We also ended up with well over $100k worth of drugs that we only paid a few thousand out of pocket for -- which is not included in the 25k max. We got VERY lucky and only needed one round but I have no doubt we would have been covered for two more rounds if needed.

Thank you for clarifying this. I paid cash for IVF, so I am not familiar with how the insurance billing works for this.

[Anonymous]

I had a non-fed plan with 25k coverage and was able to do two retrievals and three transfers with the negotiated rate. Meds don’t count towards the coverage max so be sure your pharmacy/medicine coverage is adequate under the plan you choose!

[Anonymous]

Anyone with experience with the MD-IPA health plan? It’s showing at having the most coverage for infertility services on checkbook.org. Unlike the other plans, it includes a lot of details about the covered services but I’m nonetheless wary of surprises. It’s an HMO plan and seems to have a United network so my providers including SGF are in network.

[Anonymous]

Could anybody please confirm that Shady Grove accepts BCBS standard in Northern Virginia? Based on my research, that's the optimal coverage with 15% copay and 25k annual max. In SGF website, they only mention "CareFirst Blue Cross Blue Shield"

[Anonymous]

Is Shady Grove a preferred provider for BCBS standard?

[Anonymous]

Anonymous wrote:Could anybody please confirm that Shady Grove accepts BCBS standard in Northern Virginia? Based on my research, that's the optimal coverage with 15% copay and 25k annual max. In SGF website, they only mention "CareFirst Blue Cross Blue Shield"

Yes, they do. I’m at SGF in Fairfax this year using BCBS Standard.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Could anybody please confirm that Shady Grove accepts BCBS standard in Northern Virginia? Based on my research, that's the optimal coverage with 15% copay and 25k annual max. In SGF website, they only mention "CareFirst Blue Cross Blue Shield"

Yes, they do. I’m at SGF in Fairfax this year using BCBS Standard.

May I ask if SGF Fairfax was the preferred provider for BCBS Standard since it's a PPO plan? I am following up because they differentiate preferred vs. participating and the rates are very different.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Could anybody please confirm that Shady Grove accepts BCBS standard in Northern Virginia? Based on my research, that's the optimal coverage with 15% copay and 25k annual max. In SGF website, they only mention "CareFirst Blue Cross Blue Shield"

Yes, they do. I’m at SGF in Fairfax this year using BCBS Standard.

May I ask if SGF Fairfax was the preferred provider for BCBS Standard since it's a PPO plan? I am following up because they differentiate preferred vs. participating and the rates are very different.

Does preferred mean in-network? If so, yes. I’m not sure what participating means. I searched for one of the Fairfax doctors on fepblue.org and she is in-network.