Federal Health Plans & IVF coverage

[Anonymous]

PP at 21:13 -- but what do you do if your one treatment fails -- will you have enough meds for another?

[Anonymous]

Anonymous wrote:I did cycles with both aetna 2009 and mdipa 2010. the drug cost is a huge difference for me 3500 v. 150. That said, i had to start and stop twice during aetna to switch protocols and both times because i had not made it to retrieval it did not "count" for purposes of the 3 times maximum with aetna. I still had to pay a prorated fee to the RE for the visits I went to, but with MDIPA, each time I started the drugs were considered a cycle.
By the time i used mdipa, i knew what was going to work so it was less risky. You need to weigh the pros and cons.

What plan will you choose for 2011?

[Anonymous]

I've asked this before, but didn't get an answer: why doesn't anyone consider Kaiser? I'm thinking of going with them instead of MDIPA, but would like to know if there's some problem with them.

[Anonymous]

I have Kaiser and thought they were quite good. They refer you to Shady Grove (so no choice about where to go). They pay 50% of ART procedures and drugs. I did one IVF and figured all in total cost (patient share) was about 6K (which needs to be discounted further b/c I paid with $$ from FSA health savings account). My OBGYN is Soma Chakraborty at West End - love her! And, our pediatrician is Dr. Elizabeth Biernoff at the North Capitol center (we live on Capitol Hill) - she is also delightful.

So - bottom line, I really like Kaiser!

[Anonymous]

I've done quite a bit of research on the different Federal options and for those who are still at the diagnosis stage or haven't reached the point of needing IVF, it seems like CareFirst BlueChoice HMO is the best option (not to be confused with the BCBS PPO, which is different). You get 100% coverage of diagnosis and treatment (minus a small co-pay) up to and including IUI. Most fertility meds (including injectables) are also fully covered assuming they're used with covered services.

With plans like MDIPA, Kaiser and Aetna, there's only 50% coverage for all services related to infertility. These are the go-to plans when you need IVF, but if you aren't there yet you could end up spending a lot more out of pocket.

Best case scenario--get all your diagnosis done, your Clomid cycles, your IUI's, etc. under CareFirst BlueChoice HMO, and then switch to a plan like MDIPA the following year if it turns out you need IVF.

The only downside to the above is if you need to go out of town for treatment. The HMOs generally won't cover out-of-town clinics or prescriptions written by out of network doctors.

[Anonymous]

Anonymous wrote:I've asked this before, but didn't get an answer: why doesn't anyone consider Kaiser? I'm thinking of going with them instead of MDIPA, but would like to know if there's some problem with them.

I am not going with Kaiser because my RE is not one of their docs, and this same RE helped me conceive DC #1. I had a not so great SG experience prior to that, so I am not eager to return there.

[Anonymous]

Anonymous wrote:I have Kaiser and thought they were quite good. They refer you to Shady Grove (so no choice about where to go). They pay 50% of ART procedures and drugs. I did one IVF and figured all in total cost (patient share) was about 6K (which needs to be discounted further b/c I paid with $$ from FSA health savings account). My OBGYN is Soma Chakraborty at West End - love her! And, our pediatrician is Dr. Elizabeth Biernoff at the North Capitol center (we live on Capitol Hill) - she is also delightful.

So - bottom line, I really like Kaiser!

If it cost you 6K then Kaiser is a lot higher then MDIPA (really double the cost). My total cost with MDIPA was 3500 and about 150 for meds. Aetna was 3500 and about the same for meds.

[Anonymous]

Anonymous wrote:I've asked this before, but didn't get an answer: why doesn't anyone consider Kaiser? I'm thinking of going with them instead of MDIPA, but would like to know if there's some problem with them.

I simply do not like Kaiser and would prefer to have more doctors to choose from (not just REs).

[Anonymous]

Anonymous wrote:
With plans like MDIPA, Kaiser and Aetna, there's only 50% coverage for all services related to infertility. These are the go-to plans when you need IVF, but if you aren't there yet you could end up spending a lot more out of pocket.

They only cover 50% of ART treatments, this is unrelated to diagonistics. So if you are still trying to figure out what is going on, you can get that cover like normal doctor's visits.

[Anonymous]

Thank you, last 3 or 4 posters, this has been really helpful. I guess I'll go with MDIPA, even though Aetna's open access since the difference comes down to the cost of drugs.

[Anonymous]

Anonymous wrote:I've done quite a bit of research on the different Federal options and for those who are still at the diagnosis stage or haven't reached the point of needing IVF, it seems like CareFirst BlueChoice HMO is the best option (not to be confused with the BCBS PPO, which is different). You get 100% coverage of diagnosis and treatment (minus a small co-pay) up to and including IUI. Most fertility meds (including injectables) are also fully covered assuming they're used with covered services.

With plans like MDIPA, Kaiser and Aetna, there's only 50% coverage for all services related to infertility. These are the go-to plans when you need IVF, but if you aren't there yet you could end up spending a lot more out of pocket.

Best case scenario--get all your diagnosis done, your Clomid cycles, your IUI's, etc. under CareFirst BlueChoice HMO, and then switch to a plan like MDIPA the following year if it turns out you need IVF.

The only downside to the above is if you need to go out of town for treatment. The HMOs generally won't cover out-of-town clinics or prescriptions written by out of network doctors.

thanks for sharing the results of your research! Do you use the bcbs HMO? If so, how is it for issues not related to infertility? I've always had the PPO and worried that if I switch to HMO, it'll be a total hassle to see specialists without a referral from the PCP... Any thoughts would be much appreciated!

[Anonymous]

Anonymous wrote:

Anonymous wrote:
With plans like MDIPA, Kaiser and Aetna, there's only 50% coverage for all services related to infertility. These are the go-to plans when you need IVF, but if you aren't there yet you could end up spending a lot more out of pocket.

They only cover 50% of ART treatments, this is unrelated to diagonistics. So if you are still trying to figure out what is going on, you can get that cover like normal doctor's visits.

no, NOT true. MDIPA pays 50% beginning at the diagnosis stage. They pay 50% of the first visit to the RE, the hsg, bloodwork, etc. Blue Cross will pay these visits at 100%.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I've done quite a bit of research on the different Federal options and for those who are still at the diagnosis stage or haven't reached the point of needing IVF, it seems like CareFirst BlueChoice HMO is the best option (not to be confused with the BCBS PPO, which is different). You get 100% coverage of diagnosis and treatment (minus a small co-pay) up to and including IUI. Most fertility meds (including injectables) are also fully covered assuming they're used with covered services.

With plans like MDIPA, Kaiser and Aetna, there's only 50% coverage for all services related to infertility. These are the go-to plans when you need IVF, but if you aren't there yet you could end up spending a lot more out of pocket.

Best case scenario--get all your diagnosis done, your Clomid cycles, your IUI's, etc. under CareFirst BlueChoice HMO, and then switch to a plan like MDIPA the following year if it turns out you need IVF.

The only downside to the above is if you need to go out of town for treatment. The HMOs generally won't cover out-of-town clinics or prescriptions written by out of network doctors.

thanks for sharing the results of your research! Do you use the bcbs HMO? If so, how is it for issues not related to infertility? I've always had the PPO and worried that if I switch to HMO, it'll be a total hassle to see specialists without a referral from the PCP... Any thoughts would be much appreciated!

PP here. I did use the CareFirst HMO for two years and had no problems with it. There seemed to be plenty of participating doctors and I can't think of anything I had covered under BCBS PPO that wasn't also covered under the CareFirst BlueChoice HMO. If I remember correctly, CareFirst is open access, so you don't need referrals from your PCP like you do with MDIPA.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
With plans like MDIPA, Kaiser and Aetna, there's only 50% coverage for all services related to infertility. These are the go-to plans when you need IVF, but if you aren't there yet you could end up spending a lot more out of pocket.

They only cover 50% of ART treatments, this is unrelated to diagonistics. So if you are still trying to figure out what is going on, you can get that cover like normal doctor's visits.

no, NOT true. MDIPA pays 50% beginning at the diagnosis stage. They pay 50% of the first visit to the RE, the hsg, bloodwork, etc. Blue Cross will pay these visits at 100%.

I guess I should clarify that we had Aetna, I don't know anything about MDIPA. When I went to my RE for visits that did not involve treatment, I just had to pay my co-pay. All of my blood work (as long as it went through Quest) and my husbands SA were paid at 100%. I did not have a HSG or a saline sono while on Aetna, so I can't speak to those. The plan summary is a little unclear, so if someone is thinking about Aetna they might want to get clarification on what would be covered before you start an ART cycle.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
With plans like MDIPA, Kaiser and Aetna, there's only 50% coverage for all services related to infertility. These are the go-to plans when you need IVF, but if you aren't there yet you could end up spending a lot more out of pocket.

They only cover 50% of ART treatments, this is unrelated to diagonistics. So if you are still trying to figure out what is going on, you can get that cover like normal doctor's visits.

no, NOT true. MDIPA pays 50% beginning at the diagnosis stage. They pay 50% of the first visit to the RE, the hsg, bloodwork, etc. Blue Cross will pay these visits at 100%.

I guess I should clarify that we had Aetna, I don't know anything about MDIPA. When I went to my RE for visits that did not involve treatment, I just had to pay my co-pay. All of my blood work (as long as it went through Quest) and my husbands SA were paid at 100%. I did not have a HSG or a saline sono while on Aetna, so I can't speak to those. The plan summary is a little unclear, so if someone is thinking about Aetna they might want to get clarification on what would be covered before you start an ART cycle.

MDIPA here---
so in this way Aetna and MDIPA differ. MDIPA pays 50% of any visits to the RE and all testing and treatment ordered by the RE---from visit #1 onward. So as a previous poster mentioned, the most economical way to proceed with infertility testing and IVF when using the federal plans is to have BCBS (or Aetna per your post) for testing and then MDIPA for IVF (because although the cost of IVF is the same as with Aetna, the drugs are cheaper with MDIPA). If you can manage to switch plans at just the right point in the calendar year, this would be the cheapest.