Feds - what's the best insurance for IVF?

[Anonymous]

I have carefirst blue choice and they covered IUI and fertility drugs and monitoring. And it looks the same plan will be available for 2017. The copay though went up. IVF was never and won't be covered. The one thing I hated about this plan is same meds I got for IUI and are covered are not covered for IVF. So anything that has to do with IVF is not covered. Looks like I'm keeping this insurance. Anyone knows about supplemental insurances through Obama Care that cover the cost of infertility?

[Anonymous]

Anonymous wrote:I have carefirst blue choice and they covered IUI and fertility drugs and monitoring. And it looks the same plan will be available for 2017. The copay though went up. IVF was never and won't be covered. The one thing I hated about this plan is same meds I got for IUI and are covered are not covered for IVF. So anything that has to do with IVF is not covered. Looks like I'm keeping this insurance. Anyone knows about supplemental insurances through Obama Care that cover the cost of infertility?

Does Obamacare even offer "supplemental insurance" of any kind? And how would that work?

Someone would only get a supplemental health insurance for a condition (infertility or anything else) they knew they would likely need coverage for. That would make it virtually impossible for an insurer to offer the coverage at even remotely reasonable rates.

[Anonymous]

I switched to Kaiser last year for the IVF coverage and was lucky to get 2 retrievals done. Not lucky that now the FETs won't be covered next year. However, Kaiser is very low cost compared to the other plans (at least last year) and I really loved the doctors I switched to. I think it's much better insurance than BCBS, which I used to have. So I'm going to stick with it and enjoy the lower premiums, I guess.

Just trying to look on the bright side here, for what little of one there is.

[Anonymous]

Anonymous wrote: As for Aetna, I am curious whether SG will still offer the negotiated rate. Based on the explanation the financial folks provided me, I doubt it: Aetna requires non-covered services to be offered at the negotiated rate. But if there are not any covered services, there is not a negotiated rate presumably.
I feel lucky to have had limited coverage this year and it truly saddens me that the women in public service in the DC area won't get any coverage. Infertility is a disease. It is wrongheaded that it is being treated differently than many other health conditions.

I actually heard differently. Based on a conversation with SG, keeping Aetna WILL still help get the negotiated rate next year even though the fed plan doesn't cover IVF anymore. The way I understand it - and someone should please check this and report back - even though the Aetna HMO FEHB plan will no longer cover IVF, other Aetna plans still will, and Shady Grove's contract is with Aetna generally, not specifically the FEHB plan. SG has no plans to change their contract with Aetna and as long as they keep that contract in place, if you have Aetna you'll get the negotiated rates. One catch might be they weren't able to tell me when that contract might expire or when it could be renegotiated. So there is a chance that could change the status quo - but the way I understand it, it could still be very worthwhile to keep Aetna's HMO plan if you are paying OOP for fertility treatments. I was planning to switch to BCBS but now it seems worthwhile to keep Aetna.

[Anonymous]

Anonymous wrote:I switched to Kaiser last year for the IVF coverage and was lucky to get 2 retrievals done. Not lucky that now the FETs won't be covered next year. However, Kaiser is very low cost compared to the other plans (at least last year) and I really loved the doctors I switched to. I think it's much better insurance than BCBS, which I used to have. So I'm going to stick with it and enjoy the lower premiums, I guess.

Just trying to look on the bright side here, for what little of one there is.

I had the same experience. I had BCBS, switched to Kaiser (though got luckily pregnant through IVF) and I'll be staying with Kaiser next year (though switching to the Basic plan from the High plan). I really liked my doctors and the whole process. It was virtually painless.

I'm now working with my HRMO office and OPM to see what we can do for 2018 plans. My hope is to try to bring some IVF benefits back for 2018 (when I may need to tap into my frozen embies).

[Anonymous]

Anonymous wrote:I switched to Kaiser last year for the IVF coverage and was lucky to get 2 retrievals done. Not lucky that now the FETs won't be covered next year. However, Kaiser is very low cost compared to the other plans (at least last year) and I really loved the doctors I switched to. I think it's much better insurance than BCBS, which I used to have. So I'm going to stick with it and enjoy the lower premiums, I guess.

Just trying to look on the bright side here, for what little of one there is.

BCBS family for basic is $376 next year. Kaiser basic for family is $283 but has a deductible for x-rays, in patient at hospitals, and labs. KaIser high option is $406 monthly with no deductible. BCBS has no deductile. I'm debating switching from BCBS but I don't think Kaisers is cheaper.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I switched to Kaiser last year for the IVF coverage and was lucky to get 2 retrievals done. Not lucky that now the FETs won't be covered next year. However, Kaiser is very low cost compared to the other plans (at least last year) and I really loved the doctors I switched to. I think it's much better insurance than BCBS, which I used to have. So I'm going to stick with it and enjoy the lower premiums, I guess.

Just trying to look on the bright side here, for what little of one there is.

I had the same experience. I had BCBS, switched to Kaiser (though got luckily pregnant through IVF) and I'll be staying with Kaiser next year (though switching to the Basic plan from the High plan). I really liked my doctors and the whole process. It was virtually painless.

I'm now working with my HRMO office and OPM to see what we can do for 2018 plans. My hope is to try to bring some IVF benefits back for 2018 (when I may need to tap into my frozen embies).

What has been their response thus far?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I switched to Kaiser last year for the IVF coverage and was lucky to get 2 retrievals done. Not lucky that now the FETs won't be covered next year. However, Kaiser is very low cost compared to the other plans (at least last year) and I really loved the doctors I switched to. I think it's much better insurance than BCBS, which I used to have. So I'm going to stick with it and enjoy the lower premiums, I guess.

Just trying to look on the bright side here, for what little of one there is.

BCBS family for basic is $376 next year. Kaiser basic for family is $283 but has a deductible for x-rays, in patient at hospitals, and labs. KaIser high option is $406 monthly with no deductible. BCBS has no deductile. I'm debating switching from BCBS but I don't think Kaisers is cheaper.

I don't think you are looking at the Federal plans. I'm looking at the Kaiser plan right now, and under "Lab, X-Ray and other diagnostic tests" it says that you pay NOTHING for either the high or standard option. There is a co-pay for hospital stays, but is minimal. Under the standard option, it is $250 per day for up to $750 maximum per admission.

https://healthplans.kaiserpermanente.org/federalemployees/wp-content/uploads/sites/2/2015/09/2017-KP-MidAtlanticStates-Plan-Brochure-73-047.pdf

[Anonymous]

Anonymous wrote:

Anonymous wrote: As for Aetna, I am curious whether SG will still offer the negotiated rate. Based on the explanation the financial folks provided me, I doubt it: Aetna requires non-covered services to be offered at the negotiated rate. But if there are not any covered services, there is not a negotiated rate presumably.
I feel lucky to have had limited coverage this year and it truly saddens me that the women in public service in the DC area won't get any coverage. Infertility is a disease. It is wrongheaded that it is being treated differently than many other health conditions.

I actually heard differently. Based on a conversation with SG, keeping Aetna WILL still help get the negotiated rate next year even though the fed plan doesn't cover IVF anymore. The way I understand it - and someone should please check this and report back - even though the Aetna HMO FEHB plan will no longer cover IVF, other Aetna plans still will, and Shady Grove's contract is with Aetna generally, not specifically the FEHB plan. SG has no plans to change their contract with Aetna and as long as they keep that contract in place, if you have Aetna you'll get the negotiated rates. One catch might be they weren't able to tell me when that contract might expire or when it could be renegotiated. So there is a chance that could change the status quo - but the way I understand it, it could still be very worthwhile to keep Aetna's HMO plan if you are paying OOP for fertility treatments. I was planning to switch to BCBS but now it seems worthwhile to keep Aetna.

I just talked to my SG financial person about this and she quoted me $10,700 for ER/PGS/cryo/FET (price does not include meds or the PGS lab's fee). All in all, could be worse? The self-pay amount for the equivalent package is $15,500.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: As for Aetna, I am curious whether SG will still offer the negotiated rate. Based on the explanation the financial folks provided me, I doubt it: Aetna requires non-covered services to be offered at the negotiated rate. But if there are not any covered services, there is not a negotiated rate presumably.
I feel lucky to have had limited coverage this year and it truly saddens me that the women in public service in the DC area won't get any coverage. Infertility is a disease. It is wrongheaded that it is being treated differently than many other health conditions.

I actually heard differently. Based on a conversation with SG, keeping Aetna WILL still help get the negotiated rate next year even though the fed plan doesn't cover IVF anymore. The way I understand it - and someone should please check this and report back - even though the Aetna HMO FEHB plan will no longer cover IVF, other Aetna plans still will, and Shady Grove's contract is with Aetna generally, not specifically the FEHB plan. SG has no plans to change their contract with Aetna and as long as they keep that contract in place, if you have Aetna you'll get the negotiated rates. One catch might be they weren't able to tell me when that contract might expire or when it could be renegotiated. So there is a chance that could change the status quo - but the way I understand it, it could still be very worthwhile to keep Aetna's HMO plan if you are paying OOP for fertility treatments. I was planning to switch to BCBS but now it seems worthwhile to keep Aetna.

I just talked to my SG financial person about this and she quoted me $10,700 for ER/PGS/cryo/FET (price does not include meds or the PGS lab's fee). All in all, could be worse? The self-pay amount for the equivalent package is $15,500.

I wonder if you can get a similar negotiated rate through Kaiser. Anyone tried that?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I switched to Kaiser last year for the IVF coverage and was lucky to get 2 retrievals done. Not lucky that now the FETs won't be covered next year. However, Kaiser is very low cost compared to the other plans (at least last year) and I really loved the doctors I switched to. I think it's much better insurance than BCBS, which I used to have. So I'm going to stick with it and enjoy the lower premiums, I guess.

Just trying to look on the bright side here, for what little of one there is.

BCBS family for basic is $376 next year. Kaiser basic for family is $283 but has a deductible for x-rays, in patient at hospitals, and labs. KaIser high option is $406 monthly with no deductible. BCBS has no deductile. I'm debating switching from BCBS but I don't think Kaisers is cheaper.

I don't think you are looking at the Federal plans. I'm looking at the Kaiser plan right now, and under "Lab, X-Ray and other diagnostic tests" it says that you pay NOTHING for either the high or standard option. There is a co-pay for hospital stays, but is minimal. Under the standard option, it is $250 per day for up to $750 maximum per admission.

https://healthplans.kaiserpermanente.org/federalemployees/wp-content/uploads/sites/2/2015/09/2017-KP-MidAtlanticStates-Plan-Brochure-73-047.pdf

BCBS previous poster here. Thank you! I don't know what I was looking at! I was doing a LexisNexis training at the same time, so I must've not been paying attention. I love BCBS, but in case we need IUI this time, it's. ice it's covered under Kaisers, whereas BCBS is nada.

[Anonymous]

Hello, federal employee here gearing up for IVF and disappointed to learn about non coverage next year. I'm working with SG, they confirmed to me that they would honor Aetna rates as a previous poster said. I asked if Kaiser had the same sort of thing, and I understand Aetna is the only provider that has the lower rate schedule available with SG (for procedures, not meds). I'm struggling to decide since Kaiser offers IUI coverage still. I'm a MD resident and may drop FEHB coverage all together for a Maryland Heath exchange plan. There is a BCBS HMO plan that would be $270 a month and $6550 max out of pocket, and should cover up to three cycles of IVF. the open season for that plan is 11/1 until 1/31/2017. Anyone else researching this option?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I switched to Kaiser last year for the IVF coverage and was lucky to get 2 retrievals done. Not lucky that now the FETs won't be covered next year. However, Kaiser is very low cost compared to the other plans (at least last year) and I really loved the doctors I switched to. I think it's much better insurance than BCBS, which I used to have. So I'm going to stick with it and enjoy the lower premiums, I guess.

Just trying to look on the bright side here, for what little of one there is.

I had the same experience. I had BCBS, switched to Kaiser (though got luckily pregnant through IVF) and I'll be staying with Kaiser next year (though switching to the Basic plan from the High plan). I really liked my doctors and the whole process. It was virtually painless.

I'm now working with my HRMO office and OPM to see what we can do for 2018 plans. My hope is to try to bring some IVF benefits back for 2018 (when I may need to tap into my frozen embies).

What has been their response thus far?

Sadly, not helpful. Here's their response:

As previously stated, OPM does not mandate benefits that health plans must provide or require FEHB carriers to provide coverage for In vitro fertilization (IVF) or other assisted reproduction techniques. It is not an requirement of OPM to remove the IVF benefit. It was the Plan’s decision. You can follow up with the Plans to discuss with them to reconsider dropping IVF.

I have now asked them for direct contacts at the plans. I am also now working with resolve.org to see what we can do to make some changes.

[Anonymous]

^^ Thanks for following up, the OPM message sounds fishy to me. When a carrier is paying out more than they are taking in on claims, they increase pricing. It seems very odd that all Federal carriers have decided to remove IVF, on their on volition, but are not doing that with private sectors plans. The carrier would have just told OPM, plans,are now going up $200 per month for your elected coverages (which IVF is an election an employer makes outside of state mandates). The employer then negotiates with the carrier and makes cost changes such as higher co-pays, deductibles, or removes optional coverage. Maybe OPM said we will pay X more per month and if non-mandated programs have to be removed so be it.

I hope you are able to determine the truth and find a resolution.

[Anonymous]

Hmmm, I thought someone had said (on this thread or one of the others, I don't know) that this was OPM's call, not the individual insurers. And that makes way more sense to me than all of the insurance companies making the same decision independently. Does anyone know for sure how this works?