Federal Health Plans & IVF coverage

Anonymous
Anonymous wrote:
Anonymous wrote:can anyone tell me approximately how much they pay for the ivf meds with Kaiser??


Because meds count towards the out-of-pocket maximum, the most you'll ever pay under the High Plan is $2500, regardless of how much the meds cost. I paid a total of $2500 for my IVF cycle this year (including the procedure and meds) and have never paid another single dime.

However, for next year, Kaiser is not covering IVF. Only IUIs and diagnostics.



Do you have FEHB Kaiser?? This is my first time having to use Kaiser for something other than regular appointments. So I'm not that familiar with how everything works.
Anonymous
I wonder what this will do to the IVF business in the area? You might think they are willing to offer new discounts or something...
Anonymous
Open enrollment has started. Has anyone found an insurance plan that covers IVF for 2017? If so, please share. Thanks!
Anonymous
Anonymous wrote:I wonder what this will do to the IVF business in the area? You might think they are willing to offer new discounts or something...


I've wondered this, too. There has to be a high number of federal employees/dependents using the local clinics. Has anyone gotten any feedback from local clinics regarding these changes?
Anonymous
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:can anyone tell me approximately how much they pay for the ivf meds with Kaiser??


Because meds count towards the out-of-pocket maximum, the most you'll ever pay under the High Plan is $2500, regardless of how much the meds cost. I paid a total of $2500 for my IVF cycle this year (including the procedure and meds) and have never paid another single dime.

However, for next year, Kaiser is not covering IVF. Only IUIs and diagnostics.



Do you have FEHB Kaiser?? This is my first time having to use Kaiser for something other than regular appointments. So I'm not that familiar with how everything works.


Yes, I have FEHB Kaiser. As I explained, fertility meds count towards the catastrophic out-of-pocket maximum, which varies whether you have the basic or high plan. Figure out which of the two plans you have, and you'll know how much you'll pay TOTAL for IVF including meds.

Be aware, however, that Kaiser will stop covering these meds come next year. You have 2 months left.
Anonymous
I'm planning to keep my Aetna hmo - SG is saying they will still provide us with the Aetna negotiated rate next year, so that's a savings of a few thousand off the whole process. Even just an FET is nearly $3k less.
Anonymous
I'm really grateful for this thread and all of the great information on it. Our open season starts the 16th and I am in the process of researching best (if any) coverage for IVF in 2017; I'll post what I learn and hope others do too. Thanks again to everyone who provided helpful info!
Anonymous
Hi everyone,

Thank you for starting this thread before the open enrollment. I was going through the OPM site and also the Aetna site, but is the 2017 infertility treatment coverage gone??
http://www.aetnafeds.com/brochures.php

Which plan has coverage now? I looked at the Open Access HMO (DC area) and I didn't read anything about coverage for 2017. Please help!
Anonymous
Anonymous wrote:Hi everyone,

Thank you for starting this thread before the open enrollment. I was going through the OPM site and also the Aetna site, but is the 2017 infertility treatment coverage gone??
http://www.aetnafeds.com/brochures.php

Which plan has coverage now? I looked at the Open Access HMO (DC area) and I didn't read anything about coverage for 2017. Please help!


I think the point of the pages and pages of discussion is that none of them do unfortunately
Anonymous
None of them do, but some may still cover *some* of the associated costs such as initial testing, blood work, monitoring. If anyone has any thoughts on which is the best plan for at least some coverage, please do share with the group.
Anonymous
Anonymous wrote:None of them do, but some may still cover *some* of the associated costs such as initial testing, blood work, monitoring. If anyone has any thoughts on which is the best plan for at least some coverage, please do share with the group.

Kaisers is still covering IUI in 2017.
Anonymous
It looks like ObamaCare is the only option for those who truly want to undergo IVF. Check the out of pocket max and deductible. For some, the out of pocket max and deductible is 6k but the premium is about $250+ a month. In the end you have to weigh your options if the out of pocket max is 6,500 + deductible is around 6,000 and you're paying 250-300 a month for 12 months that's 3000 - 3600 on top of 6500. Your total yearly out of pocket cost will be around 10k+. Still cheaper than one IVF cycle.

I'm working with RESOLVE and other Federal employees who are interesting in advocating for OPM to cover IVF again. Hopefully all goes well this year and we get IVF coverage again in the future. If you are interested in advocacy contact RESOLVE at info@resolve.org or contact Betsy Campbell bcampbell@resolve.org. Also, RESOLVE is part of the CFC I encourage all to donate. Hopefully we can make a positive change.

Thanks!
Anonymous
Anonymous wrote:None of them do, but some may still cover *some* of the associated costs such as initial testing, blood work, monitoring. If anyone has any thoughts on which is the best plan for at least some coverage, please do share with the group.

I did my diagnostics (bloodwork, initial ultrasound and HSG and RE appointments) under Fed BCBS and they had decent coverage at the time (2013). Unless something has drastically changed they should still cover this, since they never ever covered a dime of IVF.
Anonymous
This is from another poster on the other Feds and IVF thread

"Here's what I gathered from the various threads:
1. If you are doing IUIs, Kaiser or the local BCBS HMO is your best bet
2. If you are doing IVF and at SG, Aetna may be best: they'll give you the Aetna negotiated rate, which will provide real cost savings."
Anonymous
I have searched high and low. None of the Federal health insurance benefit plans will cover IVF. I contacted Shady Grove today because I have had Aetna and have been doing Shady Grove treatments and did not hear that they were going to offer discounts to current patients. In fact, my financial advisor said, "it's going to be interesting." (Gee thanks). Kaiser dropped coverage, MD IPA dropped it awhile back, Aetna dropped for 2017. I checked in VA for plans under the Affordable Health Care too-- no IVF coverage or medication coverage. We have to do PGD because of a severe gene disorder that my spouse's family has so without IVF, we can't have children.

Our dreams of parenthood are over. I'm stunned.
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