Fed Employees: IVF Insurance Questions

[Anonymous]

I'm a new fed employee. Just began reviewing the various health plans offered. My husband and I will expect to try our first attempt at IVF/ICSI in 2019. I would like to find the best health insurance plan to alleviate some costs. I searched various threads on this topic date back to 2016. I hope others are available to provide the most current information.

[Anonymous]

OP again, I heard many plans dropped IVF coverage for 2017?

[Anonymous]

There is not IVF coverage anymore. What state do you live in?

[Anonymous]

Right, no more IVF under federal insurance. Kaiser may still cover IUI, and there was a BCBS HMO that covered IUI but not sure of the current status.

For cost savings, I feel like the best bet is BCBS Basic. Even in an IVF cycle, the copay for monitoring is $40. This is huge savings when those visits can be hundreds per time and you have 5+ visits per cycle. They also do cover fertility medications, including injectables, if you are doing a timed intercourse cycle. So there's some potential to do a couple of TI cycles and maybe get your nurse to order extra meds. If you save what's left from those, you may not have enough for a whole cycle, but that can still be serious savings.

[Anonymous]

Anonymous wrote:Right, no more IVF under federal insurance. Kaiser may still cover IUI, and there was a BCBS HMO that covered IUI but not sure of the current status.

For cost savings, I feel like the best bet is BCBS Basic. Even in an IVF cycle, the copay for monitoring is $40. This is huge savings when those visits can be hundreds per time and you have 5+ visits per cycle. They also do cover fertility medications, including injectables, if you are doing a timed intercourse cycle. So there's some potential to do a couple of TI cycles and maybe get your nurse to order extra meds. If you save what's left from those, you may not have enough for a whole cycle, but that can still be serious savings.

The Carefirst BlueChoice HMO plans (High Option Open Access and Standard HealthyBlue) cover up to 6 IUIs. I switched the HMO plan for 2018 to get the IUI coverage. Upon doing a cost analysis of the differences in the plans, I decided the Standard HealthyBlue made more sense for us financially. It's turned out to be a Cadillac health plan compared to the BCBS basic in some respects--$0 copay any time you see your PCP, no cost for any lab testing as long as it's done through Labcorp, and $0 copay for all prescription drugs. And even though it's an HMO (restricting your geographic limits of use for in-network care; although BCBS Basic doesn't even have an out-of-network option...), it's all open access, meaning you don't need referrals from your PCP to go see a specialist.

For a federal employee planning to do IUI, I would recommend this plan. However, as PP said, the BCBS Basic may make just as much or more sense for someone doing IVF.

[Anonymous]

None of the Fed plans cover the actual IVF anymore.
BCBS is good for covering diagnostic testing. Some people have said that if you have Aetna then Shady Grove will give you a special rate for some procedures but I don't have personal experience with that.
If you qualify you might want to see if any of the shared risk plans at Shady Grove are financially worthwhile for you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Right, no more IVF under federal insurance. Kaiser may still cover IUI, and there was a BCBS HMO that covered IUI but not sure of the current status.

For cost savings, I feel like the best bet is BCBS Basic. Even in an IVF cycle, the copay for monitoring is $40. This is huge savings when those visits can be hundreds per time and you have 5+ visits per cycle. They also do cover fertility medications, including injectables, if you are doing a timed intercourse cycle. So there's some potential to do a couple of TI cycles and maybe get your nurse to order extra meds. If you save what's left from those, you may not have enough for a whole cycle, but that can still be serious savings.

The Carefirst BlueChoice HMO plans (High Option Open Access and Standard HealthyBlue) cover up to 6 IUIs. I switched the HMO plan for 2018 to get the IUI coverage. Upon doing a cost analysis of the differences in the plans, I decided the Standard HealthyBlue made more sense for us financially. It's turned out to be a Cadillac health plan compared to the BCBS basic in some respects--$0 copay any time you see your PCP, no cost for any lab testing as long as it's done through Labcorp, and $0 copay for all prescription drugs. And even though it's an HMO (restricting your geographic limits of use for in-network care; although BCBS Basic doesn't even have an out-of-network option...), it's all open access, meaning you don't need referrals from your PCP to go see a specialist.

For a federal employee planning to do IUI, I would recommend this plan. However, as PP said, the BCBS Basic may make just as much or more sense for someone doing IVF.

*$0 copay for GENERIC prescription drugs (not all drugs, as I mistakenly wrote above)

[Anonymous]

Yes, if you have Aetna FEHBP then Shady Grove gives you their Aetna negotiated rate - it’s about half the sticker price for IVF, FET etc. meds not covered of course. But I saved a boatload of money by switching to Aetna and going to Shady Grove.

[Anonymous]

If you live in Maryland you can get the supplemental insurance through the exchange and IVF is covered. MD is a IVF mandated state.

https://www.fertilityauthority.com/costs/insurance-coverage/maryland-infertility-insurance-mandate

[Anonymous]

If you can get your diagnostics done under BCBS this year then you can switch to Aetna for the negotiated rates for next year. That's what many people did back in the day when IVF was still covered.

[Anonymous]

Anonymous wrote:If you can get your diagnostics done under BCBS this year then you can switch to Aetna for the negotiated rates for next year. That's what many people did back in the day when IVF was still covered.

I know this is a "back in the day" question but does anyone know how much used to be covered under the Fed plans that covered IVF? For example, was everything covered, was there a co-pay (how much?), etc.? I know these are days past, but am just curious to know what it used to be.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If you can get your diagnostics done under BCBS this year then you can switch to Aetna for the negotiated rates for next year. That's what many people did back in the day when IVF was still covered.

I know this is a "back in the day" question but does anyone know how much used to be covered under the Fed plans that covered IVF? For example, was everything covered, was there a co-pay (how much?), etc.? I know these are days past, but am just curious to know what it used to be.

When I last did Kaiser in 2016, it was 50% coverage, but the great part was that it had a low Out of Pocket Maximum of something like $2250. So the most I ever paid was $2250 and then the rest was paid in full, including meds. Aetna and MDIPA also had coverage. I think Aetna was also 50%? I don't remember the specifics.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If you can get your diagnostics done under BCBS this year then you can switch to Aetna for the negotiated rates for next year. That's what many people did back in the day when IVF was still covered.

I know this is a "back in the day" question but does anyone know how much used to be covered under the Fed plans that covered IVF? For example, was everything covered, was there a co-pay (how much?), etc.? I know these are days past, but am just curious to know what it used to be.

I did IVF under MDIPA. Each cycle was around $4500 including ICSI. Meds were a copay of about $400. PG S , embryo freezing and any subsequent frozen transfers were not covered.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:If you can get your diagnostics done under BCBS this year then you can switch to Aetna for the negotiated rates for next year. That's what many people did back in the day when IVF was still covered.

I know this is a "back in the day" question but does anyone know how much used to be covered under the Fed plans that covered IVF? For example, was everything covered, was there a co-pay (how much?), etc.? I know these are days past, but am just curious to know what it used to be.

I did IVF under MDIPA. Each cycle was around $4500 including ICSI. Meds were a copay of about $400. PG S , embryo freezing and any subsequent frozen transfers were not covered.

yes, this is what we paid too under MDIPA at Shady Grove: about $4500 for IVF with ICSI plus $200-500 for med copays. MDIPA paid for up to 3 cycles per live birth and then the tally reset for a subsequent attempt at another pregnancy. FET were counted as one of the 3 cycles and cost about $3K out of pocket (vs. the $4.5K for a fresh cycle).
Embryo freezing and storage were not covered.

[Anonymous]

GEHA is covering monitoring and add’l charges like the anesthesia but not the actual egg retrieval itself or PGS. So that’s like thousands of dollars that we don’t have to pay. We just pay the coinsuramce and the actual procedure. .