Any MD residents purchasing exchange insurance plans for IVF?

[Anonymous]

Im planning on doing IVF next year and looking into purchasing insurance off the exchange to cover it (my current insurance through my husband's employer doesn't cover infertility, company is based out of state). Anyone else doing this? What's the best you've been able to find? Is it possible to keep my current insurance and have a secondary plan for IVF (I'm probably unnecessarily weary of using these plans for potential pre/post natal coverage). I'll be going to Shady Grove if that makes a difference.
Let's discuss!

[Anonymous]

Yes. I did this. For me there was no point in using the exchange since my income didn’t qualify me for any subsidies. I just called a private insurance broker. I kept my primary and made the new plan my secondary. I got a PPO In case I want to cycle out of state. It’s $650/month.

[Anonymous]

Anonymous wrote:Yes. I did this. For me there was no point in using the exchange since my income didn’t qualify me for any subsidies. I just called a private insurance broker. I kept my primary and made the new plan my secondary. I got a PPO In case I want to cycle out of state. It’s $650/month.

Do you mind sharing details of the coverage amount (for the IVF process and meds)? Also, if you don’t mind sharing - which plan do you have?

[Anonymous]

Anonymous wrote:Yes. I did this. For me there was no point in using the exchange since my income didn’t qualify me for any subsidies. I just called a private insurance broker. I kept my primary and made the new plan my secondary. I got a PPO In case I want to cycle out of state. It’s $650/month.

Are there any limitations on the coverage? For example, do you have to have certain numbers (like AMH and FSH in a certain range)? Are there any age limits?

[Anonymous]

I looked into Kaiser last month and found that their platinum plan was about $450 a month with a $6000 or so oop max. I really liked Kaiser when I had them and had one of my kids with them and the care was fantastic and I hardly paid anything. You can just call them and purchase directly through them. You'd likely have to use Shady Grove which again I found is fine for relatively straight forward cases. I wouldn't bother with two insurances. It's too costly and the whole coordination of benefits thing is a mess.

[Anonymous]

Anonymous wrote:I looked into Kaiser last month and found that their platinum plan was about $450 a month with a $6000 or so oop max. I really liked Kaiser when I had them and had one of my kids with them and the care was fantastic and I hardly paid anything. You can just call them and purchase directly through them. You'd likely have to use Shady Grove which again I found is fine for relatively straight forward cases. I wouldn't bother with two insurances. It's too costly and the whole coordination of benefits thing is a mess.

OP here- Thanks for sharing! I'm just now really starting to look into plans and it looks like a Kaiser plan would be the cheapest total OOP, I'm seeing. Good to know there wasn't any issues using them. That's my biggest concern as my husband's insurance has always been very reliable and easy to find doctors that accept it. Any idea what pre-authorization is needed for fertility treatments? My husband has a congenital defect in his vas deferens so IVF is our only option. We've had success previously and I hear great things about Dr. Shim so we'll probably go with Shady Grove. Do you know how much of the injectables we're covered by the insurance as well? Thanks!

[Anonymous]

Anonymous wrote:

Anonymous wrote:I looked into Kaiser last month and found that their platinum plan was about $450 a month with a $6000 or so oop max. I really liked Kaiser when I had them and had one of my kids with them and the care was fantastic and I hardly paid anything. You can just call them and purchase directly through them. You'd likely have to use Shady Grove which again I found is fine for relatively straight forward cases. I wouldn't bother with two insurances. It's too costly and the whole coordination of benefits thing is a mess.

OP here- Thanks for sharing! I'm just now really starting to look into plans and it looks like a Kaiser plan would be the cheapest total OOP, I'm seeing. Good to know there wasn't any issues using them. That's my biggest concern as my husband's insurance has always been very reliable and easy to find doctors that accept it. Any idea what pre-authorization is needed for fertility treatments? My husband has a congenital defect in his vas deferens so IVF is our only option. We've had success previously and I hear great things about Dr. Shim so we'll probably go with Shady Grove. Do you know how much of the injectables we're covered by the insurance as well? Thanks!

I'm the pp who had Kaiser previously. I didn't end up needing Ivf for my second although that's why I went to them. I was super impressed with how accommodating they were. I went there having suffered from unexplained infertility with number 1 where I needed Ivf. I had already done all my testing and went there saying I needed a referral to Sgfc for number 2. They said no problem. My testing that I arrived with showed possible fluid in a tube and so I needed the tube removed. They said no problem. My obgyn just asked if I was 100 percent sure that I wanted the tube removed and if not let's consider doing a repeat hsg. I said sure why not. The repeat hsg showed that my tube was probably open. I said I still wanted it out as probably is not definitely. They said no problem. One week before the surgery I tested positive. Little guy is 2 years old now. All this to say I was blown away by the service I received at Kaiser.

I was just researching plans for a program I am piloting hence the reason I looked up Kaiser recently. Call Their benefits people. They told me once you hit your oop everything is covered including meds. I'd suggest you try and confirm with someone on their end well versed in fertility benefits if possible.

[Anonymous]

Infertility does not count toward OOP its in the brochure for all 2018-2019 Kaiser plans.

[Anonymous]

Anonymous wrote:Infertility does not count toward OOP its in the brochure for all 2018-2019 Kaiser plans.

What exactly does this mean? As in you could end up paying more than the max OOP for IVF?

[Anonymous]

Anonymous wrote:Infertility does not count toward OOP its in the brochure for all 2018-2019 Kaiser plans.

What about for the carefirst BCBS plans? Does anyone know?

[Anonymous]

Anonymous wrote:Infertility does not count toward OOP its in the brochure for all 2018-2019 Kaiser plans.

Do you have link? The brochures I saw did not exclude infertility from the OOP.

http://info.kaiserpermanente.org/healthplans/plandocuments/maryland/individual/index.html

[Anonymous]

Anonymous wrote:

Anonymous wrote:Infertility does not count toward OOP its in the brochure for all 2018-2019 Kaiser plans.

Do you have link? The brochures I saw did not exclude infertility from the OOP.

http://info.kaiserpermanente.org/healthplans/plandocuments/maryland/individual/index.html

Exactly. Please unless you have purchased the plan on the MD exchange or directly from Kaiser for the state of MD you do not know this for sure. I myself did not see it excluded in the detailed plan brochure I saw where they specifically listed other exclusions from the oop max. Op - please call member services yourself and try to find out.

[Anonymous]

OP here- I talked to BCBS carefirst on the phone today and the sales guy read me their little bit about IVF coverage and it sounds like you get the 3 attempts per live birth and a $100k lifetime max benefit. I could not find the entire benefit booklet online. I stopped by an office and they didn't have the booklet either, but I was given a giant chart which stated "no charge, no deductible" for IVF physician charges with the HMO gold plan. So I'm assuming if you meet their criteria, IVF is covered. Now how much that is, I'm assuming will just be maybe co-pays to see the specialist and then one for the retrieval and transfer procedures if that? Either way, definitely sounds like it's worth it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Infertility does not count toward OOP its in the brochure for all 2018-2019 Kaiser plans.

Do you have link? The brochures I saw did not exclude infertility from the OOP.

http://info.kaiserpermanente.org/healthplans/plandocuments/maryland/individual/index.html

Exactly. Please unless you have purchased the plan on the MD exchange or directly from Kaiser for the state of MD you do not know this for sure. I myself did not see it excluded in the detailed plan brochure I saw where they specifically listed other exclusions from the oop max. Op - please call member services yourself and try to find out.

I am a Kaiser member. When I go into my kaiser patient portal and download evidence of coverage it's specifically states that infertility does not count toward OOP.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Infertility does not count toward OOP its in the brochure for all 2018-2019 Kaiser plans.

Do you have link? The brochures I saw did not exclude infertility from the OOP.

http://info.kaiserpermanente.org/healthplans/plandocuments/maryland/individual/index.html

Exactly. Please unless you have purchased the plan on the MD exchange or directly from Kaiser for the state of MD you do not know this for sure. I myself did not see it excluded in the detailed plan brochure I saw where they specifically listed other exclusions from the oop max. Op - please call member services yourself and try to find out.

I am a Kaiser member. When I go into my kaiser patient portal and download evidence of coverage it's specifically states that infertility does not count toward OOP.

I do not doubt this. The question is which Kaiser plan are you on? Is it an employer sponsored plan? All plans are not the same. If your plan is underwritten in the state of MD and is not an employer sponsored plan ok let's talk. But without the specifics you could very well be misleading people unintentionally. The individual plan brochure for the plan available for the state of MD states otherwise. That is what is being debated so let's first make sure we are comparing apples to apples.