Maryland exchange plans for IVF?

[Anonymous]

Would any of you who have a Maryland exchange plan that covers IVF be able to share any of the coverage details? We're thinking about getting a plan on the Maryland exchange for 2020 if we don't manage to get pregnant by then. (Our current plan through work has no fertility coverage.)

We're especially trying to figure out:

- Are there any specific requirements we should know about for the required six attempts at artificial insemination for a same-sex couple? (We're doing unmedicated IUIs with a midwife at home and want to make sure those "count" toward our required six attempts.)

- Is there any flexibility around coverage for IVF where the infertility is caused by a non-reproductive medical problem? (I know there's coverage for issues like endo and tube issues, but what about for chronic illness that affects fertility?)

I've done a good bit of googling but haven't managed to find the level of detail we need.

Thanks!

[Anonymous]

I don't think you can find info about 2020 yet. For 2019, the individual plans are kaiser and BCBS. The individual plans have to cover IVF (See https://insurance.maryland.gov/Consumer/Documents/publicnew/essentialbenefitschart.pdf)


The plan details for Kaiser plans are on this website http://info.kaiserpermanente.org/healthplans/plandocuments/maryland/individual/index.html


For BCBS, you have to click on the individual plan, then click on Plan Costs & Benefits, then continue to external website, and then click on the link on the first page after the following words: to get a copy of the complete terms of coverage, please visit

Good luck. You can try calling insurance companies, but they usually don't want to give any info about the plans over the phone

[Anonymous]

Shady Grove's website uses the terminology of "articifial insemination" and not IUI so hopefully those attempts will count towards your 6 before IVF coverage. Good luck!

https://www.shadygrovefertility.com/affording-care/accepted-insurances/knowing-your-benefits

[Anonymous]

Some plans have clauses that bypass the 6 IUI attempts. I was Aetna for a time and I think being over a certain age and having a short period of trying unsuccessfully was enough. I would recommend seeing an RE and making sure everything else is in line, like Day 3 bloodwork, HSG, etc. If some of that is abnormal, you could end up with a diagnosis that gets you coverage. Even though regular obgyns and midwives can sometimes do some of this testing, they are not specialists in this area and I've heard a lot of people say they wasted time on staying with them initially before moving on to an RE. Even without infertility coverage, lots of plans will often cover most of the diagnostic stuff that is not part of an actual ART procedure.

I was on the BCBS PPO Gold Maryland exchange plan two years ago and it had very good coverage. It's a lot more expensive now, but worth it if doing IVF and more than one cycle.

[Anonymous]

I'm the PP that just posted. According to the CareFirst MD medical policy reference manual papers on ART, here was what they listed. This was from 2017 and may have changed:

the infertility is associated with any of the following diagnosed medical conditions2:
– endometriosis;
– exposure in utero (before birth) to diethylstilbestrol, commonly known as DES;
– blockage of, or surgical removal of, one or both fallopian tubes (lateral or bilateral salpingectomy)(excluding tubal blockage due to a previous elective sterilization); or
– abnormal male factors including oligospermia, contributing to the infertility (excluding previous elective sterilization)3

Footnote 2 says: 2Updated coverage for same sex couples according to Maryland State mandate S.B 416 H.B. 838 effective 07/01/2015

Hope this helps somewhat

[Anonymous]

Thank you! I appreciate all the helpful and thoughtful responses. We have done the full RE workup for each of us, and no issues turned up there -- which is good news overall but not helpful when it comes to coverage!