Question for those who bought insurance on the MD exchange for IVF

[Anonymous]

I am a fed employee planning to start IVF next year. I live in Maryland and plan to sign up for a health insurance plan on the Maryland exchange since it will cover IVF. I was planning to just drop my current federal employee plan and switch to the Maryland one. But in other threads it sounded like people kept both. Is there some reason not to just use the Maryland plan?

I would also appreciate any recommendations on which MD plan to get.

[Anonymous]

I wasn't on Fed insurance, but a private employer plan through my husband's work. I went ahead and made the Carefirst Gold HMO plan my only plan for this year as coverage seemed pretty good and all my doctors accepted it. I personally don't think there would've been any benefit to me keeping my other insurance plan as well and it saved us a couple hundred bucks a month. I will be switching back next year, as the individual plans have a high premium and the deductible itself is more than my other plans OOP.

[Anonymous]

I kept my plan through work but only because my DH is also on it and he didn’t want to switch to the crappy plan offered by his employer. Otherwise I think it would be fine to switch but just be careful to confirm that you can definitely swap back onto your work plan when you want to. They might make you wait til the next open enrollment unless you have a qualifying event.

[Anonymous]

I’m a fed employee planning to switch to MD Carefirst for fertility coverage. I’m not going to keep my fed insurance. You can definitely get back on it next year after going off of it. As best I can tell, the only reason to stay on it would be if it offered some coverage the MD plan doesn’t (for me, I can’t see anything it offers the MD plan doesn’t). I know you need to be on FEHB for 5 consecutive years before retirement if you want to keep it into retirement but I don’t imagine that’s an issue for folks here

[Anonymous]

I plan to also get MD Carefirst next year. I am so confused of which one to get. Any recommendation?

[Anonymous]

Anonymous wrote:I plan to also get MD Carefirst next year. I am so confused of which one to get. Any recommendation?

I had the Healthyblue HMO Gold this year. But from what I understand, there's also a silver $1000 deductible? I don't know about that plan (it wasn't offered for 2019), I had no issues with the $1750 plan. I'd just super double check the fine print on the silver plan, as somethings may not be covered as much as you'd like. As for HMO vs PPO, I did HMO because all my doctors and hospitals were in network so there was no reason for me to pay the extra for PPO. You can check this on the Carefirst website

If you're curious how much things cost with this plan, at Shady Grove, I ended up paying $30 copay to see the RE, $65 imaging copay for every monitoring visit, $300 surgical copay for the HSG, and then totally random small amounts for the egg retrieval and transfer. If I went in only for bloodwork, I just owed $15 lab copay. My total SGF bill was around $2400 for all those Copays and retrieval/transfer charges plus an additional $1800 for embryo freezing. Drugs were very cheap. I only paid $385 in Copays for what was needed for one cycle.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I plan to also get MD Carefirst next year. I am so confused of which one to get. Any recommendation?

I had the Healthyblue HMO Gold this year. But from what I understand, there's also a silver $1000 deductible? I don't know about that plan (it wasn't offered for 2019), I had no issues with the $1750 plan. I'd just super double check the fine print on the silver plan, as somethings may not be covered as much as you'd like. As for HMO vs PPO, I did HMO because all my doctors and hospitals were in network so there was no reason for me to pay the extra for PPO. You can check this on the Carefirst website

If you're curious how much things cost with this plan, at Shady Grove, I ended up paying $30 copay to see the RE, $65 imaging copay for every monitoring visit, $300 surgical copay for the HSG, and then totally random small amounts for the egg retrieval and transfer. If I went in only for bloodwork, I just owed $15 lab copay. My total SGF bill was around $2400 for all those Copays and retrieval/transfer charges plus an additional $1800 for embryo freezing. Drugs were very cheap. I only paid $385 in Copays for what was needed for one cycle.

Can you please tell me the drug costs. I am a bit worried about that.

[Anonymous]

NP here. For those of you who bought the MD Carefirst plan, how long did it take to get your preauthorization? I’m hoping to start a cycle of IVF on Jan 10 but wondering if I’ll have to sit out a cycle waiting for the authorization.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I plan to also get MD Carefirst next year. I am so confused of which one to get. Any recommendation?

I had the Healthyblue HMO Gold this year. But from what I understand, there's also a silver $1000 deductible? I don't know about that plan (it wasn't offered for 2019), I had no issues with the $1750 plan. I'd just super double check the fine print on the silver plan, as somethings may not be covered as much as you'd like. As for HMO vs PPO, I did HMO because all my doctors and hospitals were in network so there was no reason for me to pay the extra for PPO. You can check this on the Carefirst website

If you're curious how much things cost with this plan, at Shady Grove, I ended up paying $30 copay to see the RE, $65 imaging copay for every monitoring visit, $300 surgical copay for the HSG, and then totally random small amounts for the egg retrieval and transfer. If I went in only for bloodwork, I just owed $15 lab copay. My total SGF bill was around $2400 for all those Copays and retrieval/transfer charges plus an additional $1800 for embryo freezing. Drugs were very cheap. I only paid $385 in Copays for what was needed for one cycle.

Can you please tell me the drug costs. I am a bit worried about that.

Definitely check out the fine print on the drug coverage for each plan. For my gold plan this year, I believe it says that medications were 100% (except for Copays) after reaching a separate $150 drug deductible. I know if you looked at the other 2019 plans, they did not have a separate drug deductible, so you would've had to have paid quite a bit OOP before getting coverage.

As for the copays, I think they were $200 for menopur, Follistim had $0 copay, $100 for lupron, and $35 for crinone. I don't remember everything exactly, but I know it was only $385 total. Maybe some of that could've been the $150 drug deductible.

[Anonymous]

We are looking to do IVF banking cycle with CCRM. Apparently that is not covered by any insurance however I am hoping to use Carefirst the insurance for the drugs. I've tried to contact them today several time but after waiting 20+ mins I had to give up because I was at work. Can the insurance be used for drugs without the procedure (since we will be doing the procedure out of pocket)?

[Anonymous]

When is the deadline to enroll in the private insurance? Is it the same as Fed Open Enrollment (Monday 12/9)?

[Anonymous]

Anonymous wrote:We are looking to do IVF banking cycle with CCRM. Apparently that is not covered by any insurance however I am hoping to use Carefirst the insurance for the drugs. I've tried to contact them today several time but after waiting 20+ mins I had to give up because I was at work. Can the insurance be used for drugs without the procedure (since we will be doing the procedure out of pocket)?

Not sure. You do have to have pre authorization for fertility drugs so I'm afraid they might know that it's not for a covered procedure through that process

[Anonymous]

Anonymous wrote:We are looking to do IVF banking cycle with CCRM. Apparently that is not covered by any insurance however I am hoping to use Carefirst the insurance for the drugs. I've tried to contact them today several time but after waiting 20+ mins I had to give up because I was at work. Can the insurance be used for drugs without the procedure (since we will be doing the procedure out of pocket)?

What insurance do you have? We did back to back rounds and both were covered under our Carefirst plan.

[Anonymous]

We plan to get Carefirst but the back-to-back procedure is a banking procedure sp it won't get covered by any insurance. It isn't a traditional full round.

[Anonymous]

For the MD Carefirst plans, did anyone get coverage for Menopur or Cetrotide during 2019? I don't see those listed on their formulary, and I'm worried they aren't covered.

Also, FWIW in terms of banking, the financial counselor at Shady Grove said that Carefirst treats a transfer as a "cycle" and will cover additional egg retrievals before you complete your third transfer. So, according to them, you can use it to cover egg banking retrievals (and SGF often suggests this to patients).