Bumping this. Has anyone made any headway in figuring this out?

This is a really old thread. The plans may be all different now. For example, the HealthyBlue Platinum doesn't exist anymore. With the hike in premiums for 2018, it is sort of a toss-up whether to try for one of these plans or buy into a shared risk program at a clinic.

hi
could any one help which policy covers ivf

I have the healthy blue platinum plan and I paid $200 for follistim and $85 for my trigger all others I paid $0. I had to take Provera, prometrium and estradiol.

PP here. Thanks for the drug cost info. I've been spoiled by my current Cigna insurance and only paying $150/round for all of the drugs. I can't believe how expensive they are!!

I have the carefirst platinum plan. Heathyblue POS

For my first IVF cycle, I'm using menopur, follistim, ganirelex and lupron. It was ordered through CVS Caremark and they said it would cost $500. Hope that helps!

I don't have these plans but I can answer the cost of drugs out of pocket to give you an idea of the difference in prices. My first IVF was done out of pocket so we paid about $3-4k per cycle for drugs. The major costs were the Bravelle/Gonal F and Menopure. the endometrium is about $250 for 3 boxes. The second rounds of IVF were covered under work insurance so we paid very little. The drugs were also on a copay and cost $110 per cycle. $35 for the Gonal F and Menopur (6 boxes Gonal F and 50 vials Menopur), $20 for 4 boxes Endometrium, $5 for trigger, estrace, Lupron and antibiotic.

So a $35 cplay you are looking at around $110-150 per cycle for drugs and for 50% coverage I would expect to pay $1500-2500 for drugs.

I've been trying to figure this out too. I've talked to two Carefirst reps, the insurance person at shady grove, and an insurance broker and still don't have a straight answer. Do you need a specific diagnosis or have to have been trying for a certain period before they will approve IVF? I haven't even tried iui bec my dr said it wouldn't work for my case. Do they require you to try that first? I'm on my 3rd IVF cycle under cobra coverage but I lose it in April and need a new plan. I was also concerned about drug costs. One platinum plan says $35 copay per specialty drug and another plan says you pay 50% for each drug and I have no clue how much that will cost out of pocket for one round. Sounds like it could get expensive! I was trying to decide which Carefirst platinum option would give me the best coverage and I'm so frustrated by the lack of information.

Anonymous wrote:It covers 3 IVF cycles per live birth, not sure of a lifetime max but I doubt you would hit it in 3 cycles anyways. Some meds were covered but not all. There is no deductible so I think it's a great plan. 20 dollar co pay for fertility related visits.
I only knew about the iVF coverage before signing up BC I had friends that had the plan and did IVF. Otherwise it's impossible to find out information. Hope this helps and good luck!!

Bumping this thread to see if anyone knows which meds are covered under the Maryland Healthyblue Platinum plan. My interest is mostly on the injectables (Bravelle, Menopur, Gonal). Thanks in advance.

Yes FET is considered a cycle.

Anonymous wrote:It covers 3 IVF cycles per live birth, not sure of a lifetime max but I doubt you would hit it in 3 cycles anyways. Some meds were covered but not all. There is no deductible so I think it's a great plan. 20 dollar co pay for fertility related visits.
I only knew about the iVF coverage before signing up BC I had friends that had the plan and did IVF. Otherwise it's impossible to find out information. Hope this helps and good luck!!

OP here. Just one more question: is an FET considered a cycle in your plan? Generally it is but just checking. Thanks again!

It covers 3 IVF cycles per live birth, not sure of a lifetime max but I doubt you would hit it in 3 cycles anyways. Some meds were covered but not all. There is no deductible so I think it's a great plan. 20 dollar co pay for fertility related visits.
I only knew about the iVF coverage before signing up BC I had friends that had the plan and did IVF. Otherwise it's impossible to find out information. Hope this helps and good luck!!

Anonymous wrote:The carefirst platinum covers 3 IVF cycles. I have the plan.

OP here. Thanks for replying. We can't get through to the insurance companies to answer these basic questions. Do you have a lifetime maximum on coverage? What about prescription coverage? The more details you can share, the better.

Many thanks.

The carefirst platinum covers 3 IVF cycles. I have the plan.

Hello,

I am trying to obtain the details of the infertility coverage from the plans listed on the MD Health Exchange web site (Blue Cross, KP, etc.). The SPDs are very basic, therefore I tried to call customer service of the marketplace and the insurance companies themselves. Each one says I need to call the other (of course). I don't want to buy into a plan without knowing all the details. Should I keep calling the marketplace or the insurance companies? Any help would be greatly appreciated.

Thanks.