Anonymous wrote:

Anonymous wrote:I’m on BCBS through the MD marketplace to get my IVF covered at SGF. I pay $380/month but after I hit my $1k deductible my meds have been $300, IVF is covered, and I only pay for PGT. In total income out under $3k. Furthermore, I get three transfers a year and can bank embryos.If I were to pay for all of this OOP I know my total would be close to $25k. Until I know that the fed coverage is as good as what I have, it doesn’t seem worth it.

How are you qualifying for MD marketplace with a fed job?

I'm not the PP you're asking, but last year I had a BCBS plan from MD Marketplace as a fed. Pretty much anyone can buy a plan from marketplace (or direct from the carrier, which is what I did rather than buy through marketplace). Only individuals with income below a certain threshold qualify for subsidies. So I paid full price for my premium and used it as a secondary plan after my family's fed plan. It was expensive, for sure, but it was a better deal than paying OOP for IVF.

Anonymous wrote:I’m on BCBS through the MD marketplace to get my IVF covered at SGF. I pay $380/month but after I hit my $1k deductible my meds have been $300, IVF is covered, and I only pay for PGT. In total income out under $3k. Furthermore, I get three transfers a year and can bank embryos.If I were to pay for all of this OOP I know my total would be close to $25k. Until I know that the fed coverage is as good as what I have, it doesn’t seem worth it.

How are you qualifying for MD marketplace with a fed job?

I’m on BCBS through the MD marketplace to get my IVF covered at SGF. I pay $380/month but after I hit my $1k deductible my meds have been $300, IVF is covered, and I only pay for PGT. In total income out under $3k. Furthermore, I get three transfers a year and can bank embryos.If I were to pay for all of this OOP I know my total would be close to $25k. Until I know that the fed coverage is as good as what I have, it doesn’t seem worth it.

Is egg/embryo freezing covered? If diagnosed with infertility?

Regards to drugs:

Reproductive Care Updates: What we cover
Specific artificial insemination procedures
The associated prescription drugs for covered services for all members. You must receive prior approval for artificial insemination.
Members diagnosed with infertility can receive up to three (3) annual drug cycles for in vitro fertilization (IVF). You must receive prior approval and buy your prescriptions through our pharmacy programs.
Standard Option members diagnosed with infertility can get any assisted reproductive technology (ART) procedure (not listed as an exclusion in the brochure). We will cover up to $25,000 annually once you receive prior approval.
Up to 40% in exclusive savings through WINFertility’s Treatment Program Bundles on Blue365®. This is another way members can receive top quality fertility care at an affordable, predictable price.

Adding for drug costs - menupor which was around $80 per vial is going to be a $65 copay through CVS specialty for 20 vials. For 1800 units of follistim is a $65 copay through CVS Speciality, was over $1,400 out of pocket. 5 Granilex shots is a $65 copay CVS speciality versus over $275 for both. Pregnyl (trigger shot) $45 pick up in CVS versus $125 out of pocket. 90 200mg progesterone pills is $15 CVS mail versus $45 out of pocket. These drugs are of course with prior approval, but these are are standard plan prices assuming they will be covered with the approval for infertile for the IVF process.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Is this a lifetime maximum or is it per benefit year?

It says annually!

Wow! That sounds a lot better than the old Fed IVF plans that only covered 3 cycles total.

With an annual cap of $25k, it's really not that much better. That doesn't even cover one cycle of IVF.

I cycled at SG under the old Fed plans that covered IVF. The negotiated rate for the cycle was around $5k and meds were also covered. They’ll probably have something like that.

Has anyone reached out to SG to see if there is a new negotiated rate for next year?

BCBS Standard has high premiums compared to what I have now. Trying to crunch the numbers to see if it’s worth it…

I mean the cost of FEP Blue Standard for Self plus One is an additional $3,253.46 including $700 and premium difference. It's difficult t to see how you aren't coming out ahead? This has no copay for maternity care and the copays are slightly cheaper, by $5. For context, this year out of pocket for Columbia was about $13k minus drugs, Dominion $11k minus drugs.

Anonymous wrote:Would anything be covered for a gay man doing IVF with a surrogate? The eggs are already purchased. Would it cover the ICSI and FET?

No, even the most generous insurance will typically not cover donor gametes or any part of IVF for a surrogate. We are a straight couple who used donor eggs and a gestational carrier, and we had gay friends who were also going through the same process at the time, when the Fed plans covered IVF several years ago. Everything was out of pocket.

I wish they would cover hearing aids

Anonymous wrote:Would anything be covered for a gay man doing IVF with a surrogate? The eggs are already purchased. Would it cover the ICSI and FET?

Nope doesn't look like, health plan member must be diagnosed with infertility. And in any even, this surrogate your are employing would not be a part of your health plan since you are not married to her, so another disqualifier.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Is this a lifetime maximum or is it per benefit year?

It says annually!

Wow! That sounds a lot better than the old Fed IVF plans that only covered 3 cycles total.

With an annual cap of $25k, it's really not that much better. That doesn't even cover one cycle of IVF.

I cycled at SG under the old Fed plans that covered IVF. The negotiated rate for the cycle was around $5k and meds were also covered. They’ll probably have something like that.

Has anyone reached out to SG to see if there is a new negotiated rate for next year?

BCBS Standard has high premiums compared to what I have now. Trying to crunch the numbers to see if it’s worth it…

Please update if you find out. Also trying to figure this out …

Would anything be covered for a gay man doing IVF with a surrogate? The eggs are already purchased. Would it cover the ICSI and FET?

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Is this a lifetime maximum or is it per benefit year?

It says annually!

Wow! That sounds a lot better than the old Fed IVF plans that only covered 3 cycles total.

With an annual cap of $25k, it's really not that much better. That doesn't even cover one cycle of IVF.

I cycled at SG under the old Fed plans that covered IVF. The negotiated rate for the cycle was around $5k and meds were also covered. They’ll probably have something like that.

Has anyone reached out to SG to see if there is a new negotiated rate for next year?

BCBS Standard has high premiums compared to what I have now. Trying to crunch the numbers to see if it’s worth it…

I'm so glad others will be able to do this!

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Is this a lifetime maximum or is it per benefit year?

It says annually!

Wow! That sounds a lot better than the old Fed IVF plans that only covered 3 cycles total.

With an annual cap of $25k, it's really not that much better. That doesn't even cover one cycle of IVF.

That would've definitely covered my IVF cycle!