I spent days reviewing all the plans knowing I would need IVF. In the end I chose Aetna Open Access HMO, however, I am going to go with MD IPA next year. What I discovered is that there were four federal plans that covered IVF (United, Kaiser, Aetna HMO, and MD IPA) all within the same price range (2800 - 3400). United only allowed 2 embryos to be transferred so that was out for me (as a 40 yr old I knew I would need the option to go with more), I already had some testing done and was told that if I went with Kaiser I would have to redo everything in house with Kaiser drs. Plus, Kaiser is a much more restrictive HMO and I wanted more options in terms of doctors (other than fertility) that I could see. That left Aetna and MD IPA. As far as I could tell the two plans were the same so I went with Aetna since it was an open access HMO. Having now gone through the process I learned that where Aetna gets you is in the med costs. Although they cover 50% they change almost double the actual cost of the meds. My 50% ended up being around 3500 0 4000 a cycle. I even pointed this out to Aetna and they didn't deny it. From what I've read about MD IPA the meds are covered at a much better rate so I'm going to try them next time since my meds ended up costing more than the actual cycle with Aetna. Other than the med cost I really liked Aetna.

Just FYI about calling around - I tried to do that when I was choosing a plan and unless you are actually getting authorization for it never believe what they tell you as it is often wrong. They are not good with hypothetical.

Two points:
(1) I have Fed Aetna Open Choice PPO and they covered meds and diagnosis only, not IVF procedure itself. IVF at GWU.
(2) Covered does not mean the same thing as eligible or allowed. So, my husband's plan (also Aetna) covers IVF, if we met their criteria. I could not get what that criteria was until after we had enrolled, then they gave me an over the phone test. I did pass, but the questions were how long we were trying, what diagnosis did we have, how old was I (no one cares about DH's age), when was my last period, had I purchased medication, did I have other insurance, etc. Basically this insurance person second-guessed my RE to determine if IVF was the right choice, whether I'd already started treatment and was now trying to get it covered, and couldn't someone else pay for this rather than them. Having good insurance is wonderful, dealing with any insurance co. is painful.

I am not so sure about calling to talk to a real person... i remember doing just that and getting different answers from the same insurer depending on who answered the phone. It's clearer w/Aetna b/c they have a special infertility office. Not saying Aetna has the best coverage...just read the brochures carefully and have it as a reference when you do call. You can get all the brochures at the OPM website -- probably best to set up your own spreadsheet. Good luck.

Just a point of clarification. If you are on a federal plan, it doesn't matter where you live. The federal plans are exempt from any state laws mandating IVF coverage. If one of you works for a private company in MD, go with that plan because MD mandates coverage for infertility. Some of the fed plans have infertility coverage, so compare those plans with whatever the private plan covers.

16:18 again...

I hope and pray that IUI will work for you ...but plan ahead and ask about IVF too. Its always better to have more coverage that you don't need than not enough coverage.

First...I would re-post your question as a new comment so more people will spot it.

If no one has a current (this calendar year) answer that meets your needs - you can do what I did....

I called (literally) every major insurance company offered to me as a Federal employee and spoke to a human. Those brochures are huge and not always specific enough to help you choose. I told the person on the phone that I needed IVF coverage and asked them for help determining what thie company covered - (diagnoisis, surgical correction, drugs, mid-cycle monitoring, IVF, IUI, ICSI, specific doctors, etc...). Be as specific as you can with your questions. Also ask if they have had recent changes or expect to make changes in the coming year.

It took me a few days to gather all of this info but I finally found one that covered what we needed with very low out of pocket costs. After years of trying, one ectopic, and multiple miscarriages, we got lucky with our first IVF at Dominion with Dr. DiMatina. Our twins just turned 2.

Stay possitive, good luck and let us know how it goes!

Hello,

We are moving to DC this summer and are eligible for federal health coverage. We have gone through preliminary testing and may be starting drugs/IUI shortly. Can anyone recommend the best plan for someone who actually lives in the District? Would it be Kaiser?

Has anyone had experience with these plans after a successful pregnancy? I'm assuming you don't have to wait the 2 yrs again if you got pregnant through IVF the first time? Any trouble getting approval for the 2nd try within a year of the first birth?

We have MDIPA and went straight to IVF. At the time of IVF#1 (2006) we had a crummy enough sperm that I couldn't imagine MDIPA making us do IUIs (and they didn't).
Now they just approved another IVF and our SA looks fantastic and is well within IUI territory but we elected to go straight to IVF given our history of success (and the fact that an IUI with MDIPA will run us about $1500 and IVF is only $2000 more but much more likely to work). My point being that now even with "unexplained" fertility and great testing results on both partners MDIPA is paying for IVF outright.

My impression from talking to my financial counselor at Shady Grove is that MDIPA will generally take the doctor's word for it if the physician recommends proceeding righth to IVF . MDIPA has one physician working for them who approves all infertility related referrals and I imagine she knows and trusts the clinical judgement of most of of REs that work in this geographic area.

With Aetna we only had to do one IUI. As long as you meet the 2 yr criteria and have tried a less expensive means (which you have with the previous IUI) they seem to be OK with IVF.

Has anyone had any luck getting coverage for IVF from a fed plan without going through IUIs? I already did 3 IUIs with clomid but my RE and I decided that we would skip IUIs with injectibles and go straight to IVF (reason for skipping is that we don't want multiples). I am now about to join the federal workforce and am wondering if there is anyway I can get coverage for IVF.

IVF at Shady Grove with MDIPA is around $3600 with ICSI ($3100ish without ICSI).
Med copays are around $150 for gonal f, menopur, trigger shot, pio and estrace.

I have MDIPA and paid $3,100 for my IVF cycle at SG. Meds were great too....a few $25 copays is all. It's a major pain to change insurance, especially with my bleeping financial person. The whole primary/secondary insurance thing has caused problems too.

I hope none of the others follow suite. I have Aetna and other than dealing with the prescription meds I have been happy with them. It is 3500 for an IVF cycle but where they get you is with the so called 50% co-pay on meds. They jack the price way up and charge you an outrageous price. I called every fertility pharmacy to get pricing on Gonal F, Follistim, etc and Aetna's 50% off price was only a hundren dollars off everyone elses full price. My meds ended up costing more than the IVF cycle. I'm not sure what plan to go with next open season. I never wanted to do United because they limited you to transferring only two embryos (and I'm 40). It sounds like MDIPA is very similar to Aetna but has better drug coverage?

I just checked out the United high-deductible plan and it looks like the benefits changed and starting in 2009 ART is no longer covered. Sucks...