Millions of Americans struggle with getting – or staying – pregnant. Based on test results and a specific diagnosis, physicians may recommend different fertility treatment options to help their patients conceive. These treatments can include:
- Fertility drugs
- Intrauterine insemination (IUI)
- In vitro fertilization (IVF)
- Intracytoplasmic sperm injection (ICSI)
- Gamete intrafallopian transfer (GIFT)
- Zygote intrafallopian transfer (ZIFT)
Fertility treatments can be highly effective. According to the Centers for Disease Control and Prevention (CDC), approximately 1.7% of all infants born in the United States every year are conceived using ART, or assisted reproductive technology. Unfortunately, some of these treatments can cost thousands of dollars and your insurance may not cover your costs.
Can Medicare help pay for your treatment?
If you are under 65 years of age, you may be receiving Medicare benefits due to a disability. You may be eligible for Medicare if:
- You have been receiving Social Security benefits or certain benefits from the Railroad Retirement Board for 24 months
- You have ALS, or Amyotrophic Lateral Sclerosis, also known as Lou Gerhig’s Disease
- You have End-Stage Renal Disease (ESRD)
If you are covered by Medicare Part A and Part B, you should know that reasonable and necessary services associated with treatment for infertility are covered under Medicare. Infertility is a condition sufficiently at variance with the usual state of health to make it appropriate for a person who normally is expected to be fertile to seek medical consultation and treatment. Part B pays for certain doctors’ services, outpatient care, medical supplies, and some medically necessary fertility treatments, but it will not cover IVF.
If your physician prescribes fertility drugs to address different problems with ovulation, such as Clomid, human menopausal gonadotropin (hMG), follicle stimulating hormone (FSH), gonadotropin releasing hormone (Gn-RH), Metformin, and Bromocriptine, you may be wondering if your Medicare Part D prescription drug coverage can help cover your out-of-pocket costs. You may have a stand-alone Prescription Drug Plan (PDP) or you may be enrolled in a Medicare Advantage plan that includes prescription drug coverage. While each plan has its own formulary, or list of covered drugs, most Part D prescription drug plans exclude fertility drugs from their coverage.