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The main difference between in vitro fertilization and artificial insemination is where fertilization takes place. In an in vitro fertilization procedure, the fertilization takes place in the laboratory. On the other hand, in artificial insemination, the fertilization takes place in the womb.
If you are considering this procedure, you may be wondering “does Medicare cover artificial insemination?” In this article, we answer the question in clear, plain English. You will also find the average costs of Artificial Insemination for those who pay for it out of pocket.
Does Medicare Cover Artificial Insemination?
The short answer is no. In most cases, Medicare will not cover the cost of artificial insemination. That said, there may be some situations where you can get related costs covered. Below we’ll take a closer look at this so you know what to expect.
Original Medicare (Medicare Part A and Part B) does not provide coverage for artificial insemination. So that means you will have to pay 100 percent for your artificial insemination. Original Medicare does not provide coverage for many types of treatments and services regarding infertility.
Original Medicare also does not provide coverage for medications to treat infertility. However, in some cases, Original Medicare may provide coverage for certain treatments and diagnostic tests for infertility.
Original Medicare provides coverage for treatment and diagnostic tests for infertility as long as it is considered medically necessary. Original Medicare also provides coverage for treatment and diagnostic tests for infertility if your healthcare provider orders it.
Coverage for certain doctor’s services, outpatient treatment, medical supplies, and medically necessary treatments are provided by Medicare Part B. Medicare Part B provides coverage for diagnostic tests and treatments for infertility such as the following:
- Testicular biopsies
- Genetic testing
- CAT scans
- MRI scans
- Semen analysis
- Testosterone levels tests
- Thyroid tests
- Hormone tests
Medicare Part B provides coverage for the diagnosis of male infertility by way of sperm analysis. A sperm analysis plays a vital role in diagnosing male infertility. Medicare Part B provides coverage for a sperm analysis if your healthcare provider orders it. A sperm analysis is a procedure that is difficult to determine if it is medically necessary or not.
Part C and Part D Coverage for Artificial Insemination
Like with Original Medicare, Medicare Advantage plans (Medicare Part C) also do not cover artificial insemination treatments. Medicare Advantage plans cover everything Original Medicare covers and some additional benefits. However, coverage and out-of-pocket costs will vary depending on the specifics of your plan.
Medicare Part C plans that include prescription drug plans will not provide coverage for medications that your healthcare provider will prescribe to you with regards to infertility. Part C plans do not provide coverage for in vitro fertility medications
Medicare Part D plans also do not provide coverage for infertility medications. Part D is a prescription drug plan. Like Medicare Part C, Medicare Part D plans are provided by private insurance companies.
How Much Does Artificial Insemination Cost?
An artificial insemination may cost somewhere from $300 to $1,000 per cycle. The cost is higher if you are using a donor’s sperm rather than your spouse’s.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover Enbrel?