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Infertility is a challenging health issue for those who want to have a baby and start a family. The good news is that there are a few medical solutions for couples to try. And some of them can be very effective. Around 1.7 percent of infants born in the United States are by way of fertility treatments every year.
If you have Medicare and are looking into infertility treatments, a common question you may have is “does Medicare cover infertility?” In this article, we answer that question in clear, plain English. You will also find the average costs of infertility if you have to pay out of pocket for it.
Does Medicare Cover Infertility?
The short answer is no. In most cases, Medicare will not cover the cost of infertility. However, there may be some related services that Medicare will cover Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for things related to infertility.
Original Medicare (Medicare Part A and Part B) does not provide coverage for infertility. So that means you will have to pay 100 percent for your infertility treatment. Original Medicare does not provide coverage for many types of treatments and services regarding infertility.
Neither Part A nor B will provide coverage for medications to treat infertility, such as In Vitro Fertilization, or aIVF. However, Original Medicare may provide coverage for certain treatments and diagnostic tests for infertility in some cases.
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.
Part C and Part D Coverage for Infertility
Like with Original Medicare, Medicare Advantage plans (Medicare Part C) also do not cover infertility treatments. Medicare Advantage plans have to cover everything Original Medicare covers. Though they will offer additional benefits as well. However, infertility treatments are not part of any Part C plan that we are aware of.
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.
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 Infertility Treatment Cost?
The costs associated with infertility vary greatly depending on the treatment or service. For example, an IVF cycle usually costs around $15,000.
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 breast prostheses?