Does Medicare Cover Fertility Treatments
This article was updated on: 09/10/2018
Approximately 10% of couples in the United States are defined as infertile based on the inability to conceive after 12 months of unprotected intercourse, according to U.S. National Library of Medicine. These couples may seek fertility treatments to help them get pregnant.
What fertility treatments are available?
The first part of fertility treatment may involve fertility testing, according to the Mayo Clinic. Male fertility testing may involve a semen analysis, hormone and genetic testing, and even a testicular biopsy. Female fertility testing may involve ovulation testing, ovarian reserve testing, hormone testing, and pelvic ultrasounds.
Fertility treatment then depends on what’s causing the infertility, how long you’ve been infertile, you and your partner’s ages and your personal preferences, according to the Mayo Clinic.
Fertility treatment for men could include:
- Changing lifestyle factors, such as exercising regularly or improving frequency of intercourse
- Medications to improve sperm count and quality
- Surgery to reverse a sperm blockage
- Sperm retrieval to obtain sperm when ejaculation is a problem or no sperm is present in ejaculate
Fertility treatment for women could include:
- Fertility drugs to treat ovulation disorders
- Intrauterine insemination to place healthy sperm directly in the uterus
- Surgery to correct endometrial polyps or intrauterine scar tissue
Couples may also try in vitro fertilization (IVF) fertility treatment. IVF involves retrieving mature eggs from the woman, fertilizing them with the man’s sperm in a lab dish and then implanting the resulting embryos in the woman’s uterus.
Does Medicare Part A and Part B cover fertility treatments?
Reasonable and necessary services associated with treatment for infertility are covered by Medicare. Reach out to your provider to make sure you meet the criteria for coverage.
Does Medicare Part D cover fertility drugs?
Medicare Part D covers prescription drugs. You can get Part D coverage from a stand-alone Part D Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage. Drugs generally excluded from Medicare Part D coverage include agents used to promote fertility. To be sure about what your drug plan covers, check the plan’s formulary, or list of covered drugs. The formulary may change from time to time but you will be notified when necessary.
Cost of fertility treatments
Some fertility treatments, such as increased exercise or increased intercourse may involve little medical intervention and may cost little or nothing.
Fertility treatment surgery costs vary depending on the surgery. Before you get a surgery, check with your provider for a cost estimate.
According to Forbes magazine, a “fresh” IVF cycle costs $12,000 before medications which can cost an additional $5,000 more. In a “fresh” cycle eggs are harvested and mixed with fresh sperm. “Frozen” IVF cycles use “frozen” embryos and can cost from $3,000 to $5,000 a cycle, plus annual storage fees for frozen embryos. American Pregnancy.org concurs that a single IVF cycle can range from $12,000 to $17,000.
Do you have more questions about Medicare coverage of fertility treatment?
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