Fertility treatments are stressful and expensive. However, you can help ease your costs and be financially prepared with tools offered by Grain Fertility
Fertility treatments are stressful and can be incredibly expensive. Patients are often overwhelmed with a litany of decisions with incomplete information. Focus Fertility strives to help patients fill in some of these gaps by providing patients with the tools to access, use, and learn from their fertility related health and financial information.
Based on my experiences working in the healthcare space for over a decade, our family’s own fertility journey, and conversations with patients, we wanted to provide you with some very basic concepts to help you understand your fertility finances and give you some tools to help you become a better advocate for yourself, stay organized to avoid unnecessary financial surprises, and hopefully help save or recoup some of your health related expenses.
Fertility Coverage 101
According to RESOLVE: The National Infertility Association, as of April 2021, 19 states have passed fertility insurance coverage laws, 13 of those laws include IVF coverage, and 11 states have fertility preservation laws for iatrogenic (medically-induced) infertility. In addition to state law, there are insurers who provide some level of coverage for fertility services. If you do have some level of coverage, there are a number of important questions that need to be asked before starting treatment, such as:
Are there limits to the coverage?
Are only certain brands of medications covered?
Is pre-certification required?
What are your copayment, coinsurance, and other financial commitments?
Are there other potential costs and limitations to your coverage?
Every insurer defines plan benefits through a detailed document you have access to as an enrollee. They can be called a benefit plan description, description of benefits, evidence of coverage, or other name. Here is an example from a Carefirst BlueChoice Advantage POS plan in Maryland
A document like this will help you understand what is and is not covered. Every insurer will have a copy on their website for their beneficiaries. If you ever have any questions about your policy, you can contact your insurer and ask as many questions as you have to ensure you are comfortable with your understanding of coverage levels.
You will also likely get Explanation of Benefits (EOBs), bills, statements and other documents that list all of the procedures that are done during your fertility treatment and describe the costs for medical care or products you’ve received. One item that many of these documents will have is a CPT code, or Current Procedural Terminology codes. Every medical procedure is assigned one of these codes to help with billing and tracking purposes. While knowing the codes themselves is not important, it can be helpful to know where to find what the codes mean so you can ensure your doctor, clinic, or insurer are properly billing you. A list of CPT codes associated with fertility services can be found here.
These codes become especially helpful for patients who are paying out of pocket. Some clinics may work with you to negotiate the prices of services. This is something my wife and I did with our first clinic. If you have any questions or want advice on how I did this, reach out to me at joe@grainfertility.com.
If you are working with a fertility clinic that offers a bundled package, you can ask for a full list of all of the services covered in the bundle. This will help you more accurately understand and budget for your treatment and help ensure you are not caught off guard with unexpected expenses.
By understanding potential coverage limits, non-covered procedures, or any other potentially unaccounted for expenses, you can better prepare for your fertility treatments, avoid unwanted financial surprises, and focus on what matters most, your health and fertility journey.
Infertility and Taxes
Another important financial consideration during your fertility treatment is your tax obligations. One bright side to fertility treatments being very expensive is they can help you improve your tax liabilities and may help you with a refund. IRS Publication 502 allows for itemized deduction of medical expenses, including fertility related care. You can deduct on Schedule A (Form 1040) only the part of your medical and dental expenses that is more than 7.5% of your adjusted gross income (AGI). As a service to our users, Grain Fertility has created a spreadsheet to help keep track of expenses and mileage to calculate your medical expense totals and help you or your tax professional determine if you are eligible to deduct your medical expenses. This sheet can be accessed by signing up for the Grain Fertility waitlist on our homepage.
For tax purposes, the IRS defines medical expenses as the costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and for the purpose of affecting any part or function of the body. The IRS says you can include in medical expenses the cost of the following procedures performed on yourself, your spouse, or your dependent to overcome an inability to have children.
Procedures such as in vitro fertilization (including temporary storage of eggs or sperm).
Surgery, including an operation to reverse prior surgery that prevented the person operated on from having children.
In addition to the medications, diagnostic tests, therapies, and procedures associated with your fertility treatment, the IRS also allows you to include in your medical expenses amounts paid for transportation primarily for, and essential to, medical care. This includes buses, public transportation, and airfare, as well as allowing you to calculate car expenses using the standard medical mileage rate of 16 cents a mile. Grain Fertility’s Medical Expense Tracking Worksheet allows you to track all of this and calculate total costs in one easy to use spreadsheet. You can get this worksheet right now by signing up for Grain Fertility's waitlist on our homepage.
Grain Fertility is also building an in depth expense tracking system, allowing fertility patients to add, calculate, and search expenses so you can stay organized and quickly pull up any cost associated with your care. A tool like this can help you quickly provide documents to whoever does your taxes or for reimbursement from your FSA or HSA
It is important to note that Grain Fertility does not provide tax, legal or accounting advice. This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. You should consult your own tax, legal and accounting advisors to determine your own eligibility.
Hopefully, some of this information will be helpful for you during your fertility journey. The unfortunate reality is, until we have universal access to fertility care across the country, finances will continue to play a major role in fertility care. It is why Grain Fertility is dedicated to advocating for expanded coverage for all family building options including fertility treatment, adoption, and surrogacy.