Does Health Insurance Cover a Surrogate?

Parenthood through surrogacy involves complex medical and financial considerations. Intended parents face a significant task in understanding the financial landscape, especially health insurance coverage. Substantial costs and intricate policy natures make determining coverage challenging.

Surrogacy-Related Medical Expenses

Surrogacy medical expenses cover distinct phases: intended parent fertility treatments, surrogate care, and newborn care. For intended parents, procedures often include fertility evaluations, egg and sperm retrieval, and in vitro fertilization (IVF). A single IVF cycle, including medication and embryo transfer, can range from $15,000 to $40,000.

For the surrogate, medical costs begin with pre-screening and psychological evaluations. Once pregnant, ongoing medical procedures include regular prenatal monitoring, labor, and delivery. Postpartum care is also necessary. These costs, including prenatal care, hospital delivery, and postpartum care, range from $10,000 to $30,000.

Newborn medical care is separate. While in utero, the baby is typically covered by the surrogate’s insurance. Once born, the newborn is not a dependent of the surrogate and not covered under her policy; responsibility shifts to the intended parents. Well-baby care, including hospital stays and routine tests, can cost up to $10,000; intensive care can reach hundreds of thousands.

Factors Influencing Insurance Coverage

Surrogacy medical expense coverage is influenced by state regulations, policy language, surrogacy type, and medical necessity. State laws vary significantly; some mandate coverage for infertility treatments, which may indirectly assist with IVF. However, few states explicitly require coverage for surrogacy procedures.

Policy language and exclusions are key to determining coverage. Many standard health plans for intended parents do not cover third-party reproduction or explicitly exclude surrogacy. If a policy lacks a specific exclusion for surrogate pregnancies, it may be legally obligated to cover costs typically covered for a traditional pregnancy. However, some policies contain general exclusion provisions that prevent surrogacy coverage.

Gestational and traditional surrogacy influence insurance. In gestational surrogacy, the surrogate is not genetically related to the child. Traditional surrogacy, where the surrogate is genetically related, has different legal and insurance implications. Medical necessity is another determinant; insurers evaluate if a procedure is medically necessary. Procedures for intended parents, like IVF, might be covered if infertility is diagnosed, but the surrogate’s pregnancy expenses are often viewed differently.

Employer-sponsored group plans may offer more comprehensive fertility benefits, potentially covering IVF or surrogacy expenses, compared to individual plans. While no official Affordable Care Act (ACA) plan exists specifically for surrogacy, ACA plans mandate maternity and newborn coverage. This can be leveraged to argue for coverage of the surrogate’s pregnancy and newborn care. However, self-insured employer plans are typically exempt from state mandates, complicating coverage.

Managing Insurance for Surrogacy

Navigating insurance for surrogacy requires a proactive, detailed approach to maximize coverage and manage costs. A fundamental step involves thoroughly reviewing insurance policy documents, especially sections on assisted reproductive technologies (ART), infertility, and third-party reproduction. Look for specific clauses related to “gestational carrier” or “surrogate pregnancy” that may indicate coverage. Many policies explicitly exclude surrogacy, but if absent, standard maternity benefits might apply.

Direct communication with the insurer is essential. Speak with a benefits specialist and request written confirmation of coverage details. Ask specific questions about how the policy applies to a gestational carrier’s pregnancy, including prenatal care, delivery, and complications, to clarify benefits. This helps understand deductibles, co-pays, and out-of-pocket maximums for intended parents.

Obtaining pre-authorization and verifying benefits before services protects against unexpected denials. For example, some IVF cycles may require prior authorization. Monitoring bills and claims closely once services begin is also important, allowing prompt identification of discrepancies or denied claims.

If a claim is denied, understanding the appeals process is important. Policyholders typically have the right to an internal appeal and potentially an external review. Multiple insurance policies, such as the surrogate’s and intended parents’ newborn plan, often require benefit coordination to determine primary coverage. While a surrogate’s insurance covers her, the newborn is generally covered under the intended parents’ policy after birth, often added within a 30-day grace period.