Is Freezing Your Eggs Covered by Insurance?

Egg freezing, a medical procedure designed for fertility preservation, allows individuals to store unfertilized eggs for future use. The decision to pursue this option often involves significant financial consideration, as the costs associated with the procedure can be substantial. A common question arises regarding whether health insurance plans provide coverage for egg freezing. Understanding the nuances of insurance policies and their approach to fertility treatments is an important step for anyone considering this path.

The Landscape of Insurance Coverage

Insurance coverage for egg freezing varies significantly among different health plans, often depending on whether the procedure is deemed medically necessary or elective. Many standard insurance policies generally do not cover egg freezing when it is undertaken for elective reasons, such as delaying childbearing for personal or career considerations. This is because it is typically not categorized as a medical necessity in these instances.

However, exceptions frequently exist for individuals facing medical conditions or treatments that could compromise their fertility. For example, if egg freezing is performed prior to cancer treatments like chemotherapy or radiation, or due to certain autoimmune diseases or conditions like endometriosis impacting reproductive health, it may be considered medically necessary. In such cases, some insurance plans may offer partial or full coverage.

State mandates also play a role in shaping fertility coverage, though their impact on egg freezing varies. Nearly half of the states have enacted laws requiring some level of fertility treatment coverage, with many of these mandates applying to fully-insured health plans. While some state mandates may include fertility preservation for medically-induced infertility, elective egg freezing is often excluded from these requirements. Self-insured employer plans, which are prevalent among large companies, are typically exempt from state-level mandates and design their own benefits.

Employer-provided benefits can offer additional avenues for coverage. Some employers, particularly larger corporations, offer enhanced fertility benefits that may extend beyond standard health insurance plans to include egg freezing. These benefits are increasingly utilized as companies seek to attract and retain talent, and they can sometimes cover elective egg freezing even if standard health plans do not.

Key Factors for Coverage Eligibility

Determining eligibility for egg freezing coverage often hinges on specific criteria established by insurance providers. A primary factor is the documentation of medical necessity. Insurers typically require clear medical evidence that the procedure is necessary to prevent a loss of fertility due to an existing condition or impending medical treatment. Robust documentation from a physician, detailing the diagnosis and how the medical intervention threatens fertility, is therefore important.

Some policies may also require an individual to have an infertility diagnosis to qualify for coverage. In such instances, infertility is often defined as the inability to achieve pregnancy after a specified period of unprotected intercourse, commonly 12 months for those under 35 and six months for those 35 or older. This diagnosis serves as a prerequisite for coverage under certain plans, even for fertility preservation efforts.

Age restrictions can also influence coverage eligibility. Some insurance policies may impose minimum or maximum age limits for fertility treatments or preservation. For example, some plans might cover women within a specific age range, such as 25 to 42 years, or have different eligibility criteria for individuals over 38 years old if using their own eggs. These age parameters are part of the policy’s terms and conditions.

Some insurance plans may require individuals to attempt less invasive fertility treatments before approving coverage for more complex procedures like egg freezing. This “step therapy” approach ensures that less costly options are explored first, even if they are not directly related to the egg freezing process. The type of insurance plan, such as a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), and specific policy riders can also affect coverage rules and may include explicit exclusions for certain fertility procedures.

Steps to Determine Your Policy Benefits

Before contacting an insurance provider, gathering specific information about your policy and the proposed medical procedure can streamline the inquiry process. It is advisable to have your insurance policy number and group number readily available. If you have received a preliminary diagnosis or discussed the procedure with your physician, obtaining relevant diagnosis codes and Current Procedural Terminology (CPT) codes for egg freezing can be helpful. Common CPT codes associated with egg freezing include 89337 for cryopreservation of mature oocytes and 58970 for follicle puncture during oocyte retrieval, while 89346 covers annual storage.

Once prepared, contact your insurance company directly by calling the member services number listed on your insurance card or by navigating their online portal. When speaking with a representative, specifically ask to be connected with the fertility benefits or medical benefits department. It is advisable to take detailed notes during the conversation, including the date, time, the representative’s name, and a reference number for the call. Requesting written confirmation of any coverage details discussed can provide an important record.

It is important to inquire about specific aspects of coverage. Ask if particular CPT codes for egg freezing procedures are covered and whether pre-authorization is required. Pre-authorization is a process where the insurance company must approve certain medical services or medications before they are rendered, to ensure they are medically necessary and covered under the plan. This process can take approximately one to two weeks for procedures, and obtaining it correctly is important to avoid denied claims.

Additionally, clarify the anticipated out-of-pocket costs, including deductibles, co-pays, and co-insurance percentages. Inquire whether fertility medications, which can be a significant expense, are covered separately, and if there are any specific limitations on their coverage. It is also important to determine if the long-term storage of frozen eggs is covered by the policy, as this can be an ongoing cost.

Managing Costs Without Full Coverage

When insurance coverage for egg freezing is limited or unavailable, several financial avenues can help manage the associated costs. Many fertility clinics offer in-house payment plans or discounted packages for self-pay patients, allowing individuals to spread the cost over a period of time or benefit from a reduced overall fee. These arrangements can make the procedure more financially accessible without relying on traditional insurance.

Specialized fertility financing companies provide loan programs specifically designed for fertility treatments. These loans can cover the entire cost of the procedure, including medications and related services, with monthly payments that fit an individual’s budget.

• Future Family
• LendingClub
• CapexMD
• PatientFi
• Sunfish
• Ally

Grants and scholarships from non-profit organizations are another potential source of financial assistance. Eligibility for these grants often depends on factors such as financial need or specific medical circumstances, such as undergoing cancer treatment.

• Tinina Q. Cade Foundation
• Baby Quest Foundation
• Chick Mission
• Livestrong Fertility

Some employers offer specific fertility benefits that extend beyond standard health insurance plans. These separate programs may provide financial assistance or coverage for egg freezing, even if the primary health insurance policy does not. Employees should consult their human resources department to ascertain if such benefits are available, as they can significantly reduce out-of-pocket expenses.

Finally, certain medical expenses, including those for fertility treatments, may be eligible for tax deductions. Under Internal Revenue Service (IRS) guidelines, medical expenses exceeding a certain percentage of your adjusted gross income, generally 7.5%, can be deducted on Schedule A (Form 1040). This may include costs for diagnosis, cure, mitigation, treatment, or prevention of disease. Individuals considering this option should maintain thorough records of all expenses and consult with a tax professional, or refer to IRS Publication 502, to understand the specific requirements and limitations for medical expense deductions.