The need for fertility treatments is not uncommon. In 2016, more women (by a slim margin) gave birth at age 30-34 than women aged 25-29. The average age for women to give birth to their first child is 28. For women who choose to wait longer to have families, the odds of them getting pregnant grow smaller.
Medical science has made it much more likely that those with fertility problems can conceive a baby with the help of specialists, medications, and patience. What was once a rare procedure is now common and, though costly, often successful.
Does Medicare Cover Fertility Treatments
Medicare Part A, which covers hospital stays, is not relevant to infertility treatment.
Medicare Part B, which covers office and outpatient care, covers medically necessary treatments. While it is possible that Medicare will cover some parts of fertility treatment, each patient will be different and depending on whether they have an appropriate Medigap plan, their coverage could be quite limited.
Medicare Part D generally does not cover medication for infertility treatments. Since Medicare Part D formularies can change, it’s a good idea to stay informed about what medications may become available under Part D.
What Are the Costs of Fertility Treatment
Each phase of fertility treatment comes with costs, many of which are not covered by Medicare.
- A visit to an endocrine specialist may be covered, depending on the doctors in your area, and the fee for that is anywhere from $200-$400 for an office visit.
- A monitored Clomid (a fertility drug many women take) cycle, which includes blood tests, ultrasounds, sperm processing and insemination can cost as much as $4000. Whether this process is covered depends on the Medicare plan and Medigap supplement the patient carries. The medication, Clomid, would not be covered by Medicare Part D.
- IVF and donor egg transplants, which will not be covered under Medicare, can cost anywhere from $11,500 to $28,000, depending on the complexity of the procedure. Freezing eggs for future use, a more and more popular option for women who plan to wait until they are older to have children, costs $7,500 per freezing cycle.
- No matter how healthy or fertile a couple is, there is only a 20-25% chance of getting pregnant any given month. There is a 60% chance a woman will get pregnant within six months of beginning to try. After that, fertility treatments can come into consideration.
- Twelve percent of married women cannot get pregnant or stay pregnant.
- 7.4 million women in the USA have sought treatment for infertility over the course of their reproductive years.
- One-third of fertility problems are attributed to the woman, one third can are attributed to the man, and one third is either a combination of the two or caused for unknown reasons.
How is Infertility Diagnosed?
For men, there are some tests and procedures that may be done to evaluate fertility. These are some of the possibilities:
- Semen analysis
- Testosterone levels
- Testicular biopsy
- Genetic testing
- CAT scan or MRI
Women’s fertility is evaluated in a variety of ways, including:
- Blood test for hormone levels
- Thyroid test
- Test for prolactin
- Follicle stimulating hormone (FSH) test
- Leutinizing hormone (LH) test
- Postcoital test to evaluate the environment in your reproductive system
There are also other, more in-depth tests done for further evaluation of a woman’s fertility. They include outpatient surgical procedures often done in a surgery center or sometimes in a doctor’s office. Fertility treatment surgeries can be quite expensive, and may not be covered by Medicare, so be sure to check before having anything done.