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Does Medicare Cover Fertility Treatments?

Does Medicare Cover Fertility Treatments?
Does Medicare Cover Fertility Treatments?

Could Medicare cover fertility treatments, as the U.S. is faces an unusual population problem: fewer babies are being born each year. Demographer Brady Hamilton noted that fertility rates are reaching record lows, since the annual fertility rate has dropped to 59 births per 1,000 women. The decrease in fertility rates is due to the changing trends in women’s social behavior, since more women are opting to delay both marriage and childbirth. In fact, more babies are now being born to women in their late 30s up to their 40s. This trend in delayed childbearing is a big concern as fertility rates decline with age. Though some companies—notably Facebook and Google—are beginning to include IVF and other fertility treatments as part of their employee benefit packages, most do not. This puts the United States far behind other countries.

For example, in Spain since 2006, all women aged 18 or older have access to reproductive technology—including artificial insemination and in vitro fertilization (IFV). Women up to 50 are accepted by Spanish clinics, and they don’t discriminate against same-sex or single ladies, either. They also have 200 treatment centers—more than any other European country. In Denmark, IVF and artificial insemination, sperm mobility measures and basically anything you or your partner would need are 100% free of charge. Since 2006, ACT is not only limited to heterosexual couples but extends to same-sex duos and single women, too. It’s estimated that 8 to 10 percent of babies born in Denmark are by ART. Israel provides two IVF Cycles up to age 45 for free, In Australia the government covers half for the first IVF cycle and more for subsequent cycles, and the provinces of Canada all have varying levels of tax credits.

Qualifications for Medicare Coverage?

Medicare is widely known as health insurance for older adults aged 65 and above. However, individuals at a reproductive age can also apply for Medicare coverage under certain circumstances. For instance, you can apply for Medicare if you have an End-Stage Renal Disease that typically requires transplants or regular dialysis. Medicare Advocacy also points out that younger people with disabilities can apply for Medicare coverage. Furthermore, people with Alzheimer’s disease, mental illness, multiple sclerosis, and Parkinson’s disease are also qualified, if their doctors deem that they meet specific criteria. As such, consult with your doctor so that they can assess whether you can qualify for Medicare coverage for your health and fertility concerns.

Medicare and Fertility Treatments?

Does Medicare cover fertility treatments? There are different Medicare plans, and each of them offers various coverages. The Kaiser Family Foundation points out that reasonable and necessary services associated with treatment for infertility are covered under Medicare. This means that your doctor must consider a fertility treatment as a necessary medical option for you to qualify for coverage. As such, treatment can only be provided if the infertility is caused by a medical condition. However, patients under the original Medicare program can only use Part B for medically necessary fertility treatments, since it covers doctor’s services and outpatient care.

Couples struggling with infertility can also get more medical coverage through Medicare Advantage plans. 

Medicare Houston outlines that these plans offer more benefits, such as prescription drug coverage for necessary medical cases involving infertility. Besides including part B and prescription drug coverage, individuals under Advantage plans also benefit from working with a wider network of doctors, hospitals, and providers. Therefore, you have more options if you want to consult a fertility doctor regarding your case.

The fertility rates in the US have been decreasing over the past years. Many people of childbearing age are struggling with infertility due to certain health conditions, making the extent that Medicare cover fertility treatments an ever more pressing need for the general population. To learn more about news and issues concerning fertility, check out the other resources on ART Compass. We have plenty of informative articles as well as our own lab management software for embryologists and IVF clinics.