It’s a busy time of year, not just for holiday shopping, home decorating, and travelling, but also for taking steps toward growing your family. With many insurance deductibles and benefits resetting on January 1, you can make the most of your coverage by booking the fertility consultation or treatment you’ve been considering before the year ends. Time is of the essence when it comes to fertility treatment, and getting a head start now helps you move forward before the new year begins.
If you’re ready to get started but confused about what may be covered by insurance, this guide walks you through how to use your fertility benefits before the end of 2025, fertility financing options at CCRM, and navigating coverage in the future.
Why book fertility treatment before the end of the year?
Fall and winter are a good time to see a fertility specialist before benefits reset in January. If you don’t use these benefits by Dec. 31, you’ll lose them. Additionally:
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If you’ve met your annual deductible and out of pocket maximum, your insurance plan may cover certain services at no additional cost to you.
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Many fertility labs, including the IVF labs across the CCRM network, close for annual maintenance during the last week(s) of December. Because fertility testing and subsequent treatment can take a few months, it’s best to make appointments now to make sure you can start your cycle before these holiday closures.
Understanding your fertility coverage
To make the most of your benefits, it’s important to know the ins and outs of your fertility coverage. Your paperwork that accompanies your plan should include a section or two that outlines what fertility services may or may not be covered. Take note of specifics, such as insurance caps or coverage limits, as well as conditions; for example, some insurance companies require a certain number of intrauterine inseminations (IUI) before covering in vitro fertilization (IVF).
You can also ask someone at your insurance company or an HR representative where you work to help you decipher your benefits. They’ll also likely share other helpful details that may not be obvious, such as what co-pays you may owe per appointment and/or if you may require a referral from an OBGYN or PCP before seeing a fertility specialist, which is typically the case with a Health Maintenance Organization (HMO) plan.
Fertility treatment covered by insurance
Each plan differs, but yours may cover some of the fertility services, such as:
- Initial fertility consultation
- Fertility testing
- Intrauterine insemination (IUI)
- In vitro fertilization (IVF)
You may also have additional fertility benefits, such as coverage of egg or embryo cryopreservation/storage, third-party reproduction services (donor eggs, donor sperm, and/or gestational surrogacy), preimplantation genetic testing (PGT), and/or egg freezing.
If you find out that some or all of your treatment isn’t covered, CCRM’s experienced financial counselors can help you explore alternative payment options to make care more affordable, including discounts for eligible patients and military families and partnerships with financing providers.
What is a mandated state?
In addition to knowing the nuances of your insurance plan, it’s important to understand your state’s laws regarding fertility coverage. The US has 21 mandated states, meaning all private insurance companies are required to cover at least some type of fertility care.
Keep in mind there are lots of loopholes; for example, some states might only cover fertility testing and IUIs, and others may only cover large-group policies for employers with a minimum number of employees.
HSA and FSA for fertility treatment
As part of your employer-sponsored insurance plan, you may have opted into a Flexible Spending Account (FSA) and/or a Health Savings Account (HSA). Both accounts allow you to set aside pre-tax dollars from your paycheck to cover certain medical expenses (including fertility treatment), but there are key differences between the two:
- FSAs are employer-owned and use-it-or-lose-it, meaning funds run out at the end of the year and don’t roll over.
- HSAs are employee-owned, can be used into the new year, and you take this account with you even if you change jobs.
The specifics will depend on your plan, but money in an FSA or HSA can be used toward certain types of fertility treatment, including:
- Intrauterine insemination (IUI)
- In vitro fertilization (IVF)
- Fertility medication
- Egg and/or embryo storage
Open enrollment when planning fertility treatment
For most corporate-sponsored insurance plans as well as Marketplace plans, the open enrollment period, meaning when you can sign up or make changes to an existing plan, is sometime in the fall through the end of the year. Though your new insurance won’t take effect until the following year, you can take proactive steps now when choosing coverage if you plan to focus on family building in the next 12 months.
Before making your selections, ask your representative what fertility treatment is and isn’t covered under which plan. If you’re planning fertility testing and treatment or are already in the midst, it’s most cost effective to enroll in an insurance plan that covers the most services with the lowest possible out-of-pocket costs.
Next steps
Now that you’re armed with all the information you need about insurance for fertility treatment, you’re ready to make the first move and get started. Letting your benefits expire is like leaving money on the table, so end your year on the right foot and book your initial fertility consultation at CCRM.
CCRM Fertility’s world-class physicians, support staff, and financial counselors are here to support you on your fertility journey every step of the way.
