Understanding Fertility Treatment Costs
There are many myths surrounding the price of fertility care, including:
- There’s a lack of coverage for fertility treatments and medications.
- There’s an increased cost associated with care from a fertility specialist.
- A referral to a specialist always means expensive fertility treatments.
The truth is, many patients begin with less invasive and more economical methods, such as timed intercourse, Intrauterine insemination (IUI), ovulation induction, and/or fertility medications. At Ontario Fertility Network (OFN), we conduct a thorough fertility analysis of both partners to determine the best path to conception, while taking into account your budget and circumstances. Scroll down for more details.
Your Extended Health Plan and Fertility Treatment
Fertility Medical Procedures
- Usually, fertility medical procedures are covered by private insurance; OHIP does not typically cover these costs. Check to see if your private plan covers fertility procedures, or partially reimburses them, including: Non -Funded In Vitro Fertilization (IVF), Intrauterine Insemination (IUI), and Intracytoplasmic Sperm Injection (ICSI).
- Check to see if your private plan covers fertility procedures, or partially reimburses them, including: In Vitro Fertilization (IVF), Intrauterine Insemination (IUI), and Intracytoplasmic Sperm Injection (ICSI).
- Prior to your fertility treatment, ask your insurance company to provide written proof or an explanation of what your specific coverage includes.
- If full coverage is unavailable, you may be eligible for partial coverage or certain stages of a procedure or treatment. For example, full medical procedures may not be eligible, but ultrasounds, blood work, and specific tests may be covered.
- Look into ‘flex’ benefits. This type of coverage may be used for non-OHIP expenses. You may also have an option to upgrade your insurance for a set monthly fee by checking with your employer. However, before you begin paying an additional fee, ensure that the insurance covers some of the treatment costs and that it’s worthwhile. You can also check if you have a Health Spending Account with your insurance.
Fertility Medical Treatment
- Fertility medications vary in cost, from an affordable $350 per cycle to thousands of dollars. You may have full, partial, or no coverage depending on your extended health plan.
If you have prescription coverage, this does not mean you’re automatically covered for fertility medications — always check to make sure this is the case.
- Prior to starting treatment, request a written explanation from your insurance provider outline your fertility treatment coverage.
- In the case of a denied claim, you have the option to appeal. When denied, request the reason for denial and the exact part of the policy that states or supports it. Resubmissions are common.
- Your insurance company may need preauthorization regarding your medications. Your Ontario Fertility Network team can provide an insurance letter outlining the medications as part of your treatment and their DINs (Drug Identification Numbers).
- Always check with your insurance plan to determine if there are total amount limits, total treatment cycle limits, yearly limits, or lifetime limits. Do this before you submit a claim, especially for medications.
- If you discover you have a yearly coverage limit, you may want to wait until the end of the year to submit your claims. This means the balance could potentially be claimed in the following year.
- If your insurance is limited by treatment cycle limits, you can choose to pay out-of-pocket for less expensive treatment options, thereby saving your benefits for pricier treatments.
- If both partners have different benefits, you may have the option to combine them. Let your OFN team know what your benefits include and we can help separate the costs to submit them to different plans.
Additional Tips for Insurance Coverage
- If you are a couple, then you should research your individual benefits and how they apply to fertility treatment and related medications.
- If possible, check to see if you are fully covered by your insurance before beginning treatment.
- Call an insurance representative to clarify your coverage and if possible, get a written explanation outlining exactly what is covered.
- Prior to submitting a claim, determine if your benefits include a yearly limit, lifetime limit, treatment cycle limit, or a total dollar limit.
- Further, determine if your benefits may cover you for our in-house naturopathic doctor who specializes in preconception care. A naturopathic doctor uses natural remedies to improve the health of the egg and sperm prior to conceiving.
Fertility Treatment and Your Income Taxes
Fertility treatments may qualify as deductible medical expenses on your income tax return. This tax credit can help individuals reduce the impact of high medical costs for themselves or their dependants. In all cases, please check with your personal accountant for further details and to confirm eligibility.
Allowable fertility medical expenses may include:
- In Vitro Fertilization (IVF)
- Select fertility medications
- Intrauterine insemination (IUI)
- Intracytoplasmic Sperm Injection (ICSI)
- Embryo Freezing
- Embryology Lab Fee
- Sperm Processing & Extraction
- Satellite Monitoring
- Transfer of Frozen Embryo
- Note: Sperm bank donations are excluded
These medical expenses must be qualified and paid by the individual or his/her legal representative. Generally, they should meet the following criteria:
Fertility Insurance or Medical Coverage
- Was paid in the 12-month period ending in the calendar year.
- Is proven by receipts.
- Can not be part of a previous calendar year’s medical expense tax credit.
- Has not been reimbursed or be reimbursable.
The above criteria offers a general outline. For detailed information, always consult with your financial advisor and have them help you determine if you are eligible for claiming any medical expense non-refundable tax credit. You can also check the Canada Revenue Agency website, https://www.cra-arc.gc.ca/, by searching ‘medical expenses tax credit’ for further information.
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