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Fertility treatments have become increasingly common. In fact, according to one study, one in three adults either used fertility treatments or know someone who has. If you are considering infertility services, knowing your options for paying for services can help you make informed decisions.
In general, health insurance companies cover services that your doctor deems to be medically necessary. If you have an ACA-compliant health insurance policy, then there are 10 essential benefits that your health insurance company is legally required to cover.
While this coverage is fairly robust, it does not cover everything. If you seek treatments that are not considered to be medically necessary, meaning that they are not necessary for your health or evaluating, diagnosing or treating an illness, injury or disease, then you should speak with a health insurance agent that can look into the individual plan benefits thoroughly for you to see what services might be covered. Services that are not usually covered include cosmetic surgery, weight loss programs, adult vision or dental services (you can, however, get coverage for vision/dental separately).
As of April 2021, the majority of states do not require private health insurance companies to cover fertility services. In California and Texas, health insurance companies have to offer at least one plan that includes this coverage. In 15 states, health insurance companies have to cover at least some fertility services.
While Nevada currently does not require health insurance companies to cover fertility services, it has a benchmark plan that does cover some fertility treatments.
Even if you live in a state that requires health insurance coverage for fertility treatments, there may be certain requirements that you have to meet to have services covered. For example, if you have unexplained infertility, you might only qualify for in vitro fertilization after a period of time or a specified number of in-vitro cycles.
Some states with required coverage for fertility treatments do not cover IVF, or they may only cover treatment up to a certain dollar amount. Other states only cover cryopreservation for someone whose fertility is expected to be compromised due to a medical diagnosis or treatment.
If you are one of the 61% of workers who are enrolled in a self-funded health insurance employer plan, then your plan may or may not cover fertility treatments, regardless of the state you live in. If you get your employer-based health insurance through a company with fewer than 50 employees, then your plan is exempt from state laws related to fertility coverage. Additionally, religious employers can file for exemptions that allow them to not offer this coverage based on ethical or philosophical beliefs.
Health insurance can be confusing, especially when it comes to issues such as fertility treatments. At Nevada Insurance Enrollment, health insurance agents can help you determine whether there is a policy available to you that includes the coverage you are looking for.
Like major medical health insurance plans, catastrophic health insurance covers the 10 essential health benefits outlined in the Affordable Care Act. However, if you have this type of plan, your out-of-pocket costs for services are considerably higher than with regular health insurance.
A prescription deductible is different and separate from the medical deductible, unless otherwise stated. One deductible is for medical, ie: hospitalization, doctors, etc., and the other deductible is for filling your prescriptions.
Gender reassignment surgery in order to be considered medically necessary, certain criteria must be met, such as if a qualified mental healthcare professional provides a referral and medical or mental health concerns are present.
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If you are among the 55 percent of Americans that are taking a prescription drug, you may be concerned about the affordability of medication therapy. Fortunately, there are a couple of things that you can do to ease the financial burden.
If you are currently on Medicaid, there are some scenarios in which you may soon be at risk of losing your coverage. Knowing your options can help ensure that you do not have a gap in health insurance coverage.
For many women, pregnancy and childbirth are among the most expensive health care costs that they will face in their lifetimes, and without adequate health insurance coverage, they can end up with tens of thousands of medical debt.
The Affordable Care Act includes 10 essential health benefits. Among these is coverage for habilitative and rehabilitative services that help those with injuries or illnesses regain physical skills.