According to the Medicare Benefit Policy Manual, Medicare can cover infertility treatments when they are “reasonable and necessary.” However, it does not outline specifically which treatments this includes or what the criteria for coverage involve.
Medicare generally does not typically cover in vitro fertilization (IVF). If a person experiences infertility, Medicare may first cover more basic fertility treatments.
Infertility is a condition of the reproductive system. According to the
IVF is an infertility treatment that involves extracting an egg, fertilizing it with sperm in a lab, and implanting the resulting embryo.
Although most Medicare enrollees are eligible based on age, many qualify due to disability or a chronic health condition. The health policy research group KFF reports that more than 1 million women between the ages of 20 and 49 years old receive health insurance via Medicare.
A person may receive coverage for fertility treatment under Original Medicare when a doctor considers it medically necessary and reasonable. While IVF may seem necessary in certain cases, Medicare may not consider it reasonable due to its cost, success rate, or other factors.
Medicare may cover other fertility treatments, such as artificial insemination. Medicare enrollees who receive intra-cervical artificial insemination pay an average of $18 at ambulatory surgical centers and $70 at hospital outpatient departments (after reaching their deductible).
Further, if a person’s doctor prescribes fertility drugs as part of their treatment plan, their Part D prescription drug plan may not cover them.
For the most accurate information about Medicare coverage of fertility treatments, a person can consider speaking with their doctor and a Medicare representative.
