Does Medicare Cover Fertility Treatments?

• by Christian Worstell
• August 1, 2023
• Reviewed by John Krahnert

Medicare Part B may help cover some fertility treatments if they are deemed medically necessary by a doctor, but specific coverage rules and costs will vary from situation to situation.

In order for Medicare to cover any infertility treatments, they would need to be deemed reasonable and necessary tests or treatments for infertility in a person when fertility would be expected.

Medicare Advantage (Part C) plans also help cover fertility treatments if the treatments would be covered by Medicare Part B.

What should I know about Medicare and fertility treatments?

We recommend speaking with your doctor or health care provider directly about your fertility treatment coverage options and to determine what kind of coverage Medicare will provide (if any) for the specific treatment you are considering.

Some questions to ask include:

• Will Medicare cover infertility treatments? If so, which ones?
• Do I need to undergo specific fertility tests before my plan covers my treatment?
• Are there any restrictions related to this coverage, for example does Medicare restrict fertility treatment or testing coverage based on age?
• Will Medicare cover fertility medications?
• Medicare Part A and Part B do not cover most prescription drugs. Most Medicare Part D Prescription Drug Plans do not cover medications used to treat infertility, such as Clomid (clomiphene citrate).
• Do I have to try certain fertility treatments before moving on to others?

Medicare Advantage plans may offer benefits Original Medicare does not cover

Medicare Advantage plans provide the same hospital and medical benefits as Original Medicare (Medicare Part A and Part B).

Since fertility treatments aren’t generally covered by Original Medicare, Medicare Advantage plans are not required to cover them.

However, many Medicare Advantage plans provide benefits beyond the standard Part A and Part B benefits.

Check your Medicare Advantage Prescription Drug Plan’s formulary (list of covered drugs) to find out if it covers certain fertility medications.

Plan availability can vary by location.

Find Medicare Advantage plans in your area

A licensed insurance agent can help you find Medicare Advantage plans in your area so that you can enroll in a plan that works for you.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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