Does Medicare Cover Fertility Treatments?

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 more benefits than Original Medicare covers

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, such as prescription drug coverage. Some plans may also offer routine vision and dental care coverage.

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

Not all plans offer some or any of these benefits. 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.