According to the Kaiser Family Foundation (KFF), over 1 million females of reproductive age (20 to 49 years old) receive health coverage from Medicare. Additionally, individuals under 65 can receive Medicare coverage if they have a qualifying disability or medical condition.
KFF also notes that as of 2020, around 10% of females state that they or their partners have received medical help to become pregnant.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
Medical professionals define infertility as the inability to become pregnant after
The Medicare Benefit Policy Manual states that Medicare covers reasonable and necessary services associated with infertility treatments. However, the manual does not list specific services and does not define “reasonable and necessary.”
Individuals can speak with their doctor or other healthcare provider to check if Medicare covers their treatment. They can also search for services or tests on Medicare’s website. If they have a Medicare Advantage (Part C) plan, they can speak with their insurer for more information on coverage.
Read about Medicare plans and coverage.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
According to KFF, fertility treatments can cost over $10,000, depending on which services a person receives.
If Medicare covers these services and treatments, the individual is responsible for their monthly premiums, deductibles, and coinsurance costs.
People with Original Medicare (parts A and B) have to pay the Part B premium, which is $185 or higher, depending on income. They must also meet the Part B deductible of $257 before Medicare will begin paying for treatments.
If they have Medicare Advantage, they are still responsible for the Part B monthly premium and the additional premium and deductible that their insurer sets.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
