Understanding Egg Donor Insurance: What’s Covered?

No one ever expects to get an infertility diagnosis and yet millions of individuals of reproductive age suffer infertility around the world. Fertility treatments are among the most expensive medical procedures, yet many insurance companies exclude infertility coverage categorizing it as a non-medical condition. 

The absence of insurance coverage is a significant barrier preventing individuals facing fertility challenges from accessing essential medical treatments that could help them build their families. Although some states are bound by fertility insurance laws mandating them to offer insurance covers for infertility, only a handful of the 50 states offer such services and even then, infertility is not covered in full. 

Navigating the issues surrounding egg donor insurance can be daunting leading to hopelessness to individuals desiring families. However understanding the state laws governing fertility insurance, the insurance plans available, the medical risks and coverage details as well as out of pocket expenses that a donor may incur is key to making informed decisions. Let's have an in-depth look at the  above concerns about egg donation insurance.

What Insurance Plans Cover Egg Donation?

An insurance plan or policy is a contract between an insurer and the insured, where the insured pays a specified subscription fee in return for coverage of medical expenses. The policy will indicate all the medical benefits that the insurance company will cover as well as those services not covered which you have to pay for. Most individuals are typically covered under group insurance policies, with employers contributing a portion of the premium while employees cover the remaining share. 

There are different insurance plans for egg donation. They vary from state to state and may be private or public in nature. Most of these health plans offer partial coverage for infertility treatments and exclude donor compensation and agency fees. 

• Private Insurance Coverage: Several states across the United States have fertility insurance laws which fall into two categories:
• Mandate to cover policy: Which requires insurance companies to include infertility treatment as part of their insurance plan and,
• Mandate to offer policy: Which requires insurance companies to offer infertility treatment coverage but individuals or employers may choose whether to include it or not in their insurance plan.
• Public Insurance Coverage: These are government sponsored insurance coverage that cater to different groups of people. Examples include:
• Medicaid: A cover meant for people with disabilities, low income earners, the elderly, children and expectant mothers. Its coverage varies from State to State with some offering fertility preservation services, diagnostic testing and fertility- related medication.
• Medicare: This is a health insurance plan for people with disability, End-Stage Renal Disease and those aged 65 years and above. It does not cover IVF treatments but only reasonable and necessary services related to infertility.
• Tricare:  This is an insurance program that covers medically necessary fertility services for military families.

Medical Risks & Coverage Details

Although egg donation is a generally safe and regulated procedure, it may carry some level of risks such as:

• Ovarian torsion: this is a rare occurrence which happens when the ovary twists itself due to strenuous activities leading to severe abdominal pain.
• Hormonal side effects: although temporary and usually end after the egg donation cycle, they still pose a risk to the donor’s health. Symptoms include, breast tenderness, mood swings, bloating and headaches that occur as a result of hormonal therapy.
• Ovarian hyperstimulation syndrome (OHSS): This condition varies in degree from mild to severe and may cause abdominal fluid retention, enlarged ovaries, abdominal pain and nausea among others. Fertility specialists generally monitor the hormone levels to avoid this risk.
• Bleeding and infection: Although this risk is minimal, clinics will prescribe antibiotics to lower the risk of infection.

Insurance coverage differs from one clinic to the other and depending on the insurance provider although different policies may cover medical screening and the egg retrieval procedure.  Other plans may include complication coverage for the risks involved in egg donation although specialized egg donor insurance policies may be necessary. Additionally some insurance plans may offer post egg retrieval cover in the event that complications arise.

Understanding the egg donation risks involved and the insurance coverage available is necessary for intended parents and egg donors to ensure that they make informed decisions.

Handling Medical Bills as a Donor

Having understood the insurance plans available and the risks involved, perhaps as an egg donor you may wonder what other costs you may incur outside of the egg donation process to facilitate financial planning as well as medical bills you may need to cater for.  Well, the egg recipient is the one who foots all the medical expenses related to the egg donation process including the compensation. 

However, the egg donor may require the services of a legal expert to help them understand the legal implications of any contracts drafted to facilitate the egg donation process as well as help them know their rights regarding the egg donation process. 

Although some clinics may offer post egg retrieval care up to three months after the fact, the egg donor may require a short term insurance policy to cover medical costs related to egg donation complications that may arise after the egg donation procedure since some insurance plans only cover the medical screening before egg donation and the egg retrieval process. Though refundable, a donor may also have to cater for travel, meal and accommodation expenses in case they have to travel to an out of town fertility clinic for egg donation. 

All in all, egg donor insurance is meant to shield both the egg donor and the intended recipients against unexpected medical expenses that may arise during the egg donation process. It is therefore important to understand all the egg donation procedures covered by the insurance policy in use as well as any medical expenses not covered to cushion against unexpected expenditure. Knowing the state mandates governing insurance plans may also assist in the choice of an egg donation insurance plan for both the egg donor and the recipient ensuring a stress free egg donation experience. Why not contact our fertility specialists at the Fertility Associates of Memphis (FAM) for more information on egg donor insurance and help a couple build their dream family?

FAQ

Are egg donors covered by insurance?

The majority of donation programs offer medical coverage to address any potential complications.

What if I experience complications from egg donation?

Egg donor medical insurance generally includes coverage for treating potential complications.