Medical coverage & (in)fertility: it’s all about the benjamins baby!

Unfortunately for us (in)fertiles, money can often be a deciding factor in how and when we proceed with treatment.

My husband and I both have family medical coverage via our employers through Great-West Life (GWL). Family coverage means that whatever isn’t covered on my plan goes through his for extra potential reimbursement.

As far as I know, it’s NOT common in Canada to have a medical insurance plan that covers IVF. I could be wrong though. Some provinces subsidize treatments depending on your medical history, but our province does not.

We do have decent AMAZING fertility drug coverage though.

So far, my Clomid + HCG + Prometrium (progesterone capsules) has been 90% covered.

Each IUI cycle costs us $350 for the procedure and about $25 for the drugs. Since our clinic is located over 40km away, we can also claim mileage and meals on our income tax. On paper, if we drive back and forth without a hotel stay, an IUI cycle with oral meds costs us about $700. I’m so glad it’s almost summer now and we don’t have to stay overnight! Canadian winters in the Prairies = harsh winter driving conditions. 

Anyway, I thought maybe calling my medical insurance company would help me decide which treatment option is best for us.

Last time I contacted GWL, they told me I had up to 90% reimbursement for fertility medications with no cap – meaning unlimited fertility drug claims.

I didn’t believe them though.

You know how it is when you get that one Customer Service Rep who tells you the WRONG info and completely screws with your plan. For all I knew, that particular Rep may have only been looking at the oral medications.

I decided to call them back if we ever decided to move to injectibles or IVF – just to be sure. 

This afternoon, I made that call. My current clinic posts a Drug Identification Numbers (DIN) list on their website for all injectible meds that they prescribe. The Customer Service Rep told me she didn’t need the list because my drug coverage would cover any fertility drug up to 90% with no maximum claim amount.

I had her double check like 3x before I would believe her. Lucky me. 

The catch is Femara (a.k.a. Letrozole) is considered primarily as a breast cancer treatment drug. Since it’s an off-label fertility drug, my insurance company requires the prescribing doctor to fill out a prior authorization form before you can fill your prescription and qualify for reimbursement.

Of course, they HAVE to make the easiest next step slightly more difficult for us. Ugh. 

Right now, I am VERY GRATEFUL for our coverage. It makes the thought of moving to injectibles less stressful.

So for now, I will hold tight and keep praying for a BFP this month.

If my stars don’t align, I have until CD1 to make up my mind.

Baby dust to you all! XO. 

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17 thoughts on “Medical coverage & (in)fertility: it’s all about the benjamins baby!

  1. Wow! You have freaking amazing coverage! Our insurance hasn’t covered anything except for the Clomid. The Follistim, Ovidrel, IUI, Sperm washing, sonograms, etc… have all been paid for out of pocket. I want to say ours costed about 1800.

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  2. Ack, you’re so lucky they don’t have a cap. My work provides no coverage, for anything, not even medication. Luckily my husband’s coverage (which also covers me) gives up to $5000 for each of us for IF medication. Well, his $5000 does us no good, he doesn’t need anything. Plus that $5000 will disappear with one cycle of IVF (and then some). I hate insurance. And up until dealing with IF, I thought us Canadians had it made in the shade!

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  3. i’m rooting for you!! and I think it’s amazing that you have fertility med coverage!! We are all out of pocket. Our IUI cycles have been about $2,000-2,500 (injectables, ultrasounds, IUI, sperm wash) and the meds for our IVF cycle (if we need it) will be a little over $5K. Hoping for your BFP this cycle so you don’t even have to think about this stuff anymore!!

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  4. Wow! That is FANTASTIC!! When I sent in all my receipts to my tax accountant this year, I had over $9,000 in receipts for fertility meds alone! None of it was covered by my medical insurance. This is by far the biggest thing I hate about living in the US now. The only good news for me with our treatments was I was able to claim some of it on my taxes because I’m self employed. Anyway, that is great news, but still hoping you won’t need to take advantage of it : )

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  5. That is awesome that your plan is so good! Unfortunately none of it is covered under DH’s plan which surprised me as any other meds have been covered 100%covered for me. The plan excludes fertility drugs all together. FYI if you do need Femara and it isn’t covered for you, it is super cheap. It was like $25.

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  6. I’m always amazed by what is covered and what isn’t. I’m grateful. We have very good coverage. Just co-pays for all my procedures…sonos, IUIs, IVF, rx. It adds up, but not like paying out of pocket. Good luck with your IUI! Right behind you!

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  7. I always find it interesting what other plans cover. At least here in the US, Femara is sold under a generic name of Letrozole. Just a helpful tip if you have that in Canada and are able to use generics. I paid like $2.40/cycle for the Letrozole. I’m glad you do have insurance coverage – it does make a big difference in the final bill for infertility treatments.

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  8. Pingback: Planning for IVF (Part 2) | Awaiting Autumn

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