Key Factors to Consider: Does Insurance Cover Surrogacy?
Ah, insurance. Everyone’s favorite topic. Finding providers, clinics, and sometimes, a live person for the most routine of procedures can feel like your sanity is being tested. So when you begin your surrogacy journey, and you consider the price tag, financial risk, and health risk of the surrogate, it’s natural to wonder what kind of “hoops” you’ll need to jump through and what aspects of surrogacy are covered by insurance. Since the relationship between insurance to surrogacy can be complicated, let’s discuss the different types and, hopefully, ease your mind a bit.
To be very clear, this is a very complicated topic. Why? So many of the details will vary by state and insurance carrier. We can safely say that there are no absolutes. It’s important for intended parents and gestational carriers to address this issue together. Our agency will assist both intended parents and surrogates to assess to what extent they will have surrogate insurance coverage for the surrogacy process. We’ll also make recommendations for securing adequate insurance coverage.
Will Intended Parents’ Insurance Cover a Surrogacy Journey?
Typically not. Your surrogate is not your dependent. Therefore, any care that she receives (in a fertility clinic or at the OB when carrying your child) is not covered under your policy.
If your policy does offer some coverage, it would typically be focused on your embryo creation. Some medical insurance plans are now starting to cover in vitro fertilization (IVF). It’s important for you to read your plan summary to see exactly what is covered and what is listed under its exclusions. Many plans that do cover IVF will only do so if specific criteria are met, such as having a specific medical diagnosis, trying other therapies without success first, or having a period of demonstrated infertility (often, this is 5+ years).
Does a Surrogate Need Insurance?
It is certainly a good idea! The average cost for maternity care and delivery in the United States is about $19,000. The costs are higher with complications and/or a c-section delivery ($25,000+). In your surrogacy contract, you will see a section that requires the intended parent(s) to make sure the surrogate has full medical coverage. It’s their obligation to make sure there is an insurance policy in place or that they have a self-payment plan in place with all providers.
Sometimes a surrogate will have a medical insurance policy through her spouse or own employer that will cover her maternity care as a surrogate (pregnancy through delivery and postnatal care). If so, then the Intended Parents are responsible for any copayments or cost sharing after insurance has paid.
If your surrogate’s insurance has a surrogacy exclusion, the intended parent(s) are obligated to provide 100% coverage. Either by purchasing a private insurance policy or by opting for a self-pay plan that is negotiated with providers. We at the Surrogacy Center of Philadelphia can absolutely help with the process of acquiring private health insurance and evaluating options for your carrier.
Will the Surrogate’s Insurance Cover the Surrogacy Pregnancy?
Again, it is possible that your selected surrogate will have medical insurance in place that offers surrogacy coverage. However, there are some caveats. Intended parents are obligated to pick up on any co-payments, cost sharing, or deductibles. Insurance plans can also change from year to year. So it’s important to evaluate your surrogate’s insurance during each open enrollment period to ensure her coverage remains the same. Finally, if she is on an employer-based plan and her employment status changes, the Intended Parents should be prepared to enroll in a different plan with equivalent coverage or pay for COBRA coverage.
Who is Covered Under a Surrogate’s Medical Policy?
The most important person covered under a surrogate’s medical insurance policy is the surrogate herself. Second, the unborn child is also covered while in-utero. Once your baby is born, they will be covered under your plan as Intended Parents, as the child is your legal dependent.
Insurance for the Newborn
As part of the surrogacy process, it’s vital that all intended parents fully understand how medical insurance works for newborns. Intended parents are responsible for the baby’s medical bills once they are born.
Intended parents should contact their insurance company prior to your child’s delivery date. If you inform them of the impending birth and your desire to cover your child, the insurance company will process the qualifying life event and add the child the moment they’re born.
What Does Insurance Usually Cover with Surrogacy?
It’s unheard of for an insurance policy to cover 100% of the surrogacy process from beginning to end. Keeping in mind that coverage will vary from one policy to another, let’s take a look at the surrogacy-related costs that are generally covered by most policies.
A lot of insurance companies will cover some portion of infertility treatment, such as diagnostic work. Some plans will also cover the cost of embryo creation through IVF but will only do so if specific criteria are met, such as having a specific medical diagnosis, trying other therapies without success first, or a period of demonstrated infertility (often, this is 5+ years).
The Surrogacy Pregnancy
This is where coverage can get complicated. A lot of insurance companies have started writing policies that specifically exclude surrogacy pregnancies. If the plan documents do not specifically state that surrogate pregnancies are excluded, insurance companies are required to cover the associated costs just as they would for a “traditional” pregnancy. When a plan document specifically excludes surrogate pregnancy, that is when the intended parents will need to purchase a private policy that covers the surrogate.
What Will Insurance NOT Cover with a Surrogacy Pregnancy?
Of course, there are a lot of surrogacy costs that have not been listed in the section above. Therefore, it’s necessary to address the surrogacy costs that are not usually covered by surrogate insurance coverage. Here is a look at some of those costs.
The Embryo Transfer Process
This is the procedure by which the embryos are inserted into the surrogate’s womb. Several attempts might be necessary, each with additional costs. Intended Parents should expect to pay the fertility clinic directly for their embryo transfer cycle, including medications. This is not covered by insurance.
SECURING DONATED EGGS AND SPERM
Insurance does not cover the cost associated with securing donor sperm or eggs. Not only are any agency or legal fees excluded, but your insurance policy will not cover the cost of infectious disease testing on your donors, nor will it cover the egg retrieval process.
How to Make Surrogacy Affordable?
Surrogacy is expensive ($85,000 – $90,000 on average if you already have embryos frozen and ready for transfer). But, with careful planning and guidance from those that have done it before – like the Surrogacy Center of Philadelphia – the process can be more affordable. This will allow you to find and take advantage of as many financial resources as you can prior to beginning the process. Some potential financial resources include loans, charitable grants, medication discounting programs, and leveraging workplace benefits. Most importantly, an experienced agency can help you evaluate your surrogate’s insurance policy to identify any expensive exclusions and help you put the right policies in place to minimize your out-of-pocket cost.
Surrogacy may be the most important and rewarding process you ever encounter in your life. It might also be the most expensive one. With so many variables to consider and obligations to uphold, working with surrogacy professionals like us can help to reduce the anxieties around the financial risks of surrogacy. As you begin or consider beginning your surrogacy journey – whether as an intended parent or surrogate – talk with a financial advisor and take an in-depth look at your insurance policies.
As always, our agency is here to help you navigate the surrogacy process and answer any questions you have. Please contact us, and we’d be happy to share resources and our advice on mitigating the costs of a surrogate pregnancy.