Does Aetna cover IVF?

Trying to conceive can be an emotionally and financially challenging journey. For many, in vitro fertilization (IVF) offers the best chance, but with costs often reaching tens of thousands of dollars per cycle, it’s not always an accessible treatment option. A common question is: Does Aetna cover IVF? 

If you’re exploring your options or considering a telehealth IVF consultation through Klarity Health, this guide will help you understand Aetna IVF coverage, eligibility, and next steps.

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Does Aetna cover IVF?

Yes, Aetna may cover IVF, but coverage depends on the specifics of your insurance plan. Many Aetna plans, especially those offered by employers, include IVF as part of their assisted reproductive technology (ART) benefits. However, this depends on meeting certain medical criteria, getting prior authorization, and using approved providers.

Aetna IVF coverage typically applies when:

• Your insurance plan specifically includes ART benefits.
• You meet medical criteria, such as a confirmed infertility diagnosis.
• Your provider submits a precertification request to Aetna’s National Infertility Unit (NIU).
• You receive care from an in-network provider or an Aetna Institute of Excellence (IOE) fertility clinic.

Not sure if your plan includes IVF? Klarity Health can connect you with a licensed provider who can review your plan and walk you through your options.

What does Aetna IVF coverage typically include?

Coverage varies by plan but may include:

• Medical services: egg retrieval, fertilization, embryo transfer, and Intracytoplasmic Sperm Injection (ICSI).
• Medications: Aetna requires precertification for fertility drugs like Gonal‑f® (follitropin alfa), Menopur® (menotropins), Cetrotide® (cetrorelix), and hCG. These medications must be approved in advance through the NIU.
• Lab services: embryo freezing, thawing, storage, and genetic testing.
• Travel/Lodging: Some plans reimburse travel expenses if the nearest provider is over 100 miles away.

Plans may cover:

• 3 to 6 IVF cycles
• Lifetime caps on fertility drug coverage (e.g., $25,000–$60,000)
• Coinsurance (typically 80–90% after your deductible)

Always confirm the details of your Aetna IVF coverage by reviewing your plan or speaking with a representative.

Eligibility criteria for Aetna coverage for IVF

To qualify for IVF under Aetna, members generally must:

• Be diagnosed with infertility, defined as:
  • You’re younger than 35 and have tried to conceive for at least 12 months without success. 
  • You’re 35 or older and have been unable to conceive after at least 6 months of trying. 
• Meet Aetna’s clinical policy criteria, such as failure of ovulation induction or IUI, unless IVF is medically necessary due to severe male infertility or blocked fallopian tubes.
• Use an in-network provider who is willing to handle the precertification process, ideally through the Availity Portal or by fax.
• For members under the age of 40, hormonal testing (like day‑3 FSH) may be required to confirm ovarian reserve. Members with premature ovarian failure may still qualify for Aetna IVF coverage up to age 45.

Does Aetna cover IVF consultation online?

Yes. Aetna generally covers telehealth consultations with fertility specialists. These virtual visits are considered part of the standard fertility treatment process. Through telehealth, providers can:

• Review your medical history and lab results.
• Recommend appropriate treatment such as ovulation induction, IUI, or IVF.
• Submit precertification requests online through the Availity system.

From evaluation to planning, telehealth makes it easier to access qualified care and start your fertility journey.

How to find out your IVF coverage with Aetna

To check if your plan includes Aetna IVF coverage, follow these steps:

1. Review your Summary of Benefits in the Aetna member portal. Look for terms like “ART,” “infertility treatment,” or “IVF.”
2. Call the Aetna Member Services number on your ID card and ask:
   • “Is IVF covered under my plan?”
   • “What are my coverage limits for IVF or fertility treatments?”
3. Contact the National Infertility Unit (NIU) at 1‑800‑575‑5999 to confirm precertification requirements.
4. Use Aetna’s provider directory to find in-network or IOE fertility specialists.
5. Speak with providers on Klarity Health. They can help verify your benefits and schedule a consultation.

Why Aetna might deny IVF coverage

Common reasons Aetna may deny coverage include:

• No precertification was submitted or there is incomplete documentation
• Not meeting clinical criteria (e.g., lack of prior ovulation induction or IUI)
• Using an out-of-network provider or a non-IOE clinic
• Not meeting age, hormonal, or biological guidelines 
• Employer-sponsored plans that exclude fertility or ART benefits

Even if your plan is under Aetna, coverage terms can vary significantly depending on the employer and plan type.

Tips for improving your chances of approval for Aetna coverage

To boost your chances of approval:

• Use in-network or IOE fertility providers
• Ensure your provider submits full precertification documentation at least 15 days before treatment
• Include a clear infertility diagnosis and treatment history
• Consider a telehealth evaluation to prepare your case thoroughly
• Know your cycle limits and medication caps in advance
• If denied, file an appeal within the specified time (usually 180 days)
• If you’re LGBTQ+, ask about inclusive coverage, Aetna updated its policy to eliminate past barriers based on partner gender or relationship status

How to get prior authorization from Aetna for IVF

To request precertification:

1. Choose an in-network or IOE fertility clinic.
2. Book a telehealth or in-person visit to develop a treatment plan.
3. Your provider submits the precertification request and supporting documents via Availity or fax at least 15 days prior to the start of your cycle.
4. Aetna’s NIU reviews the request using their policy on infertility (CPB #0327) and your plan’s criteria.
5. Once approved, you’ll receive an authorization number to proceed with treatment.

Medications like Gonal‑f and Menopur must also be approved through the same process and filled through a specialty pharmacy or another approved provider.

Next steps to get IVF covered by Aetna online

Aetna does offer IVF coverage, but you’ll need to follow the right steps, like checking your benefits, consulting a fertility provider, and obtaining prior authorization. Klarity Health can help simplify this process by connecting you with a licensed specialist who can guide you from insurance verification to treatment.Want to confirm your Aetna IVF coverage? Book a telehealth visit through Klarity Health today to get expert guidance on your eligibility and treatment options.

Find out if your insurance covers fertility care

Providers on Klarity Health can assess your fertility needs, and recommend care options that may be covered.

Book your fertility consultation today