One of the largest hurdles for many people facing the decision about whether to go forward with infertility treatment is finances. When including the cost of medications, the average price tag associated with a single round of IVF in the United States is $16,000. Most clinics do not offer in-house financing and require payment at time of service to proceed. This kind of financial pressure can push many potential parents away from attempting reproductive technology.
My husband and I found out in the late summer of 2017 that the only way we could realistically sire biological children is utilizing ICSI, a fertilization method unique to IVF. Without this assistance the chance of my husband’s sperm meeting my egg was next to nothing. With youth on our side and blind optimism we put all of our savings into our first round, as well as taking out a loan (that would set us back at least five years from buying our own home, or replacing the car we lost to hail damage). We were absolutely gutted when this round failed, and we were faced with needing to attempt a second time. Through fundraising efforts and making massive financial cuts in our lives we paid off our loan early and attempted a second round in 2018. This treatment cycle was also a failure, and our options were running low. The debt we had accrued through our treatments was more than we could pay off quickly, and the banks would not lend us any more funds. Over $37,000 had been spent and we were still childless. It was infuriating that money was the only thing stopping us from chasing our dream of becoming parents.
That is when I turned to insurance.
In the United States only 19 states have passed a law to mandate infertility coverage on insurance plans, and only 13 of those include IVF. (Even within these states finding coverage can be difficult depending on your employer and whether they fall within the required guidelines to follow these mandates). As a Nebraska citizen I was not able to rely on these mandates – because Nebraska does NOT have one. Finding a plan in this beautiful state was going to be a challenge. Instead of finding a company that was forced to offer it, I had to find an employer that went out of their way to cover infertility.
After much use of search engines, I discovered that Starbucks would offer insurance coverage to all their staff (including qualifying part-time employees) and part of this package included infertility medications and treatments. In 2019 the coverage was expanded to a $10,000 lifetime medication maximum as well as a $25,000 treatment maximum. With a history in retail and customer service I knew that, while challenging, Starbucks could be a good fit with my resume. For over a year and a half I played phone tag with management trying to secure my position as a barista. It was through sheer determination and sustained infertility that our timelines finally merged, and I was able to secure an interview.
Getting hired at Starbucks was only the first step in a five-month journey to insurance coverage. Once hired, the barista is in an immediate qualification period to see if they are eligible to be on a Starbucks medical coverage plan. The requirements for this are attainable but do require effort. Within three months a barista must work 240 hours, which breaks down to an average of 20-21 hours a week. At the completion of three full months as an employee the benefits coordinators will complete an audit. If the barista passes this 240-hour audit they are sent an enrollment package. This package allows the barista to select from five carriers, with four levels of coverage. (Every level has the same fertility package, but the deductible and co-insurance rates will vary). No matter how long the barista takes to select their package, the insurance will be active the first of that following month. Once the insurance is active, they can immediately begin billing any medical appointments to the insurance. If the barista fails this audit at the third month – another month will be added. No matter what, they must complete 240 hours in a three-month rolling period to be offered medical insurance through Starbucks.
When it came time to select my insurance package, I went with a platinum option – this left me with a $0 deductible and exceptionally low co-insurance rate. My treatments would be covered immediately at a cost very affordable to me. The downside to this choice is that my portion of the premium far exceeds what I earn as a barista. Every month Starbucks takes my entire paycheck and puts it toward my insurance. This is not enough to cover my portion of the premium, so they cover the remaining balance. This puts me in “arrears” which is essentially debt to Starbucks. I cannot receive any take-home pay until I have paid back Starbucks, even if I am rehired many years down the road. It is also possible that Starbucks could bill me the full amount due at the termination of my position, although it has been Starbucks stance to not do so as of yet, with their mission being that everyone deserves access to healthcare. Going thousands of dollars into arrears every month is a decision that I made with my spouse but is not the right choice for everyone. Had we not wanted to take this bold step we could have chosen a separate plan with a manageable deductible and paid for it in full with my paycheck. It is a personal decision that every barista makes based on their medical coverage needs.
In December of 2019 I went through my first round of IVF utilizing this insurance package and was billed a whopping $640 including medications. It was a far cry from our previous billed cycles, a true gift to experience. This singular cycle used up $7,700 of my medication maximum and roughly $4,000 of my treatment maximum. This is because when it comes to medical billing…. prescriptions are often HIGHER than cash pay prices, whereas medical procedures are LOWER than cash pay prices. With a $10,000 medication maximum we will return to cash pay on our medications during our next cycle, but if rates do not change much between our insurance and clinic, we can get roughly four additional egg retrievals from insurance. It is thrilling!
That is not to say that this arrangement does not have its drawbacks. Being a barista is a lot of work, perhaps more than most would expect. The physical demands of the job have left me limping for hours at home after every single shift… for over a year. I have endured stress on my wrists that have resulted in needing some physical therapy done to adjust to the demand and find more effective ways to use my wrists. While often extremely fulfilling, the demands of this job are high, and the stress level often matches. Every week my co-workers mention payday and their checks, while I hold onto my insurance card. Going down to a one income household to accommodate this Starbucks position has been a large change to our dynamic and we have had to adjust our spending habits.
In the long run, it is saving us thousands upon thousands in treatment costs, but every day we have had to make financial sacrifices to adjust to this new normal. When I began this Starbucks journey in 2019, I had no idea what to expect, but looking back I would not change a thing. The opportunity to attempt repeated rounds of IVF has relieved an immense amount of pressure from myself and my spouse. We can hold true hope in our hearts that our miracle baby is on the horizon. Even if it takes one, two, or more tries we are not held back by our financial limitations anymore. Being able to make decisions based on what we can emotionally handle is much more freeing than having to focus on what the bank accounts and calculators are telling us.
While it is my hope that some day finding insurance coverage for infertility will not mean working for no take-home pay, I am thankful to Starbucks for offering this insurance to their part-time partners. Finding such an opportunity is rare, and something I cherish. While it may not be the best option for everyone, it was the best choice for my family. Our fertility treatment journey has been completely flipped upside down in the best way possible.
Finding Coverage in the United States
While the world of healthcare in the United States is constantly evolving and states are surveying their needs for an insurance mandate at alarming rates – sometimes there is not time to wait. For those seeking out medical coverage without state support, there are options! When surveyed in 2019 FertilityIQ found that over 400 employers offer some form of infertility coverage to their employees. Starbucks is only one of many options available.
AT&T, Coca-Cola, Tyson, American Airlines, Target, Verizon, Bank of America, and Google are some of the big names mentioned in their 2019 review of companies offering fertility coverage. Becoming eligible for coverage, and what the cost of that coverage is, will vary by employer. When it comes to finding the right plan to fit your career ambitions, financial needs, and insurance requirements… it may take some time. Shop around, do research, and never be afraid to ask questions. For some of us battling this infertility diagnosis, searching out employment solely for the benefits may be an option to overcome financial hurdles.