The Bottom Line
Infertility is always hard and especially so for military families. Navigating the system can be tough – it’s complicated and there isn’t much good information readily accessible. Here we’ll show you what options are available so you can make the best choice for your family. But the overriding message is that there absolutely are options so don’t lose hope!
The Gouge
- TRICARE typically doesn’t cover fertility treatments
- But TRICARE does cover diagnostics and many fertility drugs
- Military treatment facilities (MTFs) offer reduced-cost IUI and IVF treatments
- TRICARE does cover treatment for service-related infertility
- Outside of the military healthcare system, there are grants and military discounts
- If you are deployed overseas, there are often cheaper options in other countries
- There are a few high-quality, low-cost providers stateside as well
- When all else fails, take a job at Starbucks – seriously
Background
If you’re reading this, I probably don’t need to tell you how difficult it can be dealing with infertility. In the military, it’s especially difficult. On the one hand, it seems like everyone around you is having kids. On the other hand, everything about the job makes it harder to have kids. You’re away from your spouse for months on end. Not to mention the stress. And then you have the duty hazards with jet fuel, gun powder residue and radiation frying the… um… equipment.
Hard data shows this struggle is real. Women in the military suffer from infertility at three times the rate that civilian women do. That means that nearly 30% of women who serve will deal with infertility. And it’s not just women, studies show that military men suffer from infertility at higher rates than their civilian counterparts.
While the military medical system has many positives, ease of navigation isn’t one of them. And fertility treatments are often effective but never cheap, which means that serving men and women sometimes need to put in a bit of work to find solutions. This article should provide a head start.
Where to begin
This process is anything but fast. If you believe you are having trouble getting pregnant, start right away. Your first point of contact is your primary care manager (PCM) if you are on a TRICARE plan. If you have TRICARE Prime, your PCM will usually want you to try to conceive naturally for 12 months before they will put in a referral to see a reproductive health specialist. The referral process is usually a bit more relaxed if you have a TRICARE select and can go right to a specialist.
Your PCM will refer you to a specialist at a military facility, if one is available nearby. Otherwise, they will refer you to another in-network doctor in the area.
What happens next
The good news is that, once you get a referral to a reproductive doctor, many of the next steps are covered by TRICARE. The specialist doctor begins with a lot of diagnostic work- blood work, semen analysis for men, Hysterosalpingogram (HSG) for women. As the process continues they may move on to more complex or more invasive tests like hormone evaluation, chromosomal studies, immunologic studies, special and sperm function tests, and bacteriologic investigation. These tests are generally covered by TRICARE.
While TRICARE does not usually cover fertility treatments like IUI and IVF, they do if you are not able to conceive due to a serious injury sustained while on active duty. In that case, you may qualify for a number of fertility related treatments, like sperm/egg retrieval, IVF or cryopreservation. In order to get that coverage, you have to see a participating in-network provider and get pre-approval before each cycle of fertility treatment. Anecdotal reports suggest getting approval can be fairly difficult so keep at it. If you have a solid case, don’t be afraid to appeal a decision from TRICARE and ask them to reconsider.
If infertility is not the result of an active-duty injury, TRICARE will still cover some underlying physical causes of infertility such as erectile dysfunction. Also, many fertility medications are covered under TRICARE. You can search the TRICARE covered drug list but they should cover drugs such as progesterone, estrogen, and Clomid. If you need a medication that is not covered by TRICARE, it is worth checking with the fertility drugmaker EMD Serrano. They offer both military discounts and income-based pricing through their Compassionate Corps
If you have already left the service, the Veterans Administration in 2017 started covering reproductive assistive technology for those with service connected reproductive injuries. Under their new policy they will even cover some adoption fees.
Where to go after that
If you have to go the route of IUI or IVF, the best value (and, of course these things are all relative) is usually a military fertility clinic.
Before you decide on any particular clinic, whether military of civilian, do a bit of research on success rates. You can find statistics and reviews online (civilian data is often easier to find than military). Look for the number of cycles attempted per year and the success rates, which you can usually find broken down by demographics. The best data on the military fertility clinics that I could find is in a 2015 Report to Congress on Efforts to Treat Infertility of Military Families, spearheaded by Senator John McCain.
Military fertility clinics
The six military treatment facilities (MTFs) that offer fertility procedures are-
- Walter Reed National Military Medical Center Bethesda, MD
- Womack Army Medical Center Fayetteville, NC
- Fort Sam Brooke Medical Center San Antonio, TX
- Naval Medical Center San Diego, CA
- Madigan Army Medical Center Tacoma, WA
- Tripler Army Medical Center Honolulu, HI
You will know upfront how much it will cost because payment is required in full before beginning treatment. The all-in cost is typically $6000 – 9000.
Each military treatment facility runs things a little differently so it’s best to call the facility or talk to your doctor to get the exact details. The military fertility clinics all have waitlists, which can be up to a year long. Get a referral from your doctor as soon as you can to get on the waitlist.
Military treatment facilities only offer a few cycles per year, usually one per season (spring, summer, fall, winter). Everyone on that cycle goes through the process together at the same time. The military won’t pay for travel, so the best thing you can do is communicate early to your chain of command to arrange for no cost TAD (to save your leave days) or request leave as far in advance as possible.
Outside of the military healthcare system
If for one reason or another, going to a military fertility clinic won’t work, there are plenty of other options but it takes a bit of work or some creativity to get a good deal.
One option that may not be immediately obvious is to look overseas. IVF is much cheaper In many other countries. If you can manage to get stationed in one of those countries and navigate the local system, you can potentially get the same service at a small fraction of the US cost.
Stateside, there are clinics like CNY Fertility that pride themselves on being affordable IVF options. Treatment is roughly $4900 plus meds. Even better, every November they offer a military IVF grant covering the IVF procedure along with medication expenses and a 7 night stay at a local hotel.
They aren’t the only ones offering IVF grants. The Bob Woodruff Foundation is another great example and there are plenty of others. It always pays to look around and apply for every grant available. Similarly, ask your local clinic if they offer a military discount. The answer will often be yes.
No matter where you go, ask for the cash price. The first price quoted is the inflated insurance company price. You can almost always pay considerably less by paying cash.
When all else fails, go to Starbucks (seriously)
Here is the story of Master Sergeant Christian Borrero-Colon who has served in the Air Force for 17 years and who, in 2017 took a part time job at Starbucks for the fertility care benefits. Christian isn’t alone in that. You can find Facebook groups with names like Starbucks IVF mamas and Starbucks IVF Warriors full of people who have done the same.
The company’s health insurance covers up to $25,000 for IVF procedures and an additional $10,000 for medication for each qualifying event. You only need to work part time for 3 months to qualify for those benefits.
Don’t give up the ship
The overriding message here is that there are a lot of things you can do. No part of this process is easy but many, many service men and women and their spouses have navigated it and now have the children they always wanted. You are certainly not alone and there are a lot of resources, if you know where to look.
Feel free to share with us any additional resources that have helped you.
And never lose hope.