Cynthia and Alex are parents to a 6-year-old son, Jake. "It was a dream come true," Alex said, of becoming a dad.
But for the high school sweethearts, conceiving a child was only possible with in vitro fertilization, which was covered by Cynthia's insurance through her employer. They have what's called "unexplained infertility."
Cynthia then left her job to become a stay at home mom. Of course, they'd like another child. Although Cynthia went back to work as a part-time teacher, she is no longer covered for fertility treatments and Alex's job doesn't provide such coverage, either.
"I work for a large shipping company and our benefits are great," he said. "I was a little shocked we don't have that coverage.
"We do have very good dental, very good medical and prescription plans, but that's the one coverage we don't have."
They've since racked up more than $24,000 in debt over the past year paying for treatments out of pocket, which is split between a credit card and a home equity loan. "That's where it gets challenging, because of the huge amount of debt," Cynthia said.
Now in their late 30s, the couple must also weigh their age along with their financial standing. It's a scenario that's increasingly common.
For the first time ever, women in their 30s are having more children than those in their 20s, according to data from the Centers for Disease Control and Prevention.
And because fertility in women is known to decline steadily with age, complications can arise. Not only is it harder to have kids as a 30-something compared to a 20-something, but treatments — such as the increasingly popular IVF — can be prohibitively expensive.
Even as demand for IVF rises, insurance coverage remains limited. With the recent addition of New York, there are only 10 states that have an IVF insurance mandate, meaning that employees in the state must be offered a health insurance option that covers the procedures. In all, there are 16 states that require some type of coverage, but that does not necessarily include IVF.
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However, depending on your employer, the state's requirements may not even apply. For example, small employers offering health insurance are often exempt, as are large corporations — such as the one Alex works for — that self-insure their plans.
About 80% of people who underwent IVF fertility treatments in 2018 had hardly any or no coverage, according to FertilityIQ, a digital database for information about fertility benefits and treatments.
That means that much of the expense is covered out of pocket. It's common for patients to spend upwards of $50,000 on IVF treatments, assuming they go through more than one cycle, FertilityIQ said.
"For a lot of people it's a really rude surprise," said FertilityIQ co-founder Jake Anderson-Bialis. "When you feel like you really want a family and time is slipping away, this is a non-negotiable bill that people feel compelled to pay whether they have the money or not."
Anderson-Bialis and his wife, Deborah, did not do IVF but they did spend $70,000 on fertility treatments in their efforts to have children. "Affordability is a monumental issue," he said.
"Most people are barely saving to begin with, forget about a $50,000 bill dropped in your lap," Anderson-Bialis said.
On the upside, some fertility clinics do offer financing options, including loans, graduated repayments or even outcome-based pricing models.
In other cases, your employer can help. As of 2019, a little more than 500 U.S. employers offer some sort of fertility benefit (including companies such as ExxonMobil, AT&T, Mass Mutual, Geico and Procter & Gamble), a 20% increase from last year, according to FertilityIQ.
"While more companies than ever before are offering full or partial IVF coverage in their benefits packages, most still do not, which means the high cost of IVF will fall almost entirely on the person or couple themselves," said Natalie Elisha Gold, an attorney and author of the upcoming book "Money Momma: The Women's Wealth Bible for the Digital Age."
"I see more and more women who have been hyper-focused on their educations and careers coming to me for advice about funding fertility treatments in their 30s and 40s," she said.
Gold advises clients to start saving in a Roth IRA as soon as possible, even before babies are on the brain. Contributions to a Roth are taxed up front and account holders can withdraw their contributions at any time without taxes or penalties.
"And if you don't end up needing it, that money will have been accruing compound interest which can be used in retirement," Gold said.
If you haven't built up a sufficient nest egg, "start from the top of what's going to be the least expensive financing option," added Carolyn McClanahan, a certified financial planner and founder of Life Planning Partners in Jacksonville, Florida.
There are better and worse ways to borrow. The interest rate on a home equity loan, for example, is just 5% to 6% on average, whereas personal loans are available at a slightly higher rate, but they do not require borrowing against something of value, like a house, which makes them attractive for those without that kind of equity.
Both options are notably better than running up a tab on a credit card, which is one of the most expensive ways to access cash.
And McClanahan, along with many other financial advisors, advises against 401(k) loans entirely.
"The problem with borrowing against a 401(k) is, let's say you have a problem with delivery and you need to quit work, or you want to stay at home with the baby, that loan is immediately due."
That's where Cynthia says she'll draw the line. Still, she's not ready to think about giving up, she added. "Since we started, I'm not OK with stopping."