The three letters that decide whether insurance covers your PGT
If you've just gotten a quote for preimplantation genetic testing and called your insurance company, you probably got one of two answers: "not covered" or "we'll need to look into that." Neither tells you much.
Here's the thing most people miss: the answer has almost nothing to do with your medical situation. It comes down to three small details that nobody explains upfront: which type of PGT you need, who your employer is, and whether your employer's plan is self-insured. Get those three facts straight and you can skip a lot of wasted phone calls.
The same test, three different answers
PGT-M screens for single-gene disorders like cystic fibrosis, sickle cell, or BRCA mutations. Insurers get this one. ACOG says the clinical utility is established, so if you're a known carrier, most plans classify PGT-M as medically necessary. A lot of carriers don't realize they already have a coverage pathway sitting in their existing plan.
PGT-A screens for chromosome count errors. It's the most commonly requested type of PGT during IVF. And this is where things get absurd.
Aetna's clinical policy calls PGT-A "experimental and investigational for all indications." UnitedHealthcare's commercial policy says "unproven." Meanwhile, a study of nearly 9,000 patients across 74 centers found that PGT-A saves $931 to $2,411 per patient and shortens treatment by up to four months when there's more than one embryo. The cost-effectiveness data exists. Insurers have just chosen to ignore it.
And yet that same PGT-A test that Aetna calls experimental? Covered at zero additional cost by Progyny for every member. Progyny isn't a traditional insurer. It's an employer fertility benefit platform. Companies like Microsoft, Amazon, and Google contract with Progyny and bundle PGT-A into every IVF Smart Cycle.
Two patients in the same clinic, same doctor, same test. One pays $4,000 to $5,000 out of pocket because her insurer calls it experimental. The other pays nothing because her employer uses Progyny.
The difference isn't medical. It's which benefits portal you log into.
PGT-P screens for polygenic conditions like type 2 diabetes, heart disease, and Alzheimer's. It has no commercial insurance pathway, and that's unlikely to change soon. But whether PGT-P is worth paying for is a different question entirely, and we'll come back to it.
Your employer is the plan
Most people stop at "my insurance doesn't cover it." That's usually the wrong place to stop.
If you work for a large company, your plan is probably self-insured under ERISA. That means state IVF mandates don't apply to you. You could live in a state with a great IVF mandate and it wouldn't matter. Your employer's benefits team chose your coverage, not your state legislature. That's also why employer fertility benefit platforms like Progyny can override what traditional insurers say about PGT-A. Your employer is the plan.
So the person to call isn't your health insurer. It's your fertility benefit directly. If your employer offers Progyny, Maven, Win Fertility, or something similar, PGT-A is likely bundled already. Most people don't check because their insurance card doesn't mention it, but the coverage is sitting in their benefits portal. If you're trying to figure out whether embryo screening is right for you, this is the first thing to look up.
Making the numbers work
If you're paying out of pocket for any type of PGT, pre-tax dollars through an FSA or HSA can lower your fertility costs by 20 to 30 percent. For PGT-A at $4,000 to $5,000 per cycle, that's $800 to $1,500 back. And if you're weighing costs across the full IVF cycle, our IVF calculator can help you map the numbers for your specific situation.
And if you carry a known single-gene mutation, don't skip the PGT-M conversation with your insurer. That's the coverage pathway most people overlook, because the conversation usually starts with PGT-A.
PGT-P is a different kind of question
PGT-P doesn't have an insurance pathway. But the value of PGT-P isn't really a coverage question. It's a math question.
For a family where both parents have type 2 diabetes, the risk spread across embryos in a single IVF cycle can range from 3.5% to 23.3%. Picking the lowest-risk embryo instead of a random one is a meaningful decision, and it's one that doesn't depend on a claims processor to validate. The information is useful whether or not anyone reimburses you for it.
If you want to understand what PGT-P screening would show for your family's specific situation, reach out to us. Herasight's counselors can walk you through what the science shows and what it costs.