How to pay for upcoming medical / IVF expenses

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boomstick
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How to pay for upcoming medical / IVF expenses

Post by boomstick » Sun Sep 23, 2018 9:43 am

Hi all,

Got a question that I need some input on. My wife and I (early 30s) got married last year. We bought our first home a month later and we've been happy since.

Unfortunately, the next stage in life seems like it is going to be a costly one. We need to go through fertility / IVF treatments which are 100% not covered by insurance. The cost is slated to be ~$16,000, but could be around ~$20,000 with medicines once all is said and done.

Unfortunately we don't have an emergency fund that big with everything else going on ( + bought a car for $17k cash months back... :x )

What are some ways of paying for this? I really don't want to take on new debt.

I have ~$80k in a 401k (I borrowed $50K from it a while back for home renovations, paying that back over 5 years).

Would a hardship withdraw from the 401K be a good move for these expenses? I understand that there are no penalties for medical withdraws at a certain percentage of income.

Also I think we might be hitting the level for medical expenses to being tax deductible ( I read somewhere that it needs to be 7.5% r 10% of income... hard to find solid numbers. Gross income in going to be around $190-200k this year).

Any thoughts or insights on this? This is a very stressful time in our short marriage, so any helpful advice is greatly appreciated.

Mike Scott
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Re: How to pay for upcoming medical / IVF expenses

Post by Mike Scott » Sun Sep 23, 2018 9:58 am

How long would it take you to save up 20K? Is there anything you could sell such as cars or collectibles to get there faster?

samsdad
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Re: How to pay for upcoming medical / IVF expenses

Post by samsdad » Sun Sep 23, 2018 10:24 am

We deducted our IVF-related expenses from our taxes. It helped some given that for everything related to the procedure we paid in excess of $50k. We did the deluxe type of deal though, doing everything they recommended: the genetic screening etc., but we are in our early 40s and didn’t think we’d have another shot at it. Be prepared to go to the pharmacy and be handed a $2k bill, multiple times. The first time I went I thought they were kidding.

But, happily, now we’re kidding so to speak with twin 9-month-old girls. Be prepared to have your entire life changed, including your retirement plans—if you’re successful, and I hope you are. Oh, and sleep now while you can. Both of you.

boomstick
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Re: How to pay for upcoming medical / IVF expenses

Post by boomstick » Sun Sep 23, 2018 10:27 am

Mike Scott wrote:
Sun Sep 23, 2018 9:58 am
How long would it take you to save up 20K? Is there anything you could sell such as cars or collectibles to get there faster?
Probably couldn't get to 20k by selling things. We are newly weds, we don't have a ton of "extras" to spare at this point. Selling things we need is counter productive in the long term.

boomstick
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Re: How to pay for upcoming medical / IVF expenses

Post by boomstick » Sun Sep 23, 2018 10:30 am

samsdad wrote:
Sun Sep 23, 2018 10:24 am
We deducted our IVF-related expenses from our taxes. It helped some given that for everything related to the procedure we paid in excess of $50k. We did the deluxe type of deal though, doing everything they recommended: the genetic screening etc., but we are in our early 40s and didn’t think we’d have another shot at it. Be prepared to go to the pharmacy and be handed a $2k bill, multiple times. The first time I went I thought they were kidding.

But, happily, now we’re kidding so to speak with twin 9-month-old girls. Be prepared to have your entire life changed, including your retirement plans—if you’re successful, and I hope you are. Oh, and sleep now while you can. Both of you.
Thanks for the kind words. We hope we are successful too. Those bills sound.... lovely.

Did you pay cash for your treatments? Or did you find some sort of financing for it?

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White Coat Investor
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Re: How to pay for upcoming medical / IVF expenses

Post by White Coat Investor » Sun Sep 23, 2018 10:32 am

boomstick wrote:
Sun Sep 23, 2018 9:43 am
Hi all,

Got a question that I need some input on. My wife and I (early 30s) got married last year. We bought our first home a month later and we've been happy since.

Unfortunately, the next stage in life seems like it is going to be a costly one. We need to go through fertility / IVF treatments which are 100% not covered by insurance. The cost is slated to be ~$16,000, but could be around ~$20,000 with medicines once all is said and done.

Unfortunately we don't have an emergency fund that big with everything else going on ( + bought a car for $17k cash months back... :x )

What are some ways of paying for this? I really don't want to take on new debt.

I have ~$80k in a 401k (I borrowed $50K from it a while back for home renovations, paying that back over 5 years).

Would a hardship withdraw from the 401K be a good move for these expenses? I understand that there are no penalties for medical withdraws at a certain percentage of income.

Also I think we might be hitting the level for medical expenses to being tax deductible ( I read somewhere that it needs to be 7.5% r 10% of income... hard to find solid numbers. Gross income in going to be around $190-200k this year).

Any thoughts or insights on this? This is a very stressful time in our short marriage, so any helpful advice is greatly appreciated.
$200K income. $20K expense. Why not stop saving for retirement for a few months to get the $20K? You should be saving something like $30-40K for retirement. Remember that lots of people don't even start saving for retirement until their 40s. If you can't afford IVF on an income of $200K, how do you think the other 98% of Americans do it? Yes, it's expensive, but so are cars, boats, homes, and early retirement. You just have to prioritize what is most important to you and spend your money on that. It's not like those kids get dramatically cheaper once you have them. This $20K is just the beginning. Their college is going to cost a whole lot more than that.

BTW, if I haven't convinced you to pay cash, I'd recommend borrowing from the 401(k) before taking a hardship withdrawal.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course

boomstick
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Re: How to pay for upcoming medical / IVF expenses

Post by boomstick » Sun Sep 23, 2018 10:39 am

White Coat Investor wrote:
Sun Sep 23, 2018 10:32 am

$200K income. $20K expense. Why not stop saving for retirement for a few months to get the $20K? You should be saving something like $30-40K for retirement. Remember that lots of people don't even start saving for retirement until their 40s. If you can't afford IVF on an income of $200K, how do you think the other 98% of Americans do it? Yes, it's expensive, but so are cars, boats, homes, and early retirement. You just have to prioritize what is most important to you and spend your money on that. It's not like those kids get dramatically cheaper once you have them. This $20K is just the beginning. Their college is going to cost a whole lot more than that.

BTW, if I haven't convinced you to pay cash, I'd recommend borrowing from the 401(k) before taking a hardship withdrawal.
agreed. that is the best case scenario, but not the reality. I have been saving, which allowed me to put $200k down on the house. but the medical costs have been ongoing for almost a year - hence money that previously went into savings has already gone to medical expenses. College and retirement are somewhat predictable. fertility treatments are not. nor can they always be "put on hold" as biology always wins over practicality.

I agree with what you're saying at a high level, but holding off 10 months or so isn't an option. Thanks for the input.
BTW, if I haven't convinced you to pay cash, I'd recommend borrowing from the 401(k) before taking a hardship withdrawal.
good info, thanks!

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pointyhairedboss
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Re: How to pay for upcoming medical / IVF expenses

Post by pointyhairedboss » Sun Sep 23, 2018 10:43 am

$20K sounds low. IVF is extremely expensive. Transfers do not always work on the first attempt. You should inquire about the cost of:
- freezing embryos for future transfers
- future transfers with those frozen embryos

These costs presume you will have extra embryos to spare from the first extraction. There is also the possibility you'll need to extract more eggs - a more expensive cost.

My overall point - be prepared for the possibility of a) far higher costs and b) failure despite the high costs.

Best wishes...
Last edited by pointyhairedboss on Sun Sep 23, 2018 11:24 am, edited 2 times in total.

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Watty
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Re: How to pay for upcoming medical / IVF expenses

Post by Watty » Sun Sep 23, 2018 10:58 am

boomstick wrote:
Sun Sep 23, 2018 9:43 am
Gross income in going to be around $190-200k this year
That is well over $15,000 a month which is a lot even after taxes.

You likely don't need the entire $20,000 all at once. I would just change your paychecks to have $3,000 a month automatically deposited into a seperate baby account.

That would likely require you make cuts elsewhere but you will still have over $12,000 a month in income before taxes.

Track your spending brutally so that you know where every dollar goes and then post your monthly costs here if you need help in figuring out where to cut your spending some more.

One thing to remember is that even if you both plan on working after the baby is born that might not be possible, or you may change your mind about using daycare then. If the baby has even temporary and minor health issues then using daycare might be difficult or impossible so you need to be prepared to live on one income if you need to so you could start living on that budget now.

There are several variations on a saying, "You can afford to do anything you want, but not everything you want." You need to start making some tradeoffs.

jbmitt
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Re: How to pay for upcoming medical / IVF expenses

Post by jbmitt » Sun Sep 23, 2018 11:12 am

I’ll preface this that DS is an ob/gyn and deals with this situation regularly and we’ve had close family go through IVF.

Until you can pay cash for it, you can’t afford it. $20,000 is just the starting point. Be prepared to spend more ($30,000 - $50,000) than you think because once you start, you will keep going and following instructions from the REI doctor until you have your baby. There is big money involved and most practices have more patients than they can handle, so you may not feel that you’re getting the service that you are paying for.

Some employers have a fertility benefit if your dead set on this.

We’re mid to late thirties and don’t have children of our own yet and recognize that we may have fertility issues. I’d urge you to consider some of the alternatives methods to building your family. Despite likely having the financial means to do it, DS also intimately understands the process and has no interest in subjecting her body to it. For us, adoption is a likely possibility.

I hate to say this, but not everyone is able to have biological children despite what you may hope or how much money you throw at it. We seen the first hand expense that families with 300k+ household incomes go through with IVF and honestly they probably couldn’t afford it.

I understand that none of what I’ve said addresses the emotional component, especially for newlyweds who may not have anticipated any issues. You have to weigh that versus your financial resources. I’d also make sure that you understand the physical process of IVF and the emotions that may come into play.
Last edited by jbmitt on Sun Sep 23, 2018 11:25 am, edited 2 times in total.

samsdad
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Re: How to pay for upcoming medical / IVF expenses

Post by samsdad » Sun Sep 23, 2018 11:18 am

boomstick wrote:
Sun Sep 23, 2018 10:30 am
samsdad wrote:
Sun Sep 23, 2018 10:24 am
We deducted our IVF-related expenses from our taxes. It helped some given that for everything related to the procedure we paid in excess of $50k. We did the deluxe type of deal though, doing everything they recommended: the genetic screening etc., but we are in our early 40s and didn’t think we’d have another shot at it. Be prepared to go to the pharmacy and be handed a $2k bill, multiple times. The first time I went I thought they were kidding.

But, happily, now we’re kidding so to speak with twin 9-month-old girls. Be prepared to have your entire life changed, including your retirement plans—if you’re successful, and I hope you are. Oh, and sleep now while you can. Both of you.
Thanks for the kind words. We hope we are successful too. Those bills sound.... lovely.

Did you pay cash for your treatments? Or did you find some sort of financing for it?
Cash. There is financing available if I recall correctly. We pulled the trigger when we looked and saw that we had the money. We figured if we didn’t do it then we’d never do it, or that life would send us a big bill for something else if we didn’t spend it on this, and then it might take years before we could gather enough money again. Plus, none of us are growing more fertile every year (the 18-year-olds with $1M to invest that come around here looking for advice notwithstanding.)

We also figured the cost of regret if we didn’t at least try would be more expensive than anything we’d take out of our bank accounts. As they often say around here, there’s more to life than just VTSAX . . .

boomstick
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Re: How to pay for upcoming medical / IVF expenses

Post by boomstick » Sun Sep 23, 2018 11:29 am

samsdad wrote:
Sun Sep 23, 2018 11:18 am
We also figured the cost of regret if we didn’t at least try would be more expensive than anything we’d take out of our bank accounts. As they often say around here, there’s more to life than just VTSAX . . .
agreed. honestly, $50k is a rounding error in the overall game of life. sure it is nicer to not have to spend that much, but I could say that same thing about my home vs. a cardboard box. i appreciate the input of this forum, but money isn't the only thing that matters when you're old and grey.

boomstick
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Re: How to pay for upcoming medical / IVF expenses

Post by boomstick » Sun Sep 23, 2018 11:31 am

jbmitt wrote:
Sun Sep 23, 2018 11:12 am
Until you can pay cash for it, you can’t afford it. $20,000 is just the starting point. Be prepared to spend more ($30,000 - $50,000) than you think because once you start, you will keep going and following instructions from the REI doctor until you have your baby. There is big money involved and most practices have more patients than they can handle, so you may not feel that you’re getting the service that you are paying for.
That's really good info, thanks. This has starting to look at the success rate of different clinics, and as far as I can tell, there is a wide delta for some reason. maybe we should be concerned more about quality vs continuing with the same doctors we've been seeing.

sailaway
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Re: How to pay for upcoming medical / IVF expenses

Post by sailaway » Sun Sep 23, 2018 11:42 am

The only people I have heard of getting IVF for $20k without insurance have done medical tourism.

Putting together the pieces (lots of medical expenses this year, in a hurry despite being early 30s), I suspect there is something very serious happening here. I suggest you both get into counseling so that you have a framework in place for dealing with the hormonal swings and other emotional aspects of IVF, as well as whatever is causing this sense of urgency.

As others have noted, it is a question of priorities. You chose to buy a car instead of focusing on making a family. There is nothing wrong with that choice until you suddenly start claiming that the family is your highest priority, must happen immediately, etc.

Is your house appropriate for your plans or could you downsize for savings? Your car? Other lifestyle choices?

Or, you can borrow the money against your own future.

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pointyhairedboss
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Re: How to pay for upcoming medical / IVF expenses

Post by pointyhairedboss » Sun Sep 23, 2018 11:47 am

boomstick wrote:
Sun Sep 23, 2018 11:31 am
jbmitt wrote:
Sun Sep 23, 2018 11:12 am
Until you can pay cash for it, you can’t afford it. $20,000 is just the starting point. Be prepared to spend more ($30,000 - $50,000) than you think because once you start, you will keep going and following instructions from the REI doctor until you have your baby. There is big money involved and most practices have more patients than they can handle, so you may not feel that you’re getting the service that you are paying for.
That's really good info, thanks. This has starting to look at the success rate of different clinics, and as far as I can tell, there is a wide delta for some reason. maybe we should be concerned more about quality vs continuing with the same doctors we've been seeing.
A fertility doctor once told me that his success rates were lower because his clinic would take on the toughest cases. I am paraphrasing, he didn't state it so bluntly. It does sound plausible that the fertility fitness of the patients taken in would play a factor in a clinic's success rate. That factor is independent of doctor quality.

samsdad
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Re: How to pay for upcoming medical / IVF expenses

Post by samsdad » Sun Sep 23, 2018 11:50 am

As far as quality goes, we went to the Colorado Center for Reproducitve Medicine. It is supposedly one of the best, if not the best, in the world. We had Dr. Schoolcraft take care of us; he’s the founder. We were lucky in that it’s about 10 minutes from our house. People come from around the world to see them. They are definitely busy, and you’ll find yourself there a lot more than you’d imagine, so you might want to pick a provider close to you—or your wife actually. Your part is, ahem, brief. You’re mostly there for, uh, hand-holding. :D They have opened locations in other states too if I recall.

Ron Ronnerson
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Re: How to pay for upcoming medical / IVF expenses

Post by Ron Ronnerson » Sun Sep 23, 2018 12:13 pm

I’m going to assume you’re doing fairly well financially but just have a short-term cash flow issue. I’m making this assumption based on your $200k income and that you put down $200k as a down payment on your home and recently paid cash for a car. I’d look to make a thousand small cuts in your budget to create more of a gap between your income and expenses to help pay for IVF on a pay-as-you go basis.

Since you just bought a home and car, I’ll assume you don’t need to finance anything for a bit. I’d open up a credit card with a good bonus offer and charge enough on there to meet the minimum spending requirement to earn the bonus. This should be easy enough to accomplish as you'll be paying for IVF. I’d pay the balance in full when the bill comes. I’d repeat the following month with a new credit card offering a good bonus in the spouse’s name. The month after would be a new card for me and so on. You can earn a lot of points/miles this way so it renders the effective cost of the IVF at least a bit lower and solves the short-term cash flow issue. This assumes you can pay off the balance in full each month and nothing like a job loss occurs.

We explored our options a few years ago and chose to do a domestic, open-adoption. It was a tough process with lots of ups and downs. It took four years and the fees were quite a bit more than $20k. I’m a public school teacher in the San Francisco Bay Area and my wife is currently staying home with our four-year-old daughter. Our income is half yours and we’re in a very expensive area. By managing our finances carefully and cutting out the stuff that is not truly important, we’re able to do pretty well. We have a ton of time with our kid and are comfortable (though not too cushy). We’re just fine living frugally because the joy our daughter brings to our lives is way better than fancy things. You’re absolutely right, OP - money isn’t the only thing that matters. You do have to be willing to make some choices, though. Watty said it very well in his post above: "'You can afford to do anything you want, but not everything you want.' You need to start making some tradeoffs."

2cents2
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Re: How to pay for upcoming medical / IVF expenses

Post by 2cents2 » Sun Sep 23, 2018 12:21 pm

Are you and/or your wife able to sign up for a Flexible Spending Account (FSA)? This would help a little bit towards your goal and it is generally around this time of the year when elections are made for the next year. If you both were eligible to sign up for a FSA ($2650 2018 limit- haven't seen 2019 limit yet) that would get you part of the way towards your goal.
One nice thing about the FSA is you can use the entire balance on the first day it goes into effect. Another is that it is tax free.

Here is a link for more details: https://www.bogleheads.org/wiki/Flexibl ... rrangement

boomstick
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Re: How to pay for upcoming medical / IVF expenses

Post by boomstick » Sun Sep 23, 2018 12:25 pm

sailaway wrote:
Sun Sep 23, 2018 11:42 am
The only people I have heard of getting IVF for $20k without insurance have done medical tourism.
Really? Our clinic prescribes prices with medicine being ~$16k. They have not suggested anything to the contrary. I am curious what we are missing here. What is the average cost you have heard?
sailaway wrote:
Sun Sep 23, 2018 11:42 am
Putting together the pieces (lots of medical expenses this year, in a hurry despite being early 30s), I suspect there is something very serious happening here.
Not really. But if you are an MD with practical experience, I am all ears for your professional diagnosis.
sailaway wrote:
Sun Sep 23, 2018 11:42 am
As others have noted, it is a question of priorities.
agreed.
sailaway wrote:
Sun Sep 23, 2018 11:42 am
You chose to buy a car instead of focusing on making a family. There is nothing wrong with that choice until you suddenly start claiming that the family is your highest priority, must happen immediately, etc.
You are suggesting that we are clairvoyant. I never made that claim. We had medical expenses related to fertility up until this point, but didn't perceive this event and cost in the future. time is a funny concept.
sailaway wrote:
Sun Sep 23, 2018 11:42 am
Is your house appropriate for your plans or could you downsize for savings? Your car? Other lifestyle choices?
Or, you can borrow the money against your own future.
Thanks for the input. i certainly agree with the last part. if left with no better options, we could downsize our home at a big loss. we will come to that reckoning soon enough.

boomstick
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Re: How to pay for upcoming medical / IVF expenses

Post by boomstick » Sun Sep 23, 2018 12:27 pm

2cents2 wrote:
Sun Sep 23, 2018 12:21 pm
Are you and/or your wife able to sign up for a Flexible Spending Account (FSA)? This would help a little bit towards your goal and it is generally around this time of the year when elections are made for the next year. If you both were eligible to sign up for a FSA ($2650 2018 limit- haven't seen 2019 limit yet) that would get you part of the way towards your goal.
One nice thing about the FSA is you can use the entire balance on the first day it goes into effect. Another is that it is tax free.

Here is a link for more details: https://www.bogleheads.org/wiki/Flexibl ... rrangement
Very good call, thanks. We do have a FSA, but I barely put money into it as medical expenses were minimal before fertility stuff. We do certainly need to adjust it in the future.

gotester2000
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Re: How to pay for upcoming medical / IVF expenses

Post by gotester2000 » Sun Sep 23, 2018 12:28 pm

If you have a slightest chance of having own biological children you should take it as they are the greatest joy of life(at least till they grow up).
It doesnt matter if you dont contribute to retirement for some time.
Be prepared to spend at least double of 20k. IVF is a 50:50 chance at your age which is great!

boomstick
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Re: How to pay for upcoming medical / IVF expenses

Post by boomstick » Sun Sep 23, 2018 12:33 pm

gotester2000 wrote:
Sun Sep 23, 2018 12:28 pm
If you have a slightest chance of having own biological children you should take it as they are the greatest joy of life(at least till they grow up).
It doesnt matter if you dont contribute to retirement for some time.
Be prepared to spend at least double of 20k. IVF is a 50:50 chance at your age which is great!
Thanks for the kind words. We will do whatever science / biology / finances allow. $20 - 40k in the grand scheme of life is pretty minimal in my opinion for such a monumental thing. It just needs to be handled in the best possible way (hence my post).

boomstick
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Re: How to pay for upcoming medical / IVF expenses

Post by boomstick » Sun Sep 23, 2018 12:36 pm

Ron Ronnerson wrote:
Sun Sep 23, 2018 12:13 pm
I’m going to assume you’re doing fairly well financially but just have a short-term cash flow issue. I’m making this assumption based on your $200k income and that you put down $200k as a down payment on your home and recently paid cash for a car. I’d look to make a thousand small cuts in your budget to create more of a gap between your income and expenses to help pay for IVF on a pay-as-you go basis.

Since you just bought a home and car, I’ll assume you don’t need to finance anything for a bit. I’d open up a credit card with a good bonus offer and charge enough on there to meet the minimum spending requirement to earn the bonus. This should be easy enough to accomplish as you'll be paying for IVF. I’d pay the balance in full when the bill comes. I’d repeat the following month with a new credit card offering a good bonus in the spouse’s name. The month after would be a new card for me and so on. You can earn a lot of points/miles this way so it renders the effective cost of the IVF at least a bit lower and solves the short-term cash flow issue. This assumes you can pay off the balance in full each month and nothing like a job loss occurs.

We explored our options a few years ago and chose to do a domestic, open-adoption. It was a tough process with lots of ups and downs. It took four years and the fees were quite a bit more than $20k. I’m a public school teacher in the San Francisco Bay Area and my wife is currently staying home with our four-year-old daughter. Our income is half yours and we’re in a very expensive area. By managing our finances carefully and cutting out the stuff that is not truly important, we’re able to do pretty well. We have a ton of time with our kid and are comfortable (though not too cushy). We’re just fine living frugally because the joy our daughter brings to our lives is way better than fancy things. You’re absolutely right, OP - money isn’t the only thing that matters. You do have to be willing to make some choices, though. Watty said it very well in his post above: "'You can afford to do anything you want, but not everything you want.' You need to start making some tradeoffs."
Thanks for the guidance and sharing your story. That is great info and gives us hope. Short term cash flow is the primary issue. Long term isn't bad. Your quote at the bottom is certainly accurate.

Sweet Betsy
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Re: How to pay for upcoming medical / IVF expenses

Post by Sweet Betsy » Sun Sep 23, 2018 12:56 pm

Have you considered a HELOC? It sounds like you put a substantial amount down when you purchased your home. You could take out a HELOC so that you can pay your ongoing medical costs as they occur. If I were you my plan would be to pare down my budget as much as possible so that you can cash flow most of the expenses.

I would take out a HELOC before I would borrow more money from retirement savings.

boomstick
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Re: How to pay for upcoming medical / IVF expenses

Post by boomstick » Sun Sep 23, 2018 1:03 pm

Sweet Betsy wrote:
Sun Sep 23, 2018 12:56 pm
Have you considered a HELOC?
No I haven't thought about that at all. Very good thought. Thanks !

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pointyhairedboss
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Re: How to pay for upcoming medical / IVF expenses

Post by pointyhairedboss » Sun Sep 23, 2018 1:36 pm

You might also want to factor the timing of your medical procedures against your insurance deductible. So for example, if you have already hit your out-of-pocket maximum this year, and if there is enough time to complete an expensive medical procedure by the end of the year, than your insurance will cover more of your expenses.

Conversely, if you are nowhere near your out-of-pocket maximum for this year, than you might want to wait early next year. In 2019, you might be able to attempt several transfers, if necessary, with the early transfers maxxing out the insurance deductibles, lessening the cost for the latter transfers.

Even if fertility expenses aren't covered by your insurance, the whole process will include non fertility medical costs that your insurance will cover.
Last edited by pointyhairedboss on Sun Sep 23, 2018 2:06 pm, edited 1 time in total.

Amy2017
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Re: How to pay for upcoming medical / IVF expenses

Post by Amy2017 » Sun Sep 23, 2018 2:02 pm

boomstick wrote:
Sun Sep 23, 2018 1:03 pm
Sweet Betsy wrote:
Sun Sep 23, 2018 12:56 pm
Have you considered a HELOC?
No I haven't thought about that at all. Very good thought. Thanks !
Quite a few banks charge $0 for opening a HELOC, including paying for your house appraisal, with very good promotional rates. Those are your best choices. If you could combine this with the credit card bonus approach suggested above, it almost like you could get a free loan. Basically you borrow money from HELOC to pay for the credit card balance in full each month. The bonus from the credit card could then be used to pay for the interest of HELOC.

samsdad
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Re: How to pay for upcoming medical / IVF expenses

Post by samsdad » Sun Sep 23, 2018 2:27 pm

From first appointment to giving birth was about a year for us, so factor that into the insurance equation. We didn’t have any NICU even though our twins were small and premature, but we were worried that we might have an extended hospital stay—so keep in mind you might max out your OOP if things get hairy.

I’d hesitate taking out a loan, since your cash flow is going to be severely impacted by a new baby (or babies!). For us, the doctor recommended putting two embryos in because it increased the chances that at least one would go to term. Guess what: two could too!

I recently paid $25k just to get my wife’s private student loan paid off to save us about $550/month in overhead. I’d honestly budget $70k cash for first appt. through hospital stay and additional purchases you’ll be making if it looks like it’s gonna happen for you.

I buy diapers by the hundreds and formula by the dry gallons. Plus there are all sorts of toys, car seats, cribs, diaper bags, etc., and baby clothes!!!!! Then there’s the time off work, which may or may not be as long or longer than you anticipated. Your wife (or you) might want to stay home after the birth for a few years. Go see what day care costs these days and figure out whether being a stay-at-home parent makes sense.

samsdad
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Re: How to pay for upcoming medical / IVF expenses

Post by samsdad » Sun Sep 23, 2018 2:52 pm

70k might be a little high on second thought, but maybe not if there’s an extended stay-at-home situation. The last thing you’re gonna want to worry about is money.

boomstick
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Re: How to pay for upcoming medical / IVF expenses

Post by boomstick » Sun Sep 23, 2018 3:50 pm

samsdad wrote:
Sun Sep 23, 2018 2:52 pm
70k might be a little high on second thought, but maybe not if there’s an extended stay-at-home situation. The last thing you’re gonna want to worry about is money.
Thanks for the good info. The majority of our family income in my salary. We are completely ready to drop her off the income bracket as soon as necessary. You bring up other good points. I should dig deeper into my insurance coverage should there be other challenges. My initial research on it said that cost for child birth OOP is ~$2500.

nhdean
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Re: How to pay for upcoming medical / IVF expenses

Post by nhdean » Sun Sep 23, 2018 7:46 pm

Our situation was very similar to your situation. It was very hard for the both of us. We seemed to have had many failures before finally IVF working. It was about a 2-year process for us.

I remember when it came to the last thing we tried it was $20,000 for one shot or $40,000 for guaranteed or after 6 attempts we would get a full refund. Up until that point we had already spent around $35,000 out of pocket. My wife only wanted to do the one shot because of expense. I knew if we did that we would only have one more attempt. I also did not want us to feel it was the end. I chose the $40,000 procedure. Of course, luck would have it we had a son with the first shot. I don't regret spending the extra money.

I am in sales and I remember just living at work trying to make as much money as I could. There were so many uncertainties and emotions in going through IVF. It seems once you start going through it you realize many have done IVF and have been very successful with it.

I would try and save for it. You make enough money.

sksbog
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Re: How to pay for upcoming medical / IVF expenses

Post by sksbog » Sun Sep 23, 2018 8:18 pm

It took us 3 attempts. We have now a wonderful 6 year old.
For IVF you have to understand that there may be multiple attempts before you will have your child(ren) .

Take a look at attain, integra-med.
It's a pre paid policy where for a set amount of price they will cover 6 ,procedures and 80% money back if you end up not having any child.
This was the plan when I went through, but they may have changed since then.

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White Coat Investor
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Re: How to pay for upcoming medical / IVF expenses

Post by White Coat Investor » Sun Sep 23, 2018 9:13 pm

boomstick wrote:
Sun Sep 23, 2018 10:39 am
White Coat Investor wrote:
Sun Sep 23, 2018 10:32 am

$200K income. $20K expense. Why not stop saving for retirement for a few months to get the $20K? You should be saving something like $30-40K for retirement. Remember that lots of people don't even start saving for retirement until their 40s. If you can't afford IVF on an income of $200K, how do you think the other 98% of Americans do it? Yes, it's expensive, but so are cars, boats, homes, and early retirement. You just have to prioritize what is most important to you and spend your money on that. It's not like those kids get dramatically cheaper once you have them. This $20K is just the beginning. Their college is going to cost a whole lot more than that.

BTW, if I haven't convinced you to pay cash, I'd recommend borrowing from the 401(k) before taking a hardship withdrawal.
agreed. that is the best case scenario, but not the reality. I have been saving, which allowed me to put $200k down on the house. but the medical costs have been ongoing for almost a year - hence money that previously went into savings has already gone to medical expenses. College and retirement are somewhat predictable. fertility treatments are not. nor can they always be "put on hold" as biology always wins over practicality.

I agree with what you're saying at a high level, but holding off 10 months or so isn't an option. Thanks for the input.
BTW, if I haven't convinced you to pay cash, I'd recommend borrowing from the 401(k) before taking a hardship withdrawal.
good info, thanks!
I agree. That's why I'd cut expenses to the bone and save it up in two. Seriously, when I really want something, I'm willing to sacrifice a lot for it. If you can save it up in two or three months, and still want it now, and need all the money now, then just take a 401(k) loan and pay it off in 3 months. No big deal.
1) Invest you must 2) Time is your friend 3) Impulse is your enemy | 4) Basic arithmetic works 5) Stick to simplicity 6) Stay the course

happy_statistician
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Re: How to pay for upcoming medical / IVF expenses

Post by happy_statistician » Sun Sep 23, 2018 9:53 pm

You have the money, you just don't have the liquidity. Having a family is a foundation of a lot of people's life plans and so I disagree with the folks who recommend delaying until you can pay cash.

We're doing IVF now although luckily my work provides some coverage. The cost won't all come at once, so you may be able to cash flow some of it. For example, you'll do an initial workup one month, then the next month you would retrieve eggs, and then either immediately or 1-2 months later you would transfer the embryos back. It may also take more months if your doctors want to do more diagnostics; you may also have to wait to begin the process with a reproductive endocrinologist. That timing may let you pay cash (given your income).

4K sounds a bit low for meds - for one retrieval I'm at around $5.5 sticker (hard to predict how much of the "good stuff" you'll need in advance, and I was on the high side). Paying cash there should be some discounts available (although they are not huge). And the retrieval drugs are more expensive than the transfer drugs. And you can't count on only needing to do one round (at ~20K each).

I would not delay if I were you -- I found that once I began thinking/planning for it, I became extremely keen to move forward and wasn't willing to accept any compromise in timing. It was worth a lot to me that my spouse was flexible and willing to take this (irrational?) desire to move through IVF ASAP seriously. This was inconvenient for him (rebooking travel, going to a wedding solo) but I really really appreciated it. Just something to think about; maybe your wife will feel the same way.

nfs
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Re: How to pay for upcoming medical / IVF expenses

Post by nfs » Sun Sep 23, 2018 9:59 pm

Good luck! Hopefully you will have success on your first shot. We have been doing this (with insurance coverage) for almost 2 years (2 retrievals, 6 transfers) and the insurance tab is currently $26k plus maybe $10k in meds... plus we've hit our max out of pocket both years ($5500 per year) plus about $4k that wasnt covered.

If you can do one of the plans where you get a certain number of attempts included, it isn't a bad plan. There is a lot of emotion (partly from all the hormones) and having to deal with the $ on top of that is too much. I have to fight with my insurance (and my clinic to get $ back once they insurance pays - they make me pay up front). In some ways you may have a lot less hassle paying out of pocket than the baloney we have dealt with.

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whodidntante
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Re: How to pay for upcoming medical / IVF expenses

Post by whodidntante » Sun Sep 23, 2018 10:19 pm

With your income you can get a credit card with a 0% purchase APR and a cash bonus and use that to float the expense for a year. AmEx cash magnet will pay you $250 bonus +15 months at 0%. You can also borrow against your car for 2%, at least I can. You can also save and wait.

amindu
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Re: How to pay for upcoming medical / IVF expenses

Post by amindu » Sun Sep 23, 2018 10:26 pm

We are in the exact same spot as you are. Our clinic also gave us a $15-$19K price range depending on if you opt for PGS. Similar to what another individual answered I am playing the card/point game. Open 4 new cards total between the 2 of you and use all those points to pay for a free hopefully baby moon. Like others have said you have the income just not the cash flow, and if you pay for interest for 4-6 months so what in the grand scheme of things.

Also auto loans are very low. You paid cash for your car just refinance it with one of the credit unions offering 0.9-1.9% interest and pay it off in 12-18 months, after doing the card game as well.

Also shop around for meds don’t go to who your clinic says make sure they are the lowest in the area. I called around to different pharmacies asking them their price then had our doctor call different meds to different clinics, although his preferred one is usually the best. Pharmacy in UK is also an option and it costs about half of what it does here for the exact same product same packaging same everything.

Good luck

sawhorse
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Re: How to pay for upcoming medical / IVF expenses

Post by sawhorse » Mon Sep 24, 2018 12:20 am

Based on the numbers people are talking about, compared with my own experience, it seems that there is considerable geographical variation in IVF costs, enough that you may want to consider traveling for the treatment to another part of the United States or to another country. Big cities with a lot of medical centers, though they have a higher cost of living for almost everything else, can cost less than places without much competition.

It's absolutely possible to do an IVF cycle in the United States for less than $15k including medications. Of course you might have to do testing before the cycle, more than one cycle, more than one implantation, etc and that will add up, so definitely be prepared to spend more than $20k.

This site has some comparisons.

https://www.ivfauthority.com/ivf-cost/

Novajen
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Re: How to pay for upcoming medical / IVF expenses

Post by Novajen » Mon Sep 24, 2018 9:35 am

We had 50% insurance coverage for IVF and two rounds of meds, egg retrievals, genetic testing, transfers etc. cost us $40k, so the total pre-insurance was $80k. Granted we're in the DC area so everything is more expensive than some other parts of the country. Didn't do a good boglehead approach, I wiped out our savings and used a 0% credit card to cover it. Still worth it for me, since we wouldn't have son #2 without it.

All that to say, if you're being told $20k is your all-in cost, you may have a great deal, but plan on a buffer in case it's more.

ems2013
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Re: How to pay for upcoming medical / IVF expenses

Post by ems2013 » Mon Sep 24, 2018 10:08 am

I agree that there's considerable geographic variation in price. I was extraordinarily lucky in that my insurance covered almost all of my 3 rounds (though unlucky in that it didn't work for us). Get to know your insurance policy because some things could be covered depending on how it's coded. There are ways to find lower cost meds, but the timing can be tricky. One of the clinics I used charges $8850 for a single round, not including initial workup or meds. I think their prices are lower because they are in a state that has mandatory coverage (MA). The organization & website Resolve can be a great source of support and information, and the CDC publishes data on clinics, which is good to check out before committing. It's a roller coaster. Take good care of yourself and good luck.

lvrpl
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Re: How to pay for upcoming medical / IVF expenses

Post by lvrpl » Mon Sep 24, 2018 2:10 pm

Just a note on the cost - as you can see, there is a lot of variation in cost for IVF. I think the biggest variables driving people's answers here (and what you can expect) are the following:

- How many times will you need to / want to try? Some people are saying it cost them $50k but then also saying they did two or three transfers with that cost (so cost per IVF cycle would be much lower).

- What is your specific health issue? There is a wide range of procedures and meds needed depending on what the doctor finds and recommends/tries. Meds can range a lot, and a lot of that has to do with health issues specific to you. Could be $3k for meds, could be a lot more. There are a lot of different drugs that could get prescribed in an IVF cycle, just depends on your specific situation.

- Will you be doing fresh or frozen transfers? Your first transfer will obviously not be frozen, but if you are lucky enough to get several viable embryos out of your first egg retrieval, you can do multiple transfers with only one retrieval. And the egg retrieval is a big chunk of the cost (like close to 1/2, at least in my experience).

We (my wife and I) have done 4 IVF cycles (which resulted in two amazing little boys, one three years old and one 4 months old). The first two cycles were fully covered by my insurance (had amazing benefits from that employer). The second two were 100% out of pocket.

Of the two out of pocket transfers, one was a full cycle (egg retrieval and embryo transfer) and one was just an embryo transfer (from frozen embryos we still had from the previous egg retrieval). The full cycle cost us about $17k all-in (workups, meds, retrieval, transfer). The transfer from frozen embryos was much less, about $8k (the egg retrieval drives a lot of cost, as I said).

$15k - $20k per full cycle (egg retrieval and transfer, including meds and all other costs) is really what we saw typically when we were looking into it, and we've worked with or investigated many different IVF docs over the years. So when people throw out $50k or $80k needed, it really depends on your specific situation and luck. If you do three full cycles and never get any extra frozen embryos, sure, could be $60k. If you need one full cycle and one transfer from frozen embryos, could be $25k. And if you're lucky enough that the first shot works, you may be in it $15k or $20k. Oh, and don't worry too much about the cost of frozen embryo storage - it's typically $400 - $600 per year (our is $450).

So when you're budgeting for this, you'll need to have an idea of how many times you'd be willing to try, if needed. Blanket estimates of $20k, $50k, or $80k miss a lot of the nuance.

And finally, on the question of how to finance it - I'd do a 401k loan if I felt compelled to do it now. If I could wait a year, I'd try to save up. But this is a process with a lot of lead time and the window can be closing depending on you and your wife's ages - a lot of people that haven't done IVF don't fully appreciate that, and so if you're already pushing the envelope or feel compelled, it might be a special circumstance where the 401k loan is warranted (but only if you can repay that money in short order comfortably).
Last edited by lvrpl on Mon Sep 24, 2018 3:32 pm, edited 1 time in total.

sawhorse
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Re: How to pay for upcoming medical / IVF expenses

Post by sawhorse » Mon Sep 24, 2018 2:13 pm

Novajen wrote:
Mon Sep 24, 2018 9:35 am
We had 50% insurance coverage for IVF and two rounds of meds, egg retrievals, genetic testing, transfers etc. cost us $40k, so the total pre-insurance was $80k. Granted we're in the DC area so everything is more expensive than some other parts of the country. Didn't do a good boglehead approach, I wiped out our savings and used a 0% credit card to cover it. Still worth it for me, since we wouldn't have son #2 without it.

All that to say, if you're being told $20k is your all-in cost, you may have a great deal, but plan on a buffer in case it's more.
You got 50% insurance coverage for two rounds for your second child?

BogleMelon
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Re: How to pay for upcoming medical / IVF expenses

Post by BogleMelon » Mon Sep 24, 2018 2:52 pm

I appreciate this thread. We are in the same boat except that we have the cash in the form of EF. We also can stop retirement contribution and pay for it in 6-12 months.
I however chose to seek another employer with overall better insurance plan, and specifically covering some fertility. Here are some facts:
- NJ (where I live) mandating having some degree of fertility coverage for group policies
- My employer got away with that because they are enrolled in what's called "Self insured"! Thus, mandating infertility thing doesnt somehow apply!
- Once the insurance include the fertility, I would pay the insurance rates. I don't mind paying 100% out of pocket, but please give me the insurance rates not the MSRP crazy rates!
- Odds of failing IVF is always at least 60% if not 75%. Success rate is probably 25% in our case if not 10% for some reasons.. I don't dare (yet) to pay $25K or $50K for such low success rate!
- I stopped enjoying my working place anyways. Couple of reason to start looking for another.

So, this is my plan. Hopefully it works out before we age more and things became more harder
"One of the funny things about stock market, every time one is buying another is selling, and both think they are astute" - William Feather

Jack FFR1846
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Re: How to pay for upcoming medical / IVF expenses

Post by Jack FFR1846 » Mon Sep 24, 2018 3:20 pm

We did several IVF cycles including some procedure that's a step farther (sorry, forgot what it's called). All for just insurance copay because insurance companies MUST cover this to offer health insurance in Massachusetts. All failed. We adopted twice. So we paid far more than full boat IVF would have cost anyways many times over (Mass is very expensive on the legal side). But we were in good shape financially, so could afford it.
Bogle: Smart Beta is stupid

Novajen
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Re: How to pay for upcoming medical / IVF expenses

Post by Novajen » Tue Sep 25, 2018 8:30 am

sawhorse wrote:
Mon Sep 24, 2018 2:13 pm
Novajen wrote:
Mon Sep 24, 2018 9:35 am
We had 50% insurance coverage for IVF and two rounds of meds, egg retrievals, genetic testing, transfers etc. cost us $40k, so the total pre-insurance was $80k. Granted we're in the DC area so everything is more expensive than some other parts of the country. Didn't do a good boglehead approach, I wiped out our savings and used a 0% credit card to cover it. Still worth it for me, since we wouldn't have son #2 without it.

All that to say, if you're being told $20k is your all-in cost, you may have a great deal, but plan on a buffer in case it's more.
You got 50% insurance coverage for two rounds for your second child?
Yes, first child was 5 rounds of IUIs. Insurance covered 6 of those and 3 rounds of IVF. Back when fed healthcare covered IVF.

sawhorse
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Re: How to pay for upcoming medical / IVF expenses

Post by sawhorse » Tue Sep 25, 2018 10:28 pm

Novajen wrote:
Tue Sep 25, 2018 8:30 am
sawhorse wrote:
Mon Sep 24, 2018 2:13 pm
Novajen wrote:
Mon Sep 24, 2018 9:35 am
We had 50% insurance coverage for IVF and two rounds of meds, egg retrievals, genetic testing, transfers etc. cost us $40k, so the total pre-insurance was $80k. Granted we're in the DC area so everything is more expensive than some other parts of the country. Didn't do a good boglehead approach, I wiped out our savings and used a 0% credit card to cover it. Still worth it for me, since we wouldn't have son #2 without it.

All that to say, if you're being told $20k is your all-in cost, you may have a great deal, but plan on a buffer in case it's more.
You got 50% insurance coverage for two rounds for your second child?
Yes, first child was 5 rounds of IUIs. Insurance covered 6 of those and 3 rounds of IVF. Back when fed healthcare covered IVF.
Wow, that is really good insurance coverage.

OP, the fact that this insurance plan covered 3 IVF cycles is a sign of how many people need more than one cycle. That's why, if you aren't prepared to give up until you have a child, I would budget for several cycles.

denovo
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Re: How to pay for upcoming medical / IVF expenses

Post by denovo » Wed Sep 26, 2018 2:07 am

boomstick wrote:
Sun Sep 23, 2018 9:43 am
Hi all,

Got a question that I need some input on. My wife and I (early 30s) got married last year. We bought our first home a month later and we've been happy since.

Unfortunately, the next stage in life seems like it is going to be a costly one. We need to go through fertility / IVF treatments which are 100% not covered by insurance. The cost is slated to be ~$16,000, but could be around ~$20,000 with medicines once all is said and done.

Unfortunately we don't have an emergency fund that big with everything else going on ( + bought a car for $17k cash months back... :x )

What are some ways of paying for this? I really don't want to take on new debt.

I have ~$80k in a 401k (I borrowed $50K from it a while back for home renovations, paying that back over 5 years).

Would a hardship withdraw from the 401K be a good move for these expenses? I understand that there are no penalties for medical withdraws at a certain percentage of income.

Also I think we might be hitting the level for medical expenses to being tax deductible ( I read somewhere that it needs to be 7.5% r 10% of income... hard to find solid numbers. Gross income in going to be around $190-200k this year).

Any thoughts or insights on this? This is a very stressful time in our short marriage, so any helpful advice is greatly appreciated.
Boonstick,

Having children is expensive, even without the IVF. You already had to raid your 401(k) to do home renovations which suggests you don't have much breathing room in your finances. I frankly don't think you can afford children right now. I know this sounds harsh, but trust me that more financial hardship with a kid on the way will cause more stress. You need to re-work your budget and see what you can afford. If you can't pay cash, you can't afford it.
Last edited by denovo on Wed Sep 26, 2018 2:14 am, edited 1 time in total.
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denovo
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Re: How to pay for upcoming medical / IVF expenses

Post by denovo » Wed Sep 26, 2018 2:12 am

gotester2000 wrote:
Sun Sep 23, 2018 12:28 pm

It doesnt matter if you dont contribute to retirement for some time.

Sounds like imprudent advice. Everyone should be realistic about what expenses they can afford even if it's something they want.
"Don't trust everything you read on the Internet"- Abraham Lincoln

gotester2000
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Re: How to pay for upcoming medical / IVF expenses

Post by gotester2000 » Wed Sep 26, 2018 2:34 am

denovo,

I think you do not understand the emotions of a couple who want their own child and are finding it difficult to conceive. Financial calculations are secondary to that need and they can adapt to that later.

The couple is in early 30s - so the IVF chances are good. They will decline every year if they wait to accumulate money in cash- specifically with female aging, chances of having a normal healthy child become lesser - this is not like accumulating down payment for a house.

The only thing that I do not agree with OP is getting a 401k loan to renovate the house.

wilshuer
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Re: How to pay for upcoming medical / IVF expenses

Post by wilshuer » Wed Sep 26, 2018 5:35 am

Seeing the thread a bit late so looks like you have a lot of good suggestions. Probably hard to comment on current costs as we went through IVF and were blessed with twin boys, now 7 years old. It took 7 cycles over 4 years, a lot of hard times, tears, hopes for success. We paid for all out of pocket, in one way we looked at it as having the cost of kids, just before we had them. A few tips on the clinic, look at a few different ones, we went through three. The last one was where we felt we belonged, the founder had actually gone through IVF in med school, so he could relate with patients. They also set it up so if the first cycle didn’t take, any subsequent cycles with frozen embryos would be covered for free. The drugs are expensive too, look for discounts. Walgreens had a deal where you signed up for the specialty pharmacy club for like $49 and it ended up giving a discount of 20% or so. You may look at charging it on a rewards credit card too, we paid for a few trips with all the points.

On the emotional side...
The longest days of your life are waiting to hear if any eggs fertilized, especially on the first cycle you spend those days planning the nursery, calculating the due date, thinking about names. Be prepared to find out none fertilize and be ready to catch your wife. I pray for nobody to have to experience that, but be ready.

May be good to find a support group for your wife, there are a few online ones that are helpful, I believe one is resolve. Good to read stories of others, share test numbers, help stay motivated and you can remain anonymous.

Be ready for others to ask why you’re not adopting, it’s not their business. I found usually asking if they considered adopting before having their kids changed the subject quickly.

You’ll actually be surprised how many have gone through IVF, our experience was almost 10 years ago now, so probably even more prevalent. Once we start talking to people we’ve been friends with for years, find out they went through IVF too.

Best of luck, hug your wife often. It’s a struggle, and well worth it. For all our challenges I wouldn’t change it, even when our boys are acting up - I just reason it as frostbite when they were frozen embryos.

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