Does our Insurance
Cover Treatment Costs?
of health insurance plans currently do not offer coverage for the treatment
of infertility. It is estimated that only 14% of large group plans, 16%
of preferred provider organizations (PPOs), and 17% of point-of-service
networks and health maintenance organizations (HMOs) routinely cover procedures
related to assisted reproductive technologies (ARTs). For the six
million Americans struggling with a medical disorder causing infertility,
cost is a significant barrier to care. The average infertile couple
will pay close to $60,000 for a successful delivery using ARTs - well out
of reach for many Americans without the benefit of health insurance coverage.
have enacted some form of an infertility insurance mandate, although
a smaller number are meaningful on a broad scale. Restrictions on
the number of treatment cycles, strict eligibility requirements for coverage,
and limited reimbursement policies ensure that many couples, even in states
which provide coverage, are still denied access to needed fertility services.
insurance carriers to cover comprehensive diagnosis and treatment of infertility,
although first child attempts are limited to 4 complete oocyte retrievals
and second birth attempts are limited to 2. Small businesses with
less than 25 employees and government agencies are excluded from the mandate.
Connecticut, and Texas only require insurance companies to offer
coverage for the treatment of infertility. This means that employees
must be made aware that coverage exists, although insurers are not obligated
to provide that coverage and employers are not required to include it in
their health benefit plans.
and Maryland require that fertilization occur with the spouse's sperm.
This excludes single women from treatment, as well as couples with male
where coverage is not mandatory, insurance companies who do choose to offer
infertility treatment may be inadvertently penalized. Couples experiencing
infertility problems will overwhelmingly join provider plans with coverage
for fertility services, placing a disproportionate financial burden on
a limited number of insurance companies. Aetna, a major national
insurance provider who previously offered coverage for infertility care,
recently decided to remove treatment benefits for this reason. Some experts
predict that this trend of reduced coverage for infertility will continue
in the absence of state or federal mandates.