Lately we’ve been getting a lot of calls and emails asking for information on infertility insurance. I was

Medical Insurance Doesn't Cover Fertility Treatment

Why do most medical insurance policies not cover the disease of infertility?!? What other disease that affects 7 million Americans is excluded?

curious why there was a steady increase in inquiries on this topic, so I did what I always do when I want to know anything—I Googled it.  Sure enough, Creating a Family was #1 on the search page results for “infertility insurance”.  Unfortunately, as I played around on the other sites on the search page results I started to get all riled up, which is what always happens when I think about health insurance coverage for fertility treatment.

Why Fertility Treatment Should Be Covered by Insurance

Here’s a not so funny riddle: what disease affects 7 million Americans, but is not covered by most insurance policies? Yep, you guessed it—infertility.

While infertility is not usually a life threatening disease, such as cancer, it is most definitely life altering, akin to arthritis.  The symptom of arthritis is inflamed and immobile joints, and the treatment in some cases in a joint replacement. The symptoms of infertility is the inability to become pregnant or carry a baby to term , and the treatment in some cases is IVF (in vitro fertilization).  Insurance policies typically cover all sorts of life altering, but not life threatening, conditions, such as joint replacements, hearing aids, eczema, pain medications for vaginal childbirth, etc.

People Bring Infertility on Themselves, Right?

As to the argument that people make lifestyle choices which result in infertility and thus the cost of treatment should not be subsidized by insurance, I would point that that although age is the number one risk factor for infertility, there are many other causes, and people of all ages are infertile and people of all ages are denied coverage regardless of the cause. At the very least infertility insurance coverage should be offered to woman under a certain age. Besides, insurance routinely covers conditions that people brought on themselves by lifestyle choices. Ever heard of an insurance policy not covering lung cancer in smokers or knee replacement in former jocks?

The lack of insurance coverage prevents many people from getting infertility treatment for this disease. This is wrong. Period.

Obamacare and Infertility Insurance

There oughta be a law making health care affordable and available. Oh wait, there is–the Affordable Care Act (otherwise known as “Obamacare”). While the jury is still out on how this new law will affect insurance coverage for fertility treatment, it appears right now that not much will change. Obamacare requires coverage for ten “essential health benefits” categories, and the powers that be have determined that infertility treatment is not included. While the federal law doesn’t require coverage, each state can choose to make it a part of their essential health benefits. So far, no state that doesn’t already require coverage has announced that they will add it to their essential health benefits. We’ll be doing a show in the fall on Obamacare and Infertility Treatment and Infertility Insurance. (To receive notice of all the Creating a Family show topics in advance and how to submit questions, sign up for our weekly e-newsletter at the bottom of this newsletter.)

Honor Roll of States

Currently there are only 15 states that require insurance coverage for infertility treatment? Yep, that’s right, just 15 states say that is you are going to sell insurance in our state you need to either include coverage of infertility treatment as a benefit in every policy, or at the very least offer policies that cover fertility treatment for employers or individuals to choose from.  Where coverage for infertility treatment is not mandated, only about 20 percent of insurance policies offered by employers cover fertility treatment, and what they cover varies widely from simply a few cycles of IUI (intrauterine insemination) up to IVF (in vitro fertilization).

This states that require insurance coverage for infertility treatment include Arkansas, California, Connecticut, HawaiiIllinoisLouisianaMaryland, Massachusetts, MontanaNew JerseyNew YorkOhioRhode Island, Texas,  West Virginia. Let’s take a moment please to give the legislators in these states a hand. We do not yet know whether all these states will continue to require coverage of infertility treatment under the new Affordable Care Act.

Resources on Fertility Insurance Coverage

We did a terrific Creating a Family show on Insurance Coverage for Fertility Treatment. We covered what treatment it typically covered in health insurance, where to look in your insurance policy to find out what infertility treatment is covered, and how to find specialized insurance to cover IVF or other fertility treatments?


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Check out the following  other resources on Infertility Insurance:

So, do you agree, ought there be a law? Should infertility treatment be covered by insurance? 

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