United States Laws & Fertility & Drug Insurance

People with infertility have options they can try, but in vitro fertilization (IVF) and disease, drugs, surgery, and other treatments can be expensive. Sometimes, medical insurance will pay more, but sometimes it won’t.

Worldwide, 15% of fertile families are affected by infertility worldwide, according to estimates by the World Health Organization (WHO). Most of the people affected by infertility (including men, women, LGBTQ couples, and singles), pay out of pocket. Depending on the treatment, out-of-pocket costs can run into the thousands of dollars.

Some states have laws that require insurance companies to cover infertility treatment, but laws vary. Here, we will explain how state laws affect insurance coverage for fertility treatment in detail.

Essentials

  • Mandatory health and drug insurance is not widely available in the US
  • Most insurers do not consider these medical services “medically necessary.”
  • Fifteen states have laws that require private insurers to pay for infertility treatment.
  • Gay people often face significant barriers to accessing reproductive health care.

What is Included in Fertility Treatment

The type of fertility treatment your doctor prescribes depends on the needs of the individual or family. Common fertility treatments include:

  • Medicine: Some medications, such as clomiphene citrate and letrozole, can help treat female infertility by stimulating ovulation. Some medications may be given along with fertility treatments, such as in vitro fertilization (IVF).
  • Intrauterine implantation: Intrauterine insemination, also known as artificial insemination, involves placing sperm in the uterus. In some cases, medication is also prescribed to help stimulate ovulation before the procedure.
  • in vitro fertilization (IVF): IVF is an assisted reproductive technology that involves fertilization of an egg outside the uterus and transfer of embryos back into the uterus.
  • Surgery: Surgical procedures such as laparoscopy and hysteroscopy may be indicated to diagnose infertility in women or to eliminate obstacles to pregnancy, such as endometriosis or uterine fibroids.


State Laws on Fertility Treatment

Fifteen states require private insurance for assisted reproduction, according to the Kaiser Family Foundation. It includes:

  • Arkansas: requires individual and group insurers to provide coverage but not HMOs and self-insurers.
  • Connecticut: Mandates all health insurers to provide coverage. Religious employers and self-insured are exempt. In addition, people must be on the plan for more than 12 months to be eligible.
  • Delaware: it is responsible for making payments that exclude employers with fewer than 50 employees, religious employers and self-insured employers.
  • Hawaii: Individual and group insurers offer coverage, but self-insureds are not allowed.
  • Illinois: it excludes employers with fewer than 25 employees, religious employers and self-insured employers from its rules.
  • Maryland: requires coverage with the following exceptions: employers with fewer than 50 employees, religious employers and self-insured employers.
  • Massachusetts: the law excludes the self-insured from the requirement.
  • Montana: requires HMOs to provide fertility treatment.
  • New Hampshire: exemption requirements are slightly different from other countries. Self-insured are exempt, as are additional changes to ACA programs and the Small Business Health Options (SHOP) program.
  • New Jersey: The law includes exemptions for employers with fewer than 50 employees, religious employers and self-insured employers.
  • new York: the law does not require the private or group markets to cover IVF, and self-insureds are exempt from state regulations.
  • Ohio: require HMOs to provide services; self-insured are not allowed.
  • Rhode Island: the law requires insurers, including HMOs, to provide coverage, but self-insurers are exempt.
  • Utah: the law, as in other countries, does not mean self-insurance to provide fertility treatment Study.
  • West Virginia: Only requires HMOs to provide reproductive health care.

California and Texas have laws that require insurance companies to provide coverage, but employers don’t have to choose insurance plans and coverage. States may also have age limits for eligibility.

Factors Affecting the Need for Fertility Insurance

Infertility is defined as the inability to conceive after one year of unprotected, same-sex intercourse. Insurance companies often use definitions like this to determine when people may be eligible for health care coverage. Fertility insurance may cover a wide range of treatments or only a limited number of services.

If you have insurance through your employer, the size of the company you work for will determine whether or not you can get fertility treatment. Most states that have laws requiring insurance companies to provide fertility coverage are exempt for employers with fewer than 50 or fewer than 25 employees. Additionally, employers who provide their own insurance are not required by state law to provide coverage. reproductive medicine.

Many employers are choosing to offer this type of service. In 2015, 36% of companies with 20,000 or more employees offered IVF services. In 2020, this number increased to 42%.

If you have health insurance through the exchange, remember that the Affordable Care Act (ACA) does not require insurers to cover reproductive health care.

Most discussions about fertility treatment focus on men and women who want to have a baby. But gay and single women who turn to fertility treatment when trying to conceive often face many obstacles. Discrimination lawsuits against major insurers could make it difficult for LGBTQ people to access fertility treatment.

Ask your employer what type of insurance they offer. An employer with a self-insured plan is not required to comply with state insurance laws, which may mean that your plan does not cover reproductive health care.

Does Insurance Cover Fertility Treatment?

Whether your insurance will help you pay for fertility treatment depends on a number of factors, including where you live, your insurance company, and your employer.

How Much Does Fertility Treatment Cost?

The average cost of one IVF is $12,400, according to the American Society of Reproductive Medicine. Most people need several IVF cycles before they can conceive. The cost of fertility treatment depends on where you live, your provider, your insurance, the type of treatment, and the duration of treatment. Your insurance may cover the cost, but it may not. Only some state laws require insurance to cover fertility.

How Many States Have Laws Requiring Some Type of Fertility Insurance?

Fifteen states require private insurance to cover fertility treatment. The amount of coverage and the type of insurance required to provide coverage varies by state.

How Does Your Employer Affect Your Erectile Dysfunction Insurance?

If you have insurance through your employer, you need to know if you qualify for coverage. In some countries, companies with limited employees are not allowed by state law to provide services. If your employer has a self-funded insurance plan, it may not comply with state laws that require fertility treatment.

What Additional Barriers to Fertility Treatment Do LGBTQ Couples and Individuals Face?

Gay couples and singles often find it difficult to get insurance coverage for assisted reproduction because they do not meet insurance’s definition of infertility. Insurers may require LGBTQ people to pay for multiple fertility treatment visits before coverage is provided.

Down Under

Couples and individuals who choose to receive fertility treatment may or may not have insurance, depending on where they live and what type of insurance they have. Whether you’re paying out of pocket or with insurance, you can expect fertility treatment to be expensive.