Lately we’ve been getting a lot of calls and emails asking for information on infertility insurance. I was
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, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode 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?
Check out the following other resources on Infertility Insurance:
- Creating a Family section on Insurance Coverage for Infertility treatment
- For assistance verifying your insurance benefits for fertility treatment, call Fertility LifeLines™ at 1-866-LETS-TRY (1-866-538-7879). This is a phenomenal resource.
So, do you agree, ought there be a law? Should infertility treatment be covered by insurance?
Image credit: Steve Rhodes
I think it should be covered
Me too.
I agree
You are misunderstanding what my position is. I am not saying that insurance should not cover anything (elective or otherwise). I am merely saying that insurance companies should not be FORCED via government legislation to cover something. They should be free to offer coverage for whatever they choose. In a free market, insurance companies and private individuals can make voluntary contacts for whatever is agreeable between the two parties.
Just because you may want something, does not make it moral for you to use government force to get it.
I was simply using auto insurance as an example of a relatively free market for insurance, unlike health insurance which the government is heavily involved in regulating and stifling competition.
Instead of the knee-jerk reaction of “there ought to be a law”, step back and ask yourself what exactly is the purpose of insurance? The purpose of insurance is simply to allow a large group of individuals to VOLUNTARILY spread out the costs of catastrophic events over a large pool of people. The insurance companies act as the medium through which this is accomplished. When you assert that an insurance company (or any company or individual) should be made to cover something via government force, you are essentially saying that others should be forced to pay for your treatment. How does something that is immoral if done privately (forcing someone to give you their money, i.e., robbery) become moral if done publicly (using government to force others to give you their money)??
Above, you stated that cars are not a necessity. I would argue that neither is having children. While it is a sad thing that some people cannot have children naturally, it does not justify forcing others to pay for your elective treatment. No one should be able to force others to pay for raising, feeding, or even conceiving their children. Our government was originally established to protect individuals from the initiation of force and fraud. It has deviated far from that original purpose.
Jesse, so long as you apply your same logic to other “elective” treatment, I would understand your point. Would you agree that insurance would not need to cover joint replacements, reconstructive breast surgery after cancer treatment, vasectomies, epidural pain relief in childbirth? My point is that much of medical treatment is for an improved standard of living and not necessarily life sustaining, yet insurance routinely covers it.
I’m not in favor of excluding treatment for “just one disease”. Like I said previously, I don’t think we should legislatively force insurance companies to cover anything because it drives up the price of insurance (among other reasons). If they want to cover something that is fine, but government force is not a solution. In a competitive market (like auto insurance), it is not unreasonable to believe that health insurance companies would compete to offer consumers what they want at the cheapest price. Unfortunately, thanks to government regulations, we do not have a free market in healthcare.
Jesse, you may be right, but what if no or few companies want to cover a disease because of the expense of treatment. Are those who suffer from this disease simply left to suffer? I see a difference between insuring our cars, which are not a necessity, and insuring our health, which is. On the other hand, I do see that some procedures should not be forced to be covered–cosmetic surgery for example. Let me stress that I am far far from an expert on anything to do with insurance.
You have to follow the money to understand why infertility is rarely covered, and why the Affordable Care Act did not include it in the ten essential health benefits.
Free contraception was added to the law, and the Obama administration expended lots of political capital by adding this benefit. Ask yourself why. Contraception was described as a “preventative health benefit”.
Pregnancy and childbirth are expensive medical events. Benefits that reduce pregnancies are more “affordable” than those that increase them. It’s an uphill battle.
Kevin, good point. [Benefits that reduce pregnancies are more “affordable” than those that increase them.] Guess we should be thankful that most policies cover pregnancy and childbirth.
You say you want healthcare to be more affordable. Using the police power of government to force insurance companies to cover infertility treatments will do the opposite. Furthermore, insurance should exist to cover catastrophic medical issues, not routine or elective procedures. That is the definition of insurance. For example, nobody is demanding that we force auto insurance to cover oil changes, tire rotations, or brake jobs. If those were covered by insurance, the costs for those them would skyrocket because no one would care anymore how much they cost. Likewise, healthcare is so expensive not because we don’t have enough insurance, but because we have too much of it.
I realize that infertility can be an emotional issue and it may seem intuitive to think that some or all of the expense for treatments can be legislated away. But don’t fall for it!
Jesse, what you say makes sense, but most medical insurance already covers many “routine or elective procedures”, such a vasectomies, epidurals for vaginal childbirth, joint replacements, and many more. Why exclude routine or elective treatment for just one disease?
Wonderful! Thanks for posting this! I couldn’t agree more!!