(461) Health Insurance Coverage for Infertility in the United States

Abstract

Abstract Introduction As many as one in five heterosexual couples in the United States experience infertility. Medical advances can help resolve infertility, however access to treatment is often out-of-pocket and can be prohibitively expensive. State benchmark health insurance plans detail minimum coverage standards that all other state offerings must match with some exceptions. Objective The objective of this study was to evaluate differences in health insurance coverage for infertility. Methods The most recent state benchmark health insurance plans submitted to Centers for Medicare and Medicaid were examined. We identified provisions to cover or exclude treatment of infertility. A literature search was also performed to identify states with legislation relating to health insurance coverage for infertility. Results Data was available for all 50 states and the District of Columbia. Fifteen states had legislation requiring coverage of infertility benefits, and two states required employers to offer at least one such plan. In benchmark offerings, 19 states did not provide any minimum coverage for diagnosis or treatment of infertility. Twenty-five states offered some type of treatment, of which 9 covered treatments of underlying cause of infertility only (ie. Fibroids, ductal obstruction). Ten states offered coverage for prescription medications, 10 states offered coverage for artificial insemination, and six states provided coverage for assisted reproductive technologies such as in vitro fertilization. Only two states covered cryopreservation of ova, but only for patients actively undergoing treatment for infertility. Conclusions Diagnosis and treatment of infertility is not guaranteed to be covered by health insurance, and nearly half of states do not provide any minimum level of coverage in state benchmark plans. Health insurance coverage for the diagnosis and treatment of infertility is highly variable and continues to be a barrier faced by patients desiring to conceive. Disclosure No