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Fertility Coverage in the US: What States Require

Hey guys!! I know its been a while but I am back. If you follow any of my social media then you know that recently I have been sharing the Fertility journey my husband and I have been on for the past few years. I also recently shared a Youtube video talking about what the military (Tricare) did or did not cover. Well I know alot of my supporters are not in the military and would love to know what is available to them in there respective states. This blog is here to help you know what is legally required in your state. Now I do want to start off by saying that NOT ALL states have a mandate.

Navigating the complexities of health insurance coverage can be a formidable task, particularly when considering the treatment of infertility. Fertility treatment can be expensive, and many people struggle to afford it. Forbes found that the cost of a single IVF cycle can range from $15,000 to $30,000 for those who are navigating infertility and choose to try IVF. Policies fluctuating from state to state further complicate the matter, leading to uncertainties surrounding the specifics of fertility coverage In recent years, there has been a growing movement to require insurance companies to cover fertility treatment. Currently, 20 states have laws that require some form of fertility coverage. These laws vary in scope, but they all aim to make fertility treatment more accessible to people who need it.

According to RESOLVE: The National Infertility Association, a mandate to cover requires health insurance companies to include infertility treatment in every policy, while a mandate to offer only requires health insurance policies to offer a policy that does include fertility treatments, but does not require employers to subsidize those.

The first state to require fertility coverage was California, which passed a law in 1999. Since then, other states have followed suit. Here are the states The states that mandate private insurers to cover some form of fertility coverage are

  • Arkansas

  • California

  • Colorado

  • Connecticut

  • Delaware

  • Hawaii

  • Illinois

  • Louisiana

  • Maine

  • Maryland

  • Massachusetts

  • Montana

  • New Hampshire

  • New Jersey

  • New York

  • Ohio

  • Rhode Island

  • Texas

  • Utah

  • West Virginia

In addition to the states listed above, there are several other states that are considering legislation that would require insurance companies to cover fertility treatment. These states include:

  • Arizona

  • Florida

  • Michigan

  • New Mexico

  • Pennsylvania

The laws vary in terms of what they require insurance companies to cover. Some states only require coverage for certain types of fertility treatment, such as in vitro fertilization (IVF). Other states require coverage for a wider range of treatments, including artificial insemination, fertility drugs, and egg freezing.

Some states also have laws that require insurance companies to cover fertility treatment for people with certain medical conditions, such as cancer or endometriosis.

Each of these state's unique requirements and restrictions vary from the extent and nature of the coverage:

  • States like Illinois, Rhode Island, and Maryland provide comprehensive coverage, including In Vitro Fertilization (IVF), Intrauterine Insemination (IUI), and fertility preservation for iatrogenic infertility.Maryland's law requires insurance companies to cover IVF for women under the age of 40 who have been diagnosed with infertility. The law also prohibits insurance companies from placing lifetime or annual caps on fertility coverage.

  • Connecticut and New York mandate insurance coverage for IVF and other Assisted Reproductive Technology (ART) treatments but impose certain limitations on the number of cycles or the age of the patient.

  • California and Texas require insurance companies to offer coverage for infertility treatment, but it's up to employers whether to include it in their health plans.

  • California's law requires insurance companies to cover all medically necessary fertility treatments, including IVF, artificial insemination, and fertility drugs. The law also prohibits insurance companies from placing lifetime or annual caps on fertility coverage.

  • New York's law requires insurance companies to cover IVF for women under the age of 45 who have been diagnosed with infertility. The law also prohibits insurance companies from placing lifetime or annual caps on fertility coverage. In NY patients are eligible for up to 3 rounds of IVF and can also tap medically necessary fertility preservation should they encounter infertility caused by medical treatment.

  • Colorado: Requires insurance companies to cover infertility diagnosis and treatment, including IVF, for women under the age of 45 who have been diagnosed with infertility.

The Affordable Care Act (ACA) and Fertility Coverage:

  • The ACA does not require coverage for fertility treatments. However, it prevents insurance companies from treating infertility as a pre-existing condition, and some states interpret essential health benefits to include fertility treatments.

The Impact

The laws requiring fertility coverage have had a significant impact on the availability of fertility treatment. In the states with these laws, more people are able to afford fertility treatment, and the wait times for treatment have decreased.

The laws have also helped to reduce the stigma associated with fertility problems. By making fertility treatment more accessible, the laws have helped to normalize the experience of struggling to conceive.

How do I make sure I am covered?

RESOLVE has a database breakdown of each eligible state’s laws, qualifications, and most recent updates.

Ensure that you clinic is properly documenting each visit so that it can also make it easier whenever you petition for fertility treatment in states that require you to have been trying for a specific amount of time.

Questions to ask your employer:

If you live or work in a state that has an infertility coverage law in place and want to know if you are covered by the state law, you should find out the following from your employer.

Is your plan:

  • Fully-insured or self-insured? Fully-insured plans are required to follow state insurance laws. Self-insured or self-funded insurance plans are exempt from state law and employers do not have to follow the state insurance laws.

  • A “greater than 25” plan, “greater than 50” plan, etc.? In these cases, employers with fewer than a set number of employees do not have to provide coverage if the law specifically excludes employers with a certain number of employees. Coverage in some states may also be limited to the individual, small or large group insurance markets, so check for the type of policies covered by the insurance law and then ask your employer what type of plan you have.

  • Written in the governed state? Generally, the policy must be written and/or reside in the state that has an infertility insurance law.

I hope all of this helps you as you navigate this journey. Please let me know what else you would like me to share.

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