Experts Debating Whether Insurance Should Cover Infertility Treatments Under New Law

Filed under: In The News, Infertility

Should health insurance cover infertility treatments? Credit: Getty

Today, most couples undergoing infertility treatments are paying out of their own pockets, but experts at the Institute of Medicine are taking a closer look at the new health care law to determine if these treatments are essential benefits that should be covered, Kaiser Health News reports.

Infertility is a painful reality for 6 million women and men across the country -- that's one in eight couples, according to the Centers for Disease Control -- so it's significant that experts are wrestling with the issue of whether or not infertility treatments should be included in health insurance policies available through state-based insurance exchanges where individuals and small businesses may buy coverage starting in 2014.

The IOM will deliver its recommendations to the Department of Health and Human Services, Kaiser reports.

Infertility coverage is slim. Only about 20 percent of employers cover assisted reproductive therapies such as in vitro fertilization, according to a 2006 survey of almost 1,000 employers, conducted for Resolve: The National Infertility Association, Kaiser reports.

Most of the employers that didn't offer coverage cited cost concerns, but 91 percent of those that did offer it said it hadn't significantly increased their costs.

Existing coverage for infertility varies dramatically. Some plans offer fertility drugs to stimulate ovulation or intrauterine insemination (IUI, often called artificial insemination), but don't cover pricier assisted reproductive technology (ART) procedures, such as in vitro fertilization, according to Kaiser.

And, even if a plan does cover IVF, it may cover only a certain number of cycles -- or attempts -- or cap the dollar amount it will pay for services.

So far, 15 states require medical insurance coverage for infertility treatment, according to research compiled by Georgetown University's Health Policy Institute, Kaiser reports.

But mandates often promise more than they deliver, Sean Tipton, a spokesman for the American Society for Reproductive Medicine, tells Kaiser, noting that small employers are generally exempt from such rules, as are large employers that self-insure or pay employee health claims directly.
Experts say it's too soon to know how the coverage issue will be resolved in the health insurance exchanges. But it's worth noting that when employers in the Resolve survey were asked why they covered infertility benefits, 65 percent said it was because employees asked them to.

"We were shocked" that it was so easy to get coverage added, Barbara Collura, executive director of the infertility group, tells Kaiser.

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