Health insurance in the US can be tricky to navigate, especially when it comes to treatments that are often considered “non-essential” by health insurance providers. Unfortunately, most health insurance providers do not cover the vast majority of infertility tests, drugs, and treatments, including egg donation. This can be a major source of stress for couples that are trying to grow their families through IVF treatments or assisted pregnancy. We’re here to give you some helpful info about how to figure out what is (or isn’t) covered by your plan and how to get the coverage you need.

Why Isn’t IVF Covered?

For many years, IVF treatments were considered “experimental” because it was new technology and there wasn’t enough data for health insurance companies to determine the coverage costs. Though it is unclear why that hasn’t been changed now that IVF is far from experimental with over 8 million babies born through IVF treatment. 

Some companies still argue that IVF treatment and assisted pregnancy are specifically “women’s health” issues, even though roughly half of all cases of infertility are linked to male factor infertility. Regardless of which partner is the cause of infertility, it affects more than 7 million Americans, and the associated costs can put couples who need IVF treatment in crippling debt. 

In some cases, IVF treatments are not included in health coverage because they are seen as “non-essential” or “elective” treatments. This is the same reason that allergy shots for food allergies and many cosmetic surgeries are left out of most healthcare plans. Many companies argue that you can just opt not to have a baby, but for couples that want a family, this does not solve the issue. 

What Is Being Done About It?

Infertility advocacy groups like the American Society for Reproductive Medicine and RESOLVE are continually lobbying for mandates that require health insurance companies to include infertility testing, drugs, and treatments in their coverage. In recent years, many companies have started to add in provisions for infertility testing and certain kinds of fertility drugs, though it is still extremely limited and doesn’t usually cover the actual treatments once the diagnosis has been given. 

Currently only 16 states have have passed laws that require insurers to either cover or offer coverage for infertility treatments:

• Arkansas
• California
• Connecticut
• Delaware
• Hawaii
• Illinois
• Louisiana
• Maryland
• Massachusetts
• Montana
• New Jersey
• New York
• Ohio
• Rhode Island
• Texas
• West Virginia

Of those listed, most require insurers to cover infertility treatment, while California & Texas only require insurers to offer coverage. 

This is a good start, but ASRM and RESOLVE are consistently pushing for a federal mandate to cover infertility, because there are still state laws that can circumvent coverage for many employees that don’t have a fully insured health plan. A federal mandate requiring coverage would ensure that everyone with health care is covered for infertility testing and treatment. 

In 2017, the American Medical Association labeled infertility as a disease with the hope that this would help encourage more insurers to include it as part of their plans and remove some of the social stigma surrounding infertility. 

How To Check Your Coverage:

The best way you can avoid a surprise from your insurance company, is to carefully review your coverage details and see what tests, treatments, drugs, and doctors are covered under your plan. If you aren’t sure how to determine what is covered, many IVF centers have someone on staff that can help you review your insurance documents and figure out what you’re covered for.

Make sure to do this before starting any treatments to avoid incurring costs for tests or treatments that aren’t covered by your plan. 

If your employee health plan doesn’t include infertility benefits, talk to your HR department about trying to find a plan that includes them. You are your own best advocate, and many companies won’t change their plan until employees bring it up as a concern. Most places that do offer infertility coverage have done so at the request of their employees. 

We know that figuring out infertility coverage can be a major source of stress for couples who want to grow their families with IVF or egg donation, and we are happy to help with any questions or concerns you may have about your specific coverage. Contact one of our compassionate case managers today with any questions you have regarding your coverage and any other financial concerns you have regarding infertility treatments, egg donation, or becoming an egg donor.