Health Insurance IVF / Infertility Coverage by State
| State | States with IVF Insurance Laws (13) | States with Fertility Preservation Laws ... |
| Arkansas | X | |
| California | X | |
| Colorado | X | X |
| Connecticut | X | X |
Which states have fertility insurance coverage?
Nineteen states have passed fertility insurance coverage laws: Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, Texas, Utah, and West Virginia. Most of these states include coverage for IVF treatment.
Does health insurance cover fertility treatment?
Finding healthcare insurance that covers fertility treatment can be time-consuming and confusing. Policies differ according to state law, and even companies that provide coverage may limit this to diagnosing fertility problems rather than treating the issue. According to the Center for Disease Control, infertility is a common problem.
Is infertility treatment covered by insurance in Delaware?
Delaware: Delaware requires that infertility treatment be covered to the same degree as pregnancy-related benefits.
Does Medicaid cover fertility treatment in New York?
Currently, NY continues to be the first and only state Medicaid program to cover any fertility treatment. For those who desire to have children, obtaining fertility care can be a stressful process.
What is fertility insurance?
Fertility insurance is health insurance that covers the diagnostics and treatments needed to help potential parents who are struggling to conceive or to carry a child to term. Fertility insurance isn’t usually a separate health insurance policy but is covered under health care plans by many health insurers. Seventeen states currently have laws ...
Where is Aetna located?
They have an app that helps you manage your care to make navigating your coverage easier. Founded in 1852 and headquartered in Hartford, Connecticut, Aetna operates in 50 states and Washington, D.C. The company received an A rating from AM Best in the category of financial strength. Read the full Aetna review .
What is the rating of Wellcare?
The National Committee for Quality Assurance (NCQA), which is an accreditation organization that rates health plans, gave WellCare a rating of 2.5 to 3.5 out of 5.0 in 2020. Read the full Wellcare review .
Does Wellcare cover vasectomies?
Coverage does not include reversal of vasectomies. Overview. Wellcare wins for the best provider of affordable fertility coverage because they offer Medicaid and Medicare coverage that includes some fertility coverage. Its coverage supports members who experience infertility between the ages of 21 and 44.
Does health insurance cover fertility?
Seventeen states currently have laws making it necessary for health insurance providers to cover fertility treatments. 1 But, since it is not required in all states, not all insurers cover treatments, and some might cover a limited number of treatments or only certain types of procedures. This roundup will help readers find a health insurance ...
Does fertility insurance cover progyny?
Except for Progyny, all are part of larger health care plans with fertility services offered as part of that plan. Your coverage from some of the health care insurance providers on this list might vary depending on your state. However, all offer coverage options for those experiencing infertility.
Does Aetna offer Medicare?
In total, Aetna’s network has 1.2 million health care professionals, over 690,000 specialists and doctors, and over 5,700 facilities. Aetna does not offer individual and family plans on the health insurance marketplace. They only offer Medicare, Medicaid, and employer-sponsored plans.
How much does fertility treatment cost?
Most patients pay out of pocket for fertility treatment, which can amount to well over $10,000 depending on the services received. This means that in the absence of insurance coverage, fertility care is out of reach for many people.
What is the diagnostic service for fertility?
Diagnostics typically include lab tests, a semen analysis and imaging studies or procedures of the reproductive organs.
What is iatrogenic infertility?
Iatrogenic, or medically induced, infertility refers to when a person becomes infertile due to a medical procedure done to treat another problem, most often chemotherapy or radiation for cancer. In these situations, persons of reproductive age may desire future fertility, and may opt to freeze their eggs or sperm (cryopreservation) for later use. The American Society for Reproductive Medicine ( ASRM) encourages clinicians to inform patients about fertility preservation options prior to undergoing treatment likely to cause iatrogenic infertility.
What is the most common cause of infertility?
Both female and male factors contribute to infertility, including problems with ovu lation (when the ovary releases an egg), structural problems with the u terus or fallopian tubes, problems with sperm quality or motility, and hormonal factors ( Figure 1 ). About 25% of the time, infertility is caused by more than one factor, and in about 10% of cases infertility is unexplained. Infertility estimates, however do not account for LGBTQ or single individuals who may also need fertility assistance for family building. Therefore, there are varied reasons that may prompt individuals to seek fertility care.
Why do people need fertility aid?
This could either be due to a diagnosis of infertility, or because they are in a same-sex relationship or single and desire children. While there are several forms of fertility assistance, many services are out of reach for most people because of cost.
How can state mandates help?
State level mandates can also help reduce inequities in access. For example, a recent bill proposed in the CA legislature would reverse existing limitations on fertility coverage and make the benefit available to single women and women in same sex relationships.
Do I need to pay for fertility services?
Most people who use fertility services must pay out of pocket, with costs often reaching thousands of dollars. Very few states require private insurance plans to cover infertility services and only one state requires coverage under Medicaid, the health coverage program for low-income people.
Arkansas
IVF coverage applies to insurance plans that offer pregnancy-related benefits.
Colorado
Covered for a person who has a medical condition or is expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment to fertility.
Connecticut
inability to conceive or sustain a successful pregnancy during a 1 year period or needs treatment due to medical necessity
Delaware
Covered for patients who must undergo medically necessary procedures that may cause an impairment of fertility due to surgery, radiation, chemotherapy, or other medical treatment.
Illinois
Covered when a necessary medical treatment may directly or indirectly cause an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
Maryland
opposite-sex couples that have failed to achieve a pregnancy through intercourse for 1 year’s duration
New Jersey
Egg or sperm freezing is covered due to an impairment of fertility caused by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes.
What is an FSA?
An FSA, or Flexible Spending Plan, lets you set aside pre-tax money for certain qualifying medical (and dental) expenses. What’s a qualifying medical expense, you ask? Ah, the devil is in the details.
Does health insurance go by the year?
Health insurance goes according to the plan year, which is usually the same as a calendar year. Flexible Spending Plans are a form of tax benefits, so they go by the tax year. But fertility treatment can easily span more than one year, so you should be mindful when these benefits reset.
Is infertility financially devastating?
For too many couples, infertility is financially as well as physically and emotionally devastating. Having health insurance that will cover at least some of the cost is critical to helping more people expand their families.
Does Obamacare cover infertility?
In most states, there is no requirement to cover infertility treatment at all. That’s partly because the federal Affordable Care Act (Obamacare) does not include infertility treatment as an “essential health benefit.”
What Is Infertility Insurance?
For people trying to conceive, infertility can be difficult to talk about and even more difficult to live through—but infertility insurance can make it a little more bearable.
How Infertility Insurance Works?
Infertility insurance usually isn’t a separate policy but can be covered under your existing policy. It’s for those who are struggling to conceive or carry to term and can cover a range of treatment options.
What Does Infertility Insurance Cover?
Treating infertility can be complex and each insurance provider can offer different coverage, which makes it even more challenging to understand coverage. However, some of the services covered under infertility insurance can include:
What is IUI in fertility insurance?
Intrauterine insemination (IUI) to pass sperm into the uterus. In vitro fertilization (IVF) which fertilizes an egg outside the body then returns it to the uterus. Egg and sperm donation. The laws surrounding fertility insurance are complicated and may be unique to a particular state.
What are the services that women receive for ovulation?
For women, these may include ovulation-inducing medications, ovulation monitoring studies, procedures to remove obstructions in the fallopian tubes, assisted embryo hatching, and other services. For men, services include semen analysis, surgeries to correct obstructions, endocrine treatments, and sperm extraction.
How much is the deductible for a bronze plan?
Expect to pay around $400 per month with a $7,000 deductible for a bronze plan, up to $1,000, with $0 deductible on the platinum plan. Depending on the plan, the maximum out-of-pocket is around $8,000. Standard ACA rules apply for waiting times and no exclusions for pre-existing health conditions.
Why is Aetna the best?
Why We Chose It: Aetna is our best for additional resources choice as they provide online tools and information about fertility treatments, and they boast an Institute of Excellence (IOE) infertility network.
How much is Aetna Medicare Plus?
These include the Aetna Medicare Plus Plan with prescription drug coverage. It has a $0 monthly premium, $0 deductible, and a maximum out-of-pocket of $999 per year. This is in addition to Medicare Part A and Part B premiums, which for most people means the standard Part B Medicare premium of $148.50. 6.
How many rounds of IVF can I get with Blue Cross Blue Shield?
Some BCBSA companies exceed the mandated three rounds of IVF and may offer up to eight total cycles, making it an obvious choice for best for multiple treatment rounds.
How many people in the US have infertility?
According to the Center for Disease Control, infertility is a common problem. About 9% of men and about 11% of women of reproductive age in the United States have experienced fertility problems. 1 Despite the need for fertility assistance, costs are high and inaccessible to many.
