Infertility insurance in the US

Does your state mandate fertility treatment? Most states in the United States do not require health insurance plans to cover the costs of fertility diagnosis or assisted reproductive technologies, but one state even mandates coverage of IVF. In the USA, about 1 in 8 women of childbearing age, approximately 12 per cent of all married couples, receive treatment for infertility, usually defined as the absence of pregnancy after at least 12 months of regular unprotected sexual intercourse. In the latest year for which statistics are available, 2005, nearly 28,000 babies were born in the United States as the result of assisted reproductive technology procedures that did not require donated egg or sperm.

The most common methods of infertility treatment are hormone therapy to stimulate ovulation and artificial insemination. When these procedures do not work, then doctors attempt to facilitate pregnancy through methods such as in vitro fertilization (IVF), in which eggs are fertilized outside the womb and then implanted into the lining of the uterus. Assisted fertility treatments are extremely expensive. On average, a single cycle of IVF costs $12,158, including $4,000 for medications.

There is considerable debate over whether insurance plans should be forced to pay for these procedures, although the average premium is increased by only $0.20 to $2.00 per month per member to provide fertility services for all. One element of the debate has become more poignant since the publicity surrounding the Octo-Mom, who bore octuplets after IVF. In vitro fertilization tends to result in an unusually high number of multiple births. Multiple births tend result in premature delivery, and care of infants born before term is extremely expensive to insurance companies and to state Medicaid programs.

Fourteen states in the USA require health insurance companies to pay for infertility diagnosis: Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. Twelve of these states require health insurance plans to pay for infertility treatment, while California and Texas require insurance companies to pay for infertility treatment. Texas requires health insurance companies to pay for in vitro fertilization (IVF), while California and New York specifically exempt health insurance plans from providing an IVF benefit.