02 May Insurance Mandates for Infertility Vary Widely from State to State
MedicalResearch.com Interview with:
Dr. Sandozi
Arshia Sandozi, DO, MPH
Urology Resident at Maimonides Medical Center
Interested in health disparities, equity, and policy
MedicalResearch.com: What is the background for this study?
Response: Infertility affects 12-15% of heterosexual couples and can be a devastating diagnosis. Healthcare for infertility can be costly, and is not always covered by insurance. This is troubling because the median cost for a procedure like in vitro fertilization is more than nineteen thousand dollars per cycle and most people require more than one cycle before a live birth.
MedicalResearch.com: What are the main findings?
Response: The landscape of coverage for infertility is highly variable in the United States. We sought to understand which states had legislation regarding infertility benefits and whether benefits were codified into individual states’ essential health benefits benchmark plans.
MedicalResearch.com: What should readers take away from your report?
Response: Twenty states have legislation regarding infertility, but the coverage provisions vary widely.
Seventeen have a mandate to cover. This means, with some exceptions, insurance plans in the state must include some type of infertility coverage. Of these states, nine cover only underlying causes of infertility, ten cover prescriptions, ten cover artificial insemination, and six cover advanced reproductive techniques, such in vitro fertilization.
Two states have mandates to offer (insurers must all offer a plan with infertility coverage, but employers and private individuals are not required to select such a plan). And finally, one state, had a prohibition from exclusion (conditions that would otherwise be covered cannot be excluded on the basis of causing infertility).
Upon delving into benchmark health plans, we saw some hopeful signs. For instance, although only twenty states legislate infertility benefits, twenty-five states altogether codify infertility benefits into their benchmark health plans. Interestingly, twelve states without any legislative mandate do codify the coverage of infertility as an essential health benefit, and seven states that legislate infertility benefits do not.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: We would like to see how this translates to actual utilization and success of infertility treatments. Do people who live in states in which infertility care is considered an essential health benefits have more access to treatment options? We also encourage patients and physicians to continue to advocate for coverage of infertility benefits.
The authors are medical providers and trainees without any disclosures.
Citation: Presented at AUA meeting April 2023 https://www.auanet.org/AUA2023
PD20-12 DISPARITIES IN INFERTILITY COVERAGE IN THE UNITED STATES
Arshia Sandozi, Dhaval Jivanji, Ariel Schulman, and Jacob Khurgin
https://doi.org/10.1097/JU.0000000000003286.12
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Last Updated on May 2, 2023 by Marie Benz