Infertility as a covered insurance benefit

August 3, 2010Carole 3 Comments »

IVF should be a covered benefit for everyone in the United States. Why?

Lowering the out-of-pocket cost of IVF promotes healthy pregnancies for moms and babies. Ask any obstetrician and they will tell you that a singleton pregnancy is more likely to have a healthy outcome compared to twins, triplets or more. Now I know that high risk obstetrical care can do a lot of things to manage these pregnancies and outcomes have been getting better all the time, but bedrest and having your bab(ies) stay in the NICU for weeks should not be a routine outcome from IVF treatment. Remove the financial pressure to transfer more than one embryo at a time and we could have more healthy singleton pregnancies and better outcomes. (Yes, single embryo transfer can result in identical twins but that’s fairly rare).  The fact is, most large order multiples occur from insemination cycles, not IVF cycles, because it’s impossible to predict the number of fertilized eggs and embryos that will implant in an insemination cycle. If patients could choose IVF sooner, where there is control over the number of embryos that are put back, fewer multiple gestation pregnancies would occur.

We can afford it– and yes,  it is so fair. I am exhausted by the arguments that fertility should not be covered because one, everyone’s insurance rates would skyrocket or two, infertility is not everybody’s problem so why should everybody’s premiums (or taxes) cover it? The first thing about insurance is that an insurance pool includes individuals who have all kinds of diseases. Lots of diseases are covered that you might never suffer from-lucky you! Does the “NO IVF COVERAGE on MY DIME” crowd actually feel cheated when they don’t suffer from every other covered disease because obviously, they are not getting their money’s worth on their premium  if they stay healthy??

I found two studies that looked at the effect of adding IVF coverage to everyone’s premiums. In 1997, William M. Mercer, Inc., an HR consulting firm, published, “Infertility as a Covered Benefit”,  an analysis of the cost of adding infertility benefits to a members insurance premiums. They found that adding infertility benefits would increase each members annual premium by $3.14 per year. Even with inflation since 1997, if we spent an extra $3.14  per month, many of us spend way more than that on Starbuck’s lattes every year. A newer study, published in 2000, “Hidden costs of infertility treatment in employee benefit plans“,  suggests that most plans (even those that exclude infertility coverage per se) are already paying for various procedures that are mostly performed for patients with infertility which already adds a whopping $0.27 to $0.50 per member per month. The most expensive calculations suggest that infertility coverage could be added in plain sight for  maximum of $2.00 per member per month, or about $24 dollars a year. The most recent (February 2010) fact sheet I could find was prepared by the Arlen Group, another employee benefit consultant group,  suggests that infertility coverage might increase member premiums by 3-5%, a somewhat larger estimate, but hardly a skyrocketing increase!

Other countries have been able to provide infertility coverage to all without imploding financially. In this article, Canada’s Infertility Awareness Association published its argument for extending infertility coverage to all Canadian citizens and joining the ranks of other progressive nations such as Great Britain, Sweden, Denmark, Belgium, Germany and France which all provide IVF coverage to all its citizens.  Data from a single province in Canada (Ontario) showed a net cost savings of 100- 111 million dollars each year in Ontario due to a reduction in the multiple pregnancy rate when IVF was covered. Cost savings came from a reduction in perinatal hospitalization ($51-70 million), reduction in post natal health costs for the first year of care of surviving low birth weight multiples ($30–40 million) and 91 – $131 million saved  in long-term health and social services expenses for caring for children with permanent disabilities as a result of pre-term birth.  I would think that avoiding the pain and suffering from these problems would be reason enough, but for those of you who need a financial reason as well, this should do. By the way, Quebec recently announced it would fully cover IVF treatment. (Warning: I don’t recommend reading the comments appended to this on-line article unless you have a strong stomach for hateful comments. Apparently, many of the NOT MY TAXES crowd had plenty to say. Of course, these ill-informed comments may illustrate why insurance coverage for infertility can’t get sustained political traction. Perhaps we need a Grandparents Coalition to step in and become politically active?)

Why don’t we have widespread insurance coverage for IVF or Where have all the activists gone? Interestingly, even as health care reform was hotly debated last year, the clamor for IVF coverage has all but disappeared. Adam Sonfield of the Guttmacher Institute summarized the political and economic around infertility coverage in his article  “Drive for Insurance Coverage Of Infertility Treatment Raises Questions of Equity, Cost” which was published in 1999!, more than a decade ago. If you are interested, this article summarizes the political struggles around getting infertility covered and the use of  the American Disabilities Act to justify coverage. There’s not been much political analysis since- at least that I could readily find.

Insurance companies are afraid too many people will elect coverage and they’ll lose money on the deal. Aetna was the first US insurance company to offer IVF coverage with it’s basic package in 1995, but by April 1998, it dropped this wildly popular benefit in every state except those that mandated coverage. Apparently, no other insurance companies jumped in to also offer coverage so many patients temporarily abandoned their old insurance company, got Aetna coverage, did their IVF treatment and then dropped the Aetna coverage.  Aetna then modified it’s offering so that employees could get the coverage, but only if they paid a higher premium. Of course, if every insurance company had to offer coverage, no one insurance company would have to take the brunt of infertility claims.

The (possible) effect of Health Care Reform. ASRM published “Health Care Reform: Implications for Reproductive Health and Health Care Providers”, which summarized the effect of Health Care Reform on obstetrical care but essentially overlooked infertility in their summary. Resolve published it’s own statement on how Healthcare reform could impact infertility coverage and did a much better job of looking for possible impacts on infertility patients.  Briefly, according to Resolve, healthcare reform:

1. Could impact the mandate for infertility coverage that currently exists in 15 states. It’s not clear if the effect will be good or bad.

2. Eliminates life time caps on coverage. Since peri-natal or post-natal care for high risk pregnancies can often exceed lifetime limits, this might help infertility patients who are at greater risk of multiple gestation pregnancies.

3. Eliminates pre-existing condition exclusions. Apparently, some insurance companies have denied infertility coverage on the basis that infertility was a pre-existing condition.

4. Increases the adoption tax credit to $13,170 for tax years starting after December 31, 2009 and moved the expiration date of this tax credit to December 31, 2011.

Requiring insurance companies to provide coverage is one way to decrease out-of-pocket costs to the consumer for fertility procedures but the other way to attack this problem is to dissect what it actually costs to provide these services and look for cost savings that can be passed on to consumers. Both approaches will likely require more political activism on behalf of or by infertility patients.

© 2010, Carole. All rights reserved.

3 Responses to this entry

  • Josey Says:

    Great information!! I’m going to link to this from my blog if that’s okay. Insurance is such a mess for those in the IF world.

  • Carole Says:

    Feel free to link from your blog- I am glad the information is useful to you. You might also like this link I found after publishing the post.

  • Fucking Infertility Says:

    Thanks for bringing attention to this!
    I thank my lucky stars I live in Germany right now (I’m an American), where I can get 3 IVF cycles covered 50% by public insurance. Plus, IVF is way cheaper here so the out-of-pocket cost to me is around 1500 EUR per cycle.
    On the down side, ethics regulations don’t permit embryo freezing, which means the success rate is lower.

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