Fifteen states require coverage for some types of infertility treatments
Q. My daughter is going through in vitro fertilization to try to become pregnant. Her health insurance doesn’t cover it, and she had to pay $18,000 out of pocket. Will the Affordable Care Act mandate that this be covered for small business or individual coverage starting in January?
A. Starting in January new individual and small group plans have to cover 10 essential health benefits. The required coverage includes hospitalization, doctor visits and prescription drugs, among other things, but not treatment for infertility.
In some states, infertility treatments may be covered, however, according to Dania Palanker, senior health counsel at the National Women’s Law Center.
There are a couple of ways this could happen. To help implement the essential health benefits requirement under the law, every state was asked to designate a “benchmark” plan to serve as a reference point for coverage. Frequently states selected the largest small-group plan in the state. If that benchmark plan covers infertility treatments, then all new individual and small group plans next year will cover them as well as part of the essential health benefits.
In addition, 15 states require insurers to cover at least some types of infertility treatments in some health plans, according to Resolve, an advocacy group for infertility issues. If your daughter’s state requires coverage of IVF, individual and small group plans will cover it to the extent that state law requires it even if the state benchmark plan doesn’t cover it.
It’s critical that the daughter research exactly what’s covered, says Palanker. (Resolve provides links to state coverage requirements.) “Some states have very restrictive limits,” she says, noting that in Maryland, for example, couples must have at least a two-year history of infertility, and the patient’s eggs must be fertilized with her husband’s sperm.
From Kaiser Health News