What States Mandate IVF Coverage?

According to research done by the Washington University School of Medicine in St. Louis, women who undergo in vitro fertilization (IVF) to achieve pregnancy have a better success rate when they have health insurance to cover fertility expenses. 

This is a major revelation for those hoping to start a family since the cost of a single IVF procedure is often too much to afford. Estimates from the American Pregnancy Association place the cost of IVF between $10,000 and $17,000, which undoubtedly prevents many people from using IVF as a viable means to get pregnant. However, given the opportunity to have a second or third attempt if the first is unsuccessful, the chance for a healthy pregnancy and less financial worry is all the more possible. 

The best way to provide individuals with affordable IVF treatments is through insurance coverage, and as of now, only 16 states mandate that insurance companies cover fertility treatments: 

Infertility Insurance Coverage in the U.S. by State

Studies show that 56% of women have insurance coverage for IVF, whereas 44% pay for IVF and other fertility treatments on their own. For those that do have coverage, they most likely do so from an employer’s insurance program or the state they reside in mandates infertility coverage.

Currently, 16 states have laws in place to provide infertility coverage for citizens. Below is a rundown of a few states that have infertility coverage laws and which ones mandate IVF coverage: 

New York

Recently, a new fertility mandate in New York, known as FAFTA passed in April 2019 that went into effect on January 1st, 2020. 

The new law requires that all private insurance companies must cover medically necessary egg freezing. It also mandates that certain large-group insurance plans covers three IVF cycles, along with assisting individuals with medical conditions and treatments that can lead to infertility. In the meantime, other patient requirements and infertility coverages include…

• Coverage cannot be denied for the diagnosis and treatment of medical conditions that cause infertility as a result
• Infertility is considered a medical condition identified by the inability to impregnate someone or conceive
• General fertility procedures for preservation are covered, but not enforced by law

New York covers a wide range of diagnostic tests and procedures. However, some exceptions for coverage involve IVF for individuals undergoing sex change procedures, along with those cloning or trying experimental surgeries. Lastly, employers who self-insure workers are not required to follow laws regarding infertility coverage. 

 

New Jersey

In this state, infertility means a medical condition that causes abnormal use of the reproductive system. 

For any women less than 46 years old, or for those who meet other classification standards arranged by the state, any insurance program that offers pregnancy-related coverage must also provide infertility treatments with certain stipulations:

• Infertility caused by voluntary sterilization isn’t covered
• The individual is unable to achieve pregnancy through more affordable infertility treatments covered by insurers
• Employers with less than 50 employees do not have to offer coverage
• Cryopreservation isn’t covered by insurers
• Experimental infertility treatments are not covered
• Religious employers do not have to cover infertility treatments
• Nonmedical expenses of sperm donors are not covered
• Employers who self-insure workers are exempt from following laws regarding infertility coverage

Rhode Island

In this state, infertility means that an otherwise healthy individual cannot conceive or impregnate someone within a one-year period of consistent attempts. 

For any women between the ages of 25 and 42, insurance coverage is provided for infertility diagnoses and treatment with certain stipulations:

• Coverage does not include fertility preservation
• HMOs and insurances providers that cover pregnancy benefits must also include coverage for infertility treatments that are medically necessary for diagnosis and treatment
• There is a $100,000 limit on treatments
• Providers may charge a 20% co-payment
• Employers who self-insure workers are exempt from following laws regarding infertility coverage

To learn more about what infertility coverage is offered in other states, click here to explore the full list and what’s included. 

Understand IVF Coverage with Kofinas Fertility Group

Navigating insurance is never as easy as you expect it to be. 

If you’re wondering how to take advantage of New York’s new fertility mandate to get IVF covered by your insurance plan, set up an appointment today with one of our fertility experts to learn more. Even if you don’t reside in New York, our team is dedicated to finding the best solutions for you and the family of your dreams. 

Don’t let insurance coverage get in the way—Kofinas Fertility Group is here to help.