How Covered is IVF in the United States?

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Analysis of in vitro fertilization policy plans offers a better picture of what kind of access patients actually have. Read the full article here.

Transcript

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Welcome to Health Lab, your destination for news and stories about the future of healthcare. 

Today: IVF insurance coverage varies greatly among larger employers. An analysis of in vitro fertilization policy plans offers a better picture of what kind of access patients actually have.

With President Trump’s executive order to expand access to families for in vitro fertilization, or IVF, the federal government has been giving special attention to insurance coverage of this important infertility treatment.

Luckily, James Dupree, M.D., M.P.H., and Anna Kirkland, J.D., Ph.D., have been working on, and researching, this topic for years.

“The World Health Organization and the American Society of Reproductive Medicine state that infertility is a disease,” Dupree explained.

“Much like patients should have access to medicines that treat diabetes and blood pressure, I believe strongly patients should have access to IVF,” explained Dupree, a urologist who sees firsthand how patients struggle to pay for these types of fertility treatments; a single round of IVF treatment can range anywhere from $15,000 to $20,000, without a guarantee of a successful pregnancy.

Dupree and Kirkland’s recent data, published in the Journal of Assisted Reproductive Genetics, revealed more on the current state of employer insurance plans for IVF.

“One of our previous papers found that patients were willing to pay $5,000 per cycle of IVF, so we started looking at IVF coverage policies at self-insured employers that are able to design their own insurance coverage policies,” said Kirkland.

State mandates have begun to pass around the country to try to bring IVF costs for patients down instead of having it be an entirely out-of-pocket cost for those who can afford it.

But it’s not that simple, as their findings showed.

“Those state IVF coverage mandates don’t apply to every employer, however, and the employers that are exempt, called self-insured employers, in our study, didn’t offer any more IVF coverage than the national average,” said Kirkland.

“The policy and legal landscape for IVF coverage is highly fragmented,” she explained.

More about the paper:

Only 15 states and Washington, DC, have passed a law that mandate private insurance coverage of IVF, but each mandate is significantly  different.

For instance, Hawaii states that a couple must be infertile for five years before receiving IVF insurance coverage, while Utah offers up to $4,000 towards IVF-related medicines and procedures.

“So, there’s coverage, but not great coverage and not the same across the board,” said Dupree.

Their team decided to break this down further, in states with mandates for IVF coverage, by looking at self-insured companies that don't have to follow the mandates.

Self-insured companies tend to be larger employers, like the University of Michigan, for example, who bear the risk of paying claims for their employees and their dependents out of their own funds.

These companies have to follow federal laws, but not state laws, regarding insurance coverage, and current federal law doesn't include an IVF coverage mandate.

The other kind of employer people can use is a fully insured one, which means an insurance company bears the risk of an employer’s plan for its employees, and is paid a set amount by that employer.

These employer plans need to abide by state mandates.

And that’s important, says Kirkland, because only 34% of people get insurance from these fully-insured companies, whereas 66% of people get insurance from self-insured employers.

“So what we did in the research is looked at self-insured employers who were headquartered in one of those states with the IVF coverage mandates. We wondered if being in a mandate state would pressure them to match coverage. What we found was that those self-insured employers are not offering any more IVF coverage than the national average in those states,” she added.

“Their coverage is low when you compare it to the fully-insured companies in those states that must follow the mandates and offer coverage about 100% of the time. The self-insured employers only provided IVF coverage about 40% of the time.”

An additional finding in their study was that, among self-insured companies that offered coverage, the details of the coverage varied widely.

“We found examples of companies covering IVF, but they only cover $5,000 to $10,000, which usually won’t even cover one IVF attempt. And then we found others that cover 5 to 6 cycles of IVF.”

Coverage by self-insured companies varied by business sector.

Educational service companies, manufacturers, finance and insurance companies were very likely to offer IVF benefits, but industries like health care services, hotel and hospitality companies were less so.

In general, non-union employer plans offered IVF coverage more commonly than union plans did.

So, what’s next?

Dupree and Kirkland’s team plans to focus on expanding their review across the country.

They hope to put together prototypes of ideal benefit coverage plans that could be used in a meaningful way as the government examines what IVF coverage is available and what could be available in the future.

For now, Dupree emphasizes the need for employees to understand their insurance plan’s IVF benefits before they may actually need to use it.

“You need to really read the details about the IVF coverage, not just hear that it’s ‘covered’. You may not care about it in that moment, but then when it does matter to you, it really matters.”

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