Does your insurance cover IVF? Probably not…
Of the four million births in the U.S. per year, between 1% to 2% are via IVF, meaning in 2020 that was a total of 73,602 babies. Yet for the vast majority of patients, this means a massive out-of-pocket expense. These lofty bills stem from the fact that in the four decades since the procedure became available, only 20 states have passed laws that mandate infertility treatment be covered by private insurance, leading to a huge gap in care. In 2018, for example, 80% of Americans who underwent IVF received little to no coverage from insurance, and a 2020 Mercer study found only 27% of companies with over 500 employees cover the procedure. In short, as the American Medical association (AMA) Journal of Ethics put it, “For most people, paying for ART out of pocket is impossible, leaving many without a financially feasible way to manage [infertility] or achieve their reproductive goals.”
This discrepancy, according to the AMA, represents a very consequential failure. The journal wrote in 2018, “Despite the expense associated with infertility treatment, the lack of mandated insurance coverage for this disease implies that infertility is a condition undeserving of financial assistance and minimizes its importance to patients.” But what is the reason for this failure, and what are the consequences?
As Dr. Richard Paulson, former president of the Society for Reproductive Medicine told CNN in 2018, many insurance companies still view IVF as experimental— despite the fact that over eight million babies have been born via IVF globally since 1978. Additionally, CNN reported: “Because infertility has long been considered a women’s health issue, insurance companies perceived it as a niche issue and denied coverage to those experiencing it.” In fact, Paulson explained, just 30 years ago, most insurance companies did not even cover childbirth, considering it to be a women’s issue. This dated mindset forces most IVF candidates to pay their own way. More than half resort to using their credit cards to pay for treatment, according to a report by StudentLoanHero. CNBC found that others resort to personal loans or dip into 401ks.
These financial pressures can affect the viability of the procedure, and lead to multiples, such as twins or triplets, or in some cases, even more than three babies at once. Such was the case for Connecticut couple Marisa and Brad Hillman, who spent $40,000 on IVF, taking out a home equity loan and moving in with Marisa’s parents to cut costs. Each cycle of IVF incurs a separate cost, and the odds of successful pregnancy after just one cycle is just 29%, meaning most patients undergo multiple cycles. Patients like Hillman who pay for IVF on their own “end up weighing the price of doing a single-embryo transfer multiple times or a multiple-embryo transfer once,” CNBC reported.
For this reason, by her third cycle, Hillman asked her doctor to implant three embryos. She commented,“We had six frozen embryos. And if we put in one at a time, that’s $2,000 each time. Or we can put in three, and it’s still $2,000. The number of embryos you put in doesn’t change the cost.”
But it does change the risks, for both carrier and infant. As Dr. Dmitry Kissin of the U.S. Centers for Disease Control and Prevention explained, “The chance of dying during pregnancy for mothers… is three times higher if they carry multiples compared to mothers who carry singleton babies. And for children, the chance of death during the first month of life is six times higher for twins and 14 times higher for triplets.” Additional risks include low birth weight, prematurity and sometimes long-term disabilities like autism and cerebral palsy for the child.
On the flipside, the American Society for Reproductive Medicine found that state insurance mandates positively impact infertility treatment success. Live births per cycle are significantly higher in states with comprehensive IVF mandates, and these states also saw a significantly lower number of multiples. Researchers concluded that “state IVF insurance mandates are an important mechanism for reducing costs for patients and improving utilization of single embryo transfer.”
As Marcelle Cedars, President-elect of the ASRM, commented, “The evidence is growing that state laws requiring insurance coverage for infertility treatments, including IVF, contribute to increased success and greater safety for patients who are trying to grow their family.” Enacting and updating state insurance mandates could lead to a more safe, successful, and accessible future for Americans seeking fertility treatment. In Michigan, this disparity remains an issue, with no state mandate requiring IVF coverage, and little recorded interest from lawmakers in making this change.
—Sabrina Nash