THE AFFORDABLE CARE ACT AND INFERTILITY TREATMENT

Insurance coverage is one of the more challenging issues faced by couples dealing with infertility. Following passage of the Affordable Care Act, insurance mandates for infertility treatments depend on which state you live in. The ACA itself does not require insurance providers to cover infertility treatments, although the following states do mandate coverage of in vitro fertilization:

• Arkansas
• Connecticut
• Hawaii
• Illinois
• Massachusetts
• Maryland
• New Jersey
• Rhode Island

Additionally, California, Louisiana, Montana, New York, Ohio, Texas and West Virginia mandate at least some coverage of infertility treatments. Massachusetts and Maryland have classified infertility treatments as an Essential Health Benefit that is included in plans sold on their exchanges. Connecticut and Rhode Island likewise consider IVF treatments an Essential Health Benefit.

You can find out whether your state has opted to classify fertility treatments as an Essential Health Benefit by visiting www.healthcare.gov. Once there, navigate to your state’s health insurance exchange to review the benefits that are available with the Gold, Silver, and Bronze plans. Some states, including Arkansas, New Jersey and Texas will require users to complete an online enrollment form to view the details of coverage plans, although doing so will not require you to purchase insurance at that time.

If you live in one of the states that mandates coverage of infertility treatments and are going through your employer for insurance, but your employer is self-insured and does not offer infertility treatment coverage in their package, you have options. You can still purchase individual coverage through the health insurance exchange that includes coverage of infertility treatments for all states where it is a mandate except Maryland and Arkansas.

The ACA does provide a number of policies that can be useful to couples who are struggling with infertility. For example, you can no longer be rejected by insurance companies for preexisting conditions, and this includes any previous diagnoses related to infertility. You also may not be charged more by insurance companies because you have a preexisting condition.

The ACA also classifies the following maternity-related treatments as Essential Health Benefits that must be provided in every plan regardless of which state you live in:

• Ambulance services
• Emergency room visits
• In-patient hospital treatments
• Maternity and newborn care
• Prescription drugs
• Laboratory services
• Preventative services, wellness services, and chronic disease management
• Pediatric services

Colorado is not one of the states where infertility treatments are classified as an Essential Health Benefit. However at Rocky Mountain Fertility Center, we offer medical financing and affordable options for those without fertility insurance benefits. Contact us today to learn how we can help.