If you and your partner are one of the one in 10 American couples struggling with infertility, you may be wondering about how to pay for the increasingly rising cost of fertility treatments. When the cost to raise a child to age 18 continues to grow, you may be reluctant -- or even unable -- to spend thousands of dollars on treatments before your child even arrives. Fortunately, the Affordable Care Act (ACA), often referred to as "Obamacare," has made sweeping national changes in the coverage for fertility treatments. Read on to learn more about how you may now be able to obtain fertility treatments without paying much (if anything) out of pocket, as well as how a personal lines insurance agent may be able to help you.
What did the ACA change about fertility coverage?
The ACA required all health insurance plans being sold in the US to provide coverage of certain deemed "essential health benefits" (EHBs). These EHBs include ambulance services, maternity coverage, and preventive care and screenings, among other coverage types. These ACA requirements are just a minimum, and some insurers may choose to offer a wider variety of coverage benefits. In addition to mandating certain levels of health insurance coverage, the ACA required states to set up healthcare exchanges -- where those who were not eligible for employer healthcare benefits, or whose healthcare benefits were too expensive or didn't offer sufficient coverage, could purchase health insurance. Many states offer insurance subsidies for those below a certain income level. A few states require that plans being sold on the state health insurance exchange fulfill additional EHB requirements -- often including coverage for fertility treatments and diagnostic exams. Currently, there are 8 states, including Illinois, Massachusetts, and New Jersey, whose healthcare exchanges mandate coverage for in-vitro fertilization (IVF). This means that anyone purchasing a healthcare plan through one of these state exchanges may be able to receive IVF (if deemed medically necessary) without paying the uninsured or out-of-network cost.
How can you find a health insurance plan that covers infertility?
If you live in one of the IVF mandate states, it should be relatively simple to find and purchase a health insurance plan that offers infertility coverage. However, even if you don't live in one of these states, you may be able to find such a plan in your own state. There are an additional 7 states that require plans to provide some type of infertility coverage (even if not IVF). If you live in one of the other 35 states, you may be able to purchase health insurance with infertility coverage through your employer. In many cases, your employer will have a number of insurance plans from which to choose -- these could include a high-deductible health plan (HDHP) or preferred provider organization (PPO) with varying premium costs and deductible limits. If the plan offering infertility coverage is more expensive than some of the other options, you may be able to switch to a less-expensive plan once you've finished fertility treatments (and because all plans in the U.S. are now required to cover maternity expenses, you won't need to worry about losing important coverage during the conversion process).
In other situations, you can purchase a separate short-term or supplemental health insurance plan outside your employer that provides only coverage for fertility diagnostic exams and infertility treatment procedures. Although these types of supplemental plans can be relatively expensive compared to the amount of coverage provided, you won't need the plans for long -- and the cost of treatments paid by the insurance company will often dwarf the cost of the insurance itself.
In order to investigate one of these plans, your best bet is to consult with an independent insurance agent who specializes in "personal lines" -- family insurance, rather than business or commercial insurance. This insurance agent will be able to evaluate potential health insurance plans in conjunction with your other insurance coverages and may be able to obtain discounts for you by acting as an intermediary in the purchase process.
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