Insurance Coverage for Infertility Treatments

Fourteen states in the U.S. require health insurance coverage for treatment of infertility, which is defined as an inability to conceive after at least a year of unprotected sexual intercourse. However, two of the states exclude from coverage in vitro fertilization (IVF) treatment, which is fertilization of the egg outside the womb.

State Laws

• States that require insurance companies to either cover infertility or offer coverage, as decided on a case-by-case basis, are Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New York, Ohio, Rhode Island, Texas and West Virginia. California and New York, however, exclude IVF from the required coverage because of the potential for escalating expense for repeated treatment to achieve success.

Fertility Treatments

• Treatments include insemination and hormone therapy.

  Infertility is most commonly treated by insemination, which involves injection of sperm into a woman's reproductive tract by medical means, or hormone therapy for the production of eggs. Pregnancy can also be achieved by having eggs fertilized outside the womb and then implanted.

Costs

• Infertility treatment costs range from $50 to $18,000.

  Costs for infertility treatment range from $50 to $18,000 depending on the method. Hormone injections can cost $50 per treatment, insemination $345, and the transfer of a fertilized egg into the uterus or IVF methods up to $18,000. Additional costs include examinations, diagnosis, tests, drugs, surgical fees, embryo screening and sperm analysis.

Insurance Benefits

• In states that require health insurance coverage, the extent of coverage varies depending on the insurer's definition of infertility. At least two states, Arkansas and Maryland, allow insurance companies to cap the benefits covered in a lifetime. The laws in some states apply only to group health plans, while others apply also to private plans.

Requirements

• In most cases, those seeking infertility treatment must get "preauthorization" or "predetermination" from the insurer to determine exactly what treatments will be covered, and whether drugs and screenings will be paid for. If benefits are denied, the decision may be appealed.