Health Care Reform: What it Means for Infertility

Health Care Reform Health Care Reform

Infertility advocates have been working to get infertility treatment insurance coverage for all. Unfortunately, national health care laws do not require insurers to offer infertility treatment benefits. Instead, state leaders decide whether insurers must offer infertility coverage to their residents. In spite of this, some recent changes in national health care laws could still impact you and your reproductive health.

State laws and infertility coverage
For a rundown on infertility insurance benefits by state, visit RESOLVE's website or check out our overview of infertility insurance coverage by state. You will find that some states require insurers to offer infertility benefits to employees. However, some employers (like religious organizations) don't have to abide by these state laws. To avoid any surprise expenses, be sure to verify your benefits with your insurance company before you take on any infertility-related costs.

New laws protect infertility patients
Have you been rejected by a potential insurer because of a medical condition? That shouldn't happen much longer. Starting in 2014, it will be illegal for potential insurers to exclude you from an insurance policy due to a pre-existing health or medical condition. This means that future insurers can't exclude you due to an infertility diagnosis.

Free well visits and preventive care
Another benefit for your fertility health? New health care laws eliminate co-pays for some reproductive health services, including:

  • Routine immunizations
  • Well visits with your primary care physician and OB/GYN
  • Screenings for STIs and HIV

However, these services will only be free of charge for new insurance plans. If you are already on an insurance plan, your insurer gets to decide whether to offer these services for free. Current insurance plans are being grandfathered in, allowing them to continue charging well visit co-pays, if they so choose. Ask your insurer for more details about this benefit.

Flexible spending account and infertility treatment
Another change that could affect your finances? There is a new cap on medical flexible spending accounts (FSA). FSA money is money taken from your paycheck, pre-tax, that you can spend on medical expenses. In recent years, individual employers have been able to determine that amount. Many companies have been setting that limit at $5,000. Starting in 2013, the feds will cap everyone's medical FSA contribution at $2,500 per year, leaving less money in your pocket for medical expenses.

Paying for infertility out of pocket
Some of these benefits may be helpful. Yet you may still have to fund most or all of your infertility-related services yourself. Check out these options when financing expensive treatments:

  • If your doctor recommends in vitro fertilization (IVF), ask your fertility clinic about bundling IVF services for a discounted fee (like Attain IVF).
  • Apply for a fertility loan (such CapexMD or Lending Club Patient Solutions).
  • Charge your services on a credit card. If your credit history is strong, ask your credit card company to reduce your interest rate for infertility treatment payments.
  • Homeowners can finance treatment with a home equity line of credit.

Whichever way you choose, hopefully a day will come when all insurers help to cover the high expenses associated with infertility diagnosis and treatment.