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As more health plan members turn to fertility treatments to help build their families, limited—or non-existent—coverage for fertility has left many to navigate the complex and expensive treatments with little financial or emotional support.
Fortunately, health plans looking to provide more comprehensive, whole-person care to their members and meet employer demand have more opportunities than ever to expand their fertility benefits beyond basic infertility care. Here’s what health plans need to know about building modern fertility benefits:
Why health plans need to expand fertility benefits
Currently, many plans only cover diagnostic infertility services, forcing couples facing infertility, as well as same-sex couples and single parents by choice, to pay for fertility services out of pocket. And these services can carry significant costs for members. One study in Northern California found that a successful round of intrauterine insemination (IUI) costs $19,566 out of pocket, and in vitro fertilization (IVF) costs $61,377.
The costs associated with fertility support cause many members to abandon their plans of a biological family altogether. In a survey from Family Equality, 63% of same-sex couples said they couldn’t start a family because insurance wouldn’t cover the treatment.
Expanding fertility benefits can do more than help members begin their family-building journeys. Increased access to fertility coverage also improves outcomes. Birthing parents who live in states that mandate infertility treatment are more likely to have a successful birth resulting from IVF, as well as lower rates of multiple births.
Employers are looking for more
In addition to improved access and outcomes for members, the need for more comprehensive fertility benefits also stems from employers’ desires to support increased demand from their employees. Forty-four percent of employees want help starting a family, but only 29% of large employers currently offer fertility benefits. Additionally, 32% of employers plan to add or expand reproductive health services in the coming year.
With employees demanding more coverage from their employers, health plans can differentiate themselves by offering expanded fertility services to employers, helping them attract and retain employees in a competitive market.
Key components of comprehensive fertility benefits
Expanded fertility care means far more than coverage for infertility. Comprehensive fertility benefits include support for anyone starting a family, whether through fertility treatments, surrogacy, or adoption. To best meet the needs of members and their employers, fertility benefits should include:
IVF/IUI for all members
As of 2022, 20 states mandate insurance coverage for infertility, and only 14 of those include IVF treatment in that mandate. What’s more, insurance often doesn’t cover IVF treatments without a diagnosis of fertility, excluding same-sex couples and single parents by choice. As a result, the vast majority of people pay for IUI and IVF treatment out of pocket, a cost that remains out of reach for many Americans. A study by the American Society for Reproductive Medicine found that 70% of women who undergo IVF go into debt, and 34% stop treatment because they can’t afford it.
Health plans can better support members by increasing coverage for IVF and IUI treatments without the need for an infertility diagnosis. Expanding virtual access to reproductive endocrinologists, fertility coaches, and other specialists can also help provide members with the resources and education necessary to make informed decisions about their fertility journey.
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