What your sexuality, age and location have to do with your IVF coverage
Advocates argue that in vitro fertilization, like other medical treatments, should come standard in the menu of coverage offered by insurance carriers.
Only eight states across the country require carriers to cover IVF in their plans, according to Resolve, a national organization fighting for states and employers to expand coverage of infertility treatments. Resolve President and CEO Barbara Collura said a few states have a mandate that requires insurance companies to at least propose IVF coverage, often at an extra cost.
Just because a state mandates it, insurance provides it and a person wants it, that doesn't mean the person will qualify for it. A litany of criteria could exclude a woman from coverage, including her age, the amount of time she's tried to conceive and even the size of her company.
Some states restrict who can be the sperm donor. Hawaii and Arkansas offer coverage only if the egg is fertilized with the partner's sperm, an obvious roadblock for lesbian couples. Collura called the law "discriminatory" and said Resolve is working to overturn the regulation.
The criteria used by some states and insurance companies remain a barrier for certain demographics, said Nanette Elster, vice president of Spence & Elster, a Chicago law firm specializing in fertility law. Some state statutes use phrases such as "husband and wife," which she said "clearly is problematic" for same-sex couples. Age requirements also can be a barrier. Elster said she's encouraged that some of these restrictions are going away.
The requirements vary by state. Here's a snapshot of coverage in each of the eight states that require carriers to cover IVF.
Massachusetts: The state requires the best IVF coverage, Collura said, with few restrictions. To qualify as infertile in Massachusetts, a woman under age 35 would have to not conceive for a year. For those older than 35, that period is six months. There is no limit to the number of IVF treatments covered and no dollar lifetime cap. An IVF treatment, Collura said, costs $12,000 to $15,000.
Rhode Island: Treatment is available to women ages 25 to 40 with a $100,000 treatment cap after two years of trying to have a baby.
Illinois: Women qualify for IVF after a year of unprotected sex or the inability to maintain or achieve a pregnancy with a less-expensive infertility treatment. Insurance covers up to four egg retrievals. If there's a live birth, two additional egg retrievals will be covered. Employers with less than 25 employees do not have to provide coverage.
New Jersey: The state requires women under 35 to try to conceive a baby for at least two years; those older than 45 have to try for one year. Only women under 46 qualify. Employers with staffs of less than 50 do not have to provide coverage.
Connecticut: Infertility is defined as being unable to conceive or sustain a pregnancy after one year. The state covers two cycles of IVF. Religious organizations don't have to offer coverage.
More coverage:
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7 things you should never say to a woman experiencing infertility
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Reason for infertility: 'We don’t have a uterus, we need to find friends who do'
Maryland: The state requires two years of trying, unless infertility is tied to other conditions such as endometriosis. There's a lifetime cap of $100,000, and the plan must cover up to three IVF treatments per live birth. Employers with less than 50 employees and religious employers do not have to provide coverage.
Arkansas: The state requires two years of unexplained infertility or a medical condition. The patient's egg must be fertilized with the partner's sperm, and there's a $15,000 lifetime cap.
Hawaii: The state requires five years of infertility, unless the condition is connected to a medical condition. The state requires coverage for one IVF cycle, and the sperm must come from the spouse.
Collura said Resolve is the only national organization fighting for IVF coverage and doesn't have the money to effectively lobby and enact change in all 50 states. In places where progress has been made, Collura credited the hard work of dedicated grass-roots volunteers.
"The infertility space doesn't have that kind of money," she said. "It takes money and it takes persistence and it takes grass-roots advocates."
She said the legislative process isn't the only way to expand IVF coverage. Other options include promoting awareness and encouraging large companies to adopt IVF coverage on their own.
"We don't think a mandate solves everything," she said, "but it certainly has helped many many people start their families."
Follow Sean Rossman on Twitter: @SeanRossman