Fertility Insurance Coverage Myths and Facts

Busted:  Studies indicate that including comprehensive fertility coverage may actually reduce costs and improve outcomes.

According to a 2021 employer survey conducted by consulting firm Mercer, and commissioned by RESOLVE: 97% of respondents offering infertility treatment have not experienced an increase in their medical costs as a result of providing this coverage.

Busted: There is no one-size-fits-all treatment for infertility, but often patients select treatment based on what is covered in their health benefits plan rather than what is most appropriate treatment.

For example, a woman having trouble conceiving because of blocked fallopian tubes or tubal scarring may opt for tubal surgery, a covered treatment, which can cost $8,000-$13,000 per surgery. Many patients are forced to forgo in vitro fertilization (IVF) because it is not a covered service even though it costs about the same as tubal surgery and statistically is more likely to result in a successful pregnancy.

According to William M. Mercer, “The decline in use of high-cost procedures like tubal surgery would likely offset the cost to include IVF as a benefit and provide improved health outcomes.” (William M. Mercer, Infertility as a Covered Benefit, 1997).

Busted: A 2016 online consumer survey commissioned by RESOLVE of more than 700 employees pursuing IVF found that those with employer-provided IVF benefits had higher satisfaction with their employer compared to respondents without coverage. Covered employees were less likely to miss time from work due to treatments, psychological stress, depression or other conditions related to infertility; were more likely to recommend their employer as a place to work; and felt their employer listened and met their needs and cared about their well-being.

A 2017 survey conducted by FertilityIQ of patients who had undergone IVF found that employees who had their IVF covered reported being more likely to remain in their job for a longer period (62%), were more willing to overlook shortcomings of their employer (53%) and were more likely to work harder (22%).

• In 2018, a survey conducted by Willis Towers Watson indicated that 55% of companies offered some form of family building benefit to their employees and predicted an increase to 66% of employers by the end of 2019.
• 12% of American women have difficulty becoming pregnant or staying pregnant and will need infertility services
• 63% of LGBTQ millennials are considering having children and may need Assisted Reproductive Technology to have a family.
• In states with mandated infertility insurance, the rate of multiple births is lower than in states without coverage. (New England Journal of Medicine, “Insurance Coverage and Outcomes of In Vitro Fertilization,” August 2002). Couples with insurance coverage are free to make more appropriate decisions with their physicians based on medical necessity rather than financial considerations that often result in multiple births and a high rate of complications during and after pregnancy.
• Comprehensive infertility coverage may reduce premium expense by as much as $1 per member/per month. According to The Hidden Costs of Infertility Treatment in Employee Health Benefits Plans, insurance premiums that now indirectly provide coverage for “hidden” infertility benefits—surgeries to remove scarring in a woman’s fallopian tubes or varicose vein removal for men—were calculated to be adequate to cover more effective and often less expensive treatments such as ovulation induction, intrauterine insemination and in vitro fertilization. (Blackwell, Richard E. and the William Mercer Actuarial Team, 2000)
• The cost of infertility services as a percent of the total health premiums went down after the 1987 Massachusetts mandate. (Study by Griffin and Panak, Fertility & Sterility, 1998).
• According to a 2003 Harris Interactive Poll, 80% of the general population believes infertility treatment should be covered by insurance. (Harris Interactive Inc., Survey, 2003).