If you or someone close to you has been trying to get pregnant through in-vitro fertilization (IVF), you're well aware that it's an expensive undertaking. Changes in U.S. health care mandates, however, are projected to influence these costs. So how much would IVF cost under the American Health Care Act (AHCA)? A couple clues indicate that fertility procedures will rise in its wake.
In most states, it's currently not a requirement that health insurers include IVF in their coverage. Only 15 states (Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia) "require insurers to either cover or offer coverage for infertility diagnosis and treatment," according to the National Conference of State Legislatures (NCSL). The NCSL also emphasizes that the extent of infertility coverage varies from state to state, so whereas one state may offer comprehensive IVF services, others are much more restrictive. In fact, California, Louisiana, and New York all have laws that explicitly prevent insurance companies from covering IVF.
Though IVF's intricacies are largely determined on a state level, federal health care regulations also guide providers' levels of coverage. At present, under the Affordable Care Act (ACA), premiums aren't determined by pre-existing conditions, in an effort to make coverage more easily attainable. But, under the proposed AHCA, states would be able to obtain waivers that exempt them from covering maternity care, among a few other services that are loosely defined as "pre-existing conditions." But what counts as a pre-existing condition? According to the Kaiser Family Foundation, which is a nonprofit focusing on health care research, "pregnancy" can be considered pre-existing condition, so one can then infer that reproductive issues would also be included in the exclusion.
CBS News clarified the fine print, stating that, under the AHCA, insurance companies would be allowed to "charge people more if they have a pre-existing condition — a health issue that existed before the patient's coverage starts, if that person has had a lapse in insurance."
The cost of IVF cycles hovers at about $12,000 per round. Add in the medications required and the repeated cycles needed for the treatment to be successful and you can expect to spend $20,000, easily, on IVF. In the same way that states offer varied degrees of coverage for IVF, insurers cover IVF to different degrees, too. Some cover just the diagnostic phase, and others can help with some of the procedure.
If your insurer doesn't cover IVF treatments under the ACA, you can expect to pay the same, out-of-pocket costs under the AHCA. If your insurance company helps assist IVF costs, though, your coverage will likely be affected; If infertility is considered a pre-existing condition under the AHCA, then insurers will have no need to include it in their coverage and, considering that it's a costly procedure, will be likely to drop it altogether.