Over the course of the past decade, in vitro fertilization, or IVF, has become increasingly common. As the technology supporting the procedure continues to advance, many women and families interested in the procedure are curious to know: Is IVF covered by insurance? Unfortunately, coverage varies widely from state to state, and in many cases, IVF isn't covered at all.
Generally speaking, IVF is one of the least-supported forms of assisted reproductive technology. According to the Advanced Fertility Center of Chicago, many health insurance plans will cover testing for infertility, but once a problem has been diagnosed, the plan doesn't pay for treatment options or assisted reproduction. And if the plan does cover some form of assisted reproduction, it's more likely to cover artificial insemination. What's the difference, you ask? With artificial insemination, the sperm is implanted into a woman's uterus or cervix, and conception occurs normally from there. IVF is a less common procedure in which conception occurs outside the body, and the resultant embryo (or embryos) is then implanted in the uterus.
According to WebMD, in vitro fertilization often occurs after artificial insemination has failed, or following a diagnosis suggesting that artificial insemination won't be successful. IVF tends to be more expensive — which is, of course, why insurance companies are less willing to cover it.
Presently, 15 states have some sort of law requiring insurance companies to cover certain types of infertility diagnoses and treatments, according to the National Council of State Legislatures (NCSL). These states are: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. The specifications for each state vary widely though, and some of these states specifically exclude IVF from the mandate. According to The National Infertility Association, seven of the 15 states with infertility mandates specify IVF procedures as qualifying for some sort of coverage, though often limited. These states are: Arkansas, Connecticut, Hawaii, Illinois, Massachusetts, Maryland, New Jersey, Rhode Island.
The NCSL reports that on average, a single cycle of IVF will cost $8,158, plus costs of medications, which are typically in the $5,000 range. And that's just for a single round. Due to the high roof of IVF costs, most insurance plans that cover IVF will cap the number of cycles covered. As reported at New York Magazine, a recent study revealed the very real implications of insurance caps on IVF coverage: Women making over $100,000 per year were found to be more than twice as likely to be successful with IVF than those making less.
Given the high costs of IVF, it's little surprise that celebrities have been shown hostility for receiving the procedure. Celebrity model Chrissy Teigen, for example, has been very open about conceiving her daughter Luna via IVF after years of struggling with infertility, but that didn't stop nosy naysayers from criticizing her over issues ranging from selecting the gender of the embryo to the cost of her procedure.
Unfortunately, this is yet another case of individual women being blamed and judged for a systemic failure that isn't their fault. IVF is expensive, in part, because the U.S. health care industry lacks the type of regulations that keep costs down in other countries. The other major factor, of course, is insurance coverage, or lack thereof.
According to David Sables, an obstetrician and professor of biotechnology at Columbia who writes about IVF at Forbes, IVF is more expensive in the U.S. than anywhere else in the world. In Japan and and Australia, for example, a round of IVF averages between $4,000 and $6,000. Due to high costs, American women are traveling to other countries in a new wave of "IVF tourism." According to Amy Speier, an anthropology professor at the University of Texas at Arlington, these IVF tourists favor the Czech Republic, where the procedure is especially inexpensive, and the laws limiting it are liberal.
For the many women who struggle with infertility, expansion of IVF coverage would certainly be most welcome. Here's to hoping that it's not a too-distant dream.