HMOSs Frugal on Infertility

Last Editorial Review: 1/30/2005

Coverage comes slowly for those trying to conceive.

WebMD Feature Health plans don't typically cover the cost of evaluation and treatment for infertility. Among health plan sponsors with at least 10 employees, only a quarter provide coverage for infertility services, according to the American Society for Reproductive Medicine -- even though about 10% of all men and women of childbearing age are affected by infertility. (A woman is considered infertile if she has not conceived after one year of unprotected intercourse.)

The reason most often given? Not surprisingly, it's the cost. Adding infertility benefits would jack up premiums too far. So for many infertile women and their partners, having the child they dream of means saving up for years, mortgaging the house, or running up the credit cards.

Surprising Findings

But now researchers from the University of Iowa have evaluated their own university health plan (which is self-funded) and found that the infertility benefits it provides cost each member just 67 cents a month.

In the study -- just published in the journal Fertility and Sterility -- a team of researchers analyzed the university's total health care costs, and those costs specific to infertility treatments, over a three-year period. Total costs over the three-year period were more than $86 million. Infertility treatment costs were $680,000, or about 0.79% of the total.

The researchers also found that only 2% of the plan's members seeking infertility treatment reached the maximum benefit of $25,000 in 1995.

Less Expensive Technologies

Most infertile couples, the researchers note, do not need the most expensive technologies -- such as in vitro fertilization (in which sperm and egg are brought together in a lab dish) with embryo transfer. For many couples, less expensive techniques -- such as medicines that induce ovulation -- are enough to achieve pregnancy.

Bradley J. VanVoorhis, M.D., a co-author of the study and Associate Professor of Obstetrics and Gynecology at the University of Iowa, expects this will be eye-opening for insurance companies. "We're trying to raise awareness that [employers] can cover infertility without maximum costs," he says. He thinks the findings at the University of Iowa can apply in other workplaces as well.

VanVoorhis points out that it isn't only the cost of the treatment itself that makes insurers worry. There's also the possible expense of covering several children born at once after infertility treatments. But in recent years fertility experts have urged infertile couples who use in vitro fertilization to limit the number of embryos they have transferred, to avoid giving birth to many offspring. When that becomes the norm, VanVoorhis speculates, insurance companies may be less wary.

A Nationwide Problem

Since 1981, more than 90,000 babies have been born in the United States with the help of in vitro fertilization and other assisted reproductive technologies, according to the American Society for Reproductive Medicine.

Thirteen states currently require health insurers to offer some level of infertility care, according to the Society, which publishes Fertility and Sterility. But many employers are exempt from the mandates. Two bills aimed at expanding infertility coverage -- H.R. 2706 and H.R. 2774 -- were introduced in the U.S. Congress in August. Both bills have been referred to committees.

But not everyone believes infertility coverage should be compulsory. "Our concern is that these types of benefits not be mandated," says Richard Coorsh, a spokesman for the Health Insurance Association of America, a trade group in Washington, D.C. Increasing the cost of coverage, he says, increases the number of uninsured Americans. The first concern, he says, is making basic coverage affordable for all.

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