January 10, 2015

Does the Affordable Care Act Translate Into Affordable Fertility Benefits?

Affordable Care Act Fertility Benefits

The impact of the Patient Protection and Affordable Care Act (ACA) are not yet understood, with the majority of law taking effect this year.  What remains to be clarified is the role of fertility benefits allowed.  Does the Affordable Care Act translate into affordable fertility benefits? If it is anticipated that patients would gain the privilege of fertility coverage as afforded by mere fifteen states that offer benefits.   Therefore, many Americans may be able to undergo fertility treatments previously to be out of financial reach.  However, if the ACA provides only minimal essential coverage, then fertility benefits may not be covered and current coverage downscaled.  The question remaining to be answered is what constitutes minimum essential coverage with regard to fertility and who or what body makes this decision.

There are obvious long-term consequences regarding coverage and fertility benefits.  Thus far, the ACA standards for fertility benefits have been outlined in broad strokes and no certain terms.    Responsible for this outline is the Department of Health and Human Services (HHS).  In 2011, their designated proposal provides the states with flexibility to implement the ACA.  Thus, the states individually, establish standards for minimal essential coverage.  Leaving this decision to the states has implications for fertility coverage.  Historically, those states with mandates (despite the sometimes sweeping limitations and exceptions) demonstrate significant increases in fertility benefits covered.

Few changes to fertility benefits were noted in states like Massachusetts where a mandate already stands.  Massachusetts, for instance, had included already Assisted Reproductive Technologies (ART) as a minimal essential coverage.  No state added fertility benefits if already they did not exist.  It may be that states offering coverage may reassess fertility benefits and ART services covered may be excluded.

On the other hand, the ACA could provide additional benefit for patients.  It may prohibit the denial of ART coverage for pre-existing conditions (ie: tubal ligation or vasectomy) or may dissuade higher prices from being charged.  Affording plans with these benefits attracts younger and more fit and better-health patients.  Ultimately, attracting of younger patients (child-bearing age) and offering the potential of infertility coverage may actually increase profit margins for insurance carriers.

There is much uncertainty as legislatures, health care systems, physicians and patients wade through this quagmire in search of better established health care.  For patients who suffer from infertility, the time is now and empowerment comes from within.

If you have questions regarding your infertility coverage, please contact us! We can help!

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Danielle Vitiello, Ph.D., M.D.

Danielle Vitiello, Ph.D., M.D. Board-Certified in Obstetrics and Gynecology, Reproductive Endocrinology and Infertility