Preconceived Notions: Cancer, Fertility Coverage and the Law

A CANCER DIAGNOSIS may spur a person to think first about mortality, and only later to consider maintaining their fertility. But anyone with cancer who wants to have children now or in the future should raise the subject with an oncologist, because side effects of some cancer treatments and medical procedures could cause infertility. It is a good idea for a person with cancer to ask their oncologist whether their cancer treatment will cause infertility, and whether it is a good idea to preserve fertility prior to beginning treatment. For people who want to have children, it’s important to know whether your health insurance covers fertility preservation and infertility treatment and, if so, how to optimize that coverage.

Federal law does not require health insurance companies to cover treatments related to fertility. The Patient Protection and Affordable Care Act (ACA), a federal law passed in 2010 and implemented in 2014, does not mandate coverage of fertility preservation and infertility treatment. That’s because the ACA, often referred to as “Obamacare,” does not consider this type of health care to be one of the essential health benefits for which coverage is mandated. But the ACA instituted changes to previous law that can help people who need these treatments.

The ACA prevents insurers from setting higher insurance rates for women and also blocks insurance companies from discriminating against people with preexisting conditions. Before the ACA, women had been denied insurance coverage for infertility treatment because their condition was considered to be a preexisting condition. In addition, the ACA eliminated lifetime caps on insurance coverage. This is critical for people facing infertility because of the extremely high costs associated with treatment.

Some states have laws that mandate infertility coverage. The ACA requires that most Americans obtain health insurance that offers minimum essential coverage. Unlike the ACA, however, some state laws define “essential coverage” as including infertility treatment. According to the National Conference of State Legislatures, 17 states have passed laws that require insurance companies to cover or offer coverage for infertility diagnosis and treatment. Since less than half the states provide such insurance coverage, many Americans lack health coverage for infertility treatments and must pay these costs out of pocket. According to the Society for Assisted Reproductive Technology, the average cost of an in vitro fertilization cycle in the U.S. is between $10,000 and $15,000. The actual cost to patients depends on their insurance coverage, the medical center performing the treatment and the patients’ specific needs. The American Society of Reproductive Medicine provides a summary of state infertility insurance laws, including what if any coverage each state requires.

Some insurance covers fertility preservation in advance of trying to conceive. Insurance coverage for oncofertility–fertility preservation in advance of a person with cancer trying to conceive–is important given advances in both oncology and reproductive endocrinology. But state mandates to cover fertility preservation for those who want to conceive later are less common than mandatory coverage of infertility treatments. Those with cancer who are considering fertility preservation, such as cryopreservation of eggs or in vitro fertilization, need to understand their health insurance and whether the law in their state mandates coverage of fertility preservation.

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