Fertility treatment costs: should insurers pay them?

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In summary

Most health insurance plans do not cover the cost of infertility treatment, which can amount to tens of thousands of dollars. California lawmakers are now debating whether to include coverage and protect another type of reproductive choice.

Californians who seek to start a family through in vitro fertilization are often hooked on the full cost of treatment, which is tens of thousands of dollars. Cost can keep some people away from children, and it can leave others in disproportionate debt.

So far 17 states have laws requiring health insurers to cover fertility treatments, most of which include in vitro, California does not.

The debate over whether health insurance plans should provide birth insurance is not new to Sacramento, but even in a state where Democrats like to brag about their struggle for reproductive health, these efforts have not gone very far. The main delay is money.

Assembly member Buffy Weeks, a Democrat from Auckland, is trying again this year. Her 2029 Assembly Bill some health insurance plans will be required to cover fertility treatment, including in vitro fertilization. The bill also expands the definition of infertility so that more people have the right to be diagnosed and treated, including single, same-sex couples and transgender people.

Wicks recently passed amendments in an attempt to reduce the cost of his bill, which in the first part had a Cost $ 715 million for employers and entrants to the health plan. The mandate for coverage in its revised bill will only apply to a large group of health insurance covering about 9 million California residents. Plans in small groups and individual markets will be released. Even as it was written, the bill will not apply to Medi-Cal, an insurance program for low-income residents.

The bill will also limit a person’s lifetime benefit to $ 75,000 and limit egg retrieval to three.

“I’m doing it for the third time,” Wicks said. “We’re trying to get that accepted, and that means amending to narrow it down.”

Weeks said it’s a personal issue: her second child is the product of in vitro fertilization. (In 2020, Wicks took her away then a newborn in the Capitol vote for the family leave bill.) The goal, she said, is to expand the benefits to more people over time.

Learn more about the legislators mentioned in this story

State Assembly, County 15 (Auckland)

As she voted in 2019-2020


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Contributions to the company

Asm. Buffy Weeks took at least
$ 521,000
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sector since she was elected to the legislature. This represents
her total contributions to the campaign.

California law currently requires insurance companies to offer fertility treatment, except in vitro, but the employer or group must decide whether this is included as covered benefits. This bill will make this coverage mandatory.

Anabel Adams, who recently testified in support of the Wicks bill, paid about $ 50,000 for three rounds of in vitro fertilization. She was born with a chromosomal inversion that makes it difficult for her to survive the pregnancy, she suffered six losses.

Her doctors recommended in vitro fertilization, or IVF, a process in which eggs are extracted from the ovaries and fertilized with sperm in a laboratory. The fertilized egg, or embryo, is then transferred to the uterus. For Adams, this process allows her doctors to check the embryos to make sure they are not affected by her genetic problems, increasing her chances of a sustainable pregnancy.

According to her, the first course of treatment, including medication, cost her $ 25,600. Her Kaiser insurance plan, proposed by an employer at the University of California, did not cover it. Her husband’s insurance helped cover part of the costs for the second and third rounds.

“Every pregnancy is filled with horror. This is a desired pregnancy; these are the children we represent and plan for the future, ”said Adams, a Long Beach resident and founder of California Fertility Advocates. “Learning that IVF was essentially a cure for my illness, and knowing it wasn’t easy for me, it felt like an extra layer of harm.”

The health insurance lobby and business group oppose the Wicks bill, citing the bill. They say that, like other legislation requiring new benefits, the bill will increase health insurance premiums for employers and workers.

According to the California Association of Health Plans, this is the most expensive bill the organization opposes this year, and Wicks ’latest amendments do not change its position.

“Every pregnancy is filled with horror. This is a desired pregnancy; these are the children we represent. ”

Anabel Adams, founder of California Fertility Advocates

“As health plans, we need to be concerned about costs for everyone,” said Mary Ellen Grant, a spokeswoman for the association. “We do not dispute the value of this bill, but they increase the cost of health care for California residents. It’s just not that health plans can be left behind. “

Grant said lawmakers should consider the amount of all preferential seats they choose to adopt, not just one bill. This year, the association opposes 14 bills that require new benefits – in total, these bills could increase annual bonuses by $ 1.5 billion, the association said.

The California Chamber of Commerce and various local chambers representing business interests have also expressed their hostility to the bill because of the cost. Next, the bill will be sent to the Appropriations Committee of the Assembly, which weighs the fiscal implications of the bill.

In 2019 California passed the law clarifying that insurers should cover the cost of preserving eggs, sperm or embryos for patients undergoing treatment for diseases that affect their ability to have children. Two previous bills introduced by Wicks in 2019 and 2020 aimed more broadly at birth coverage have not advanced.

While much of the talk around the current Weeks bill focuses on in vitro fertilization as it is the most expensive type of fertility treatment, the bill addresses the broader issue of fertility coverage in general, he said. Dr. Marcel Cedars, a reproductive endocrinologist from the University of California, San Francisco. Not everyone who is infertile needs in vitro fertilization.

“Actually, it’s about recognizing infertility as a disease,” Cedars said. “As with any other disease, patients should have access to all evidence-based and medically sound treatment options.”

Cedars said she has patients whose diagnosis is covered by insurance but not treatment. “You’ll never say, ‘Oh, by the way, you have diabetes, but we’re not going to give you insulin to treat it.’ I mean, it’s crazy, what other disease would you treat like that? ”

Infertility is estimated to affect about every eight pairs, or about 15% of the U.S. population, Dr. Cedars said that while infertility is recognized as a disease by the World Health Organization and the American Medical Association, socially and politically it is more bleak. Treatment is often seen as elective.

“Reproductive health in this country is difficult, as we saw this week,” said Cedars, referring to news of a leaked draft conclusion which showed that the U.S. Supreme Court was ready to kill Rowe v. Wade. “Reproductive health is really a whole spectrum, it’s not having children if you don’t want to, and being able to have them if you do.”

In the abortion debate, California is positioning itself as a state reserve for people from abroad who want to terminate a pregnancy. Democratic lawmakers were the authors of a package of bills breaking through the legislature to protect access and accessibility of abortion. Gov. Gavin Newsom has already done so signed one of these billsexcluding marginal abortion costs.

Wicks and supporters of her bill said that ultimately the bill also concerns choice – allowing people to start a family whenever and when they want. “That’s why I’m working on bills for safe and legal abortion and muzzle coverage,” Wicks said. “All of these things are very connected to me.”

Calmatters COVID and health care coverage are supported by grants from the California Blue Shield Foundation, the California Health Foundation and the California Health Foundation.

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