IVF Insurance Coverage in California
By Francis Polansky, M.D.
Infertility affects hundreds of thousands of men and women in California. In Vitro Fertilization can be a very effective treatment for many of these patients.
Unfortunately, the cost of In Vitro Fertilization can be prohibitively high for many couples needing IVF. California has an infertility insurance mandate, but it does not include In Vitro Fertilization, and a large proportion of patients end up paying the entire cost of IVF treatment.
The “live birth” cost of IVF depends on success rates. The per-cycle cost must be multiplied by the average number of cycles needed to conceive.
In California, the approximate cost of an IVF cycle is $15,000. Nationwide, the probability of IVF resulting in a singleton birth ranges from 3% to 36% depending on the female partner’s age. This averages as $41,000 to $500,000 per successful outcome.
Infertility is a disease, as recognized by medical organizations such as the American Medical Association, the American Society for Reproductive Medicine, the American Congress of Obstetricians and Gynecologists, and the World Health Organization. Treatment for infertility, including IVF, should be covered by health insurance just like other diseases.
Nine states — Arkansas, Connecticut, Delaware, Hawaii, Illinois, Massachusetts, Maryland, New Jersey, and Rhode Island — require insurance companies to cover IVF treatments. The addition of IVF to insurance plans results in an increase of less than a dollar per member per month.
Assembly Bill 767 (Wicks) would update California law by clarifying that infertility is a disease and to require health care plans issued after January 1, 2020, to provide, not merely offer, coverage for infertility treatments including In Vitro Fertilization.
AB 767 is scheduled to be heard before the Assembly Health Committee in mid to late April. Passing this legislation will provide the opportunity of access to health care for families and individuals experiencing infertility and needing In Vitro Fertilization to conceive.