February 22, 2024

Jessica Tincopa and her husband, Rob Tran, stand for a portrait in Orange, Calif. on Friday, May 5, 2023. Tincopa may be leaving the photography business she spent 14 years building for one reason: to find coverage for fertility treatment . After six miscarriages, Tincopa and her husband started saving for IVF, which can cost well over $20,000, but the pandemic has wiped out their savings and the state health insurance market doesn’t cover things like IVF. in vitro. (AP Photo/Jae C.Hong)

By Tom Murphy | The Associated Press

Orange resident Jessica Tincopa may be leaving the photography business she spent 14 years building for one reason: to find coverage for fertility treatment.

After six miscarriages, Tincopa and her husband started saving for IVF, which can cost well over $20,000. But the pandemic has wiped out their savings, and they can’t find IVF coverage on the state health insurance market. So, the couple is saving again and asking politicians to help expand access.

No one should ever have to go through this, Tincopa said.

Infertility, or the inability to get pregnant after a year or more of trying, is a common problem. The U.S. Centers for Disease Control and Prevention estimates that it affects nearly one in five girls or married women between the ages of 15 and 49.

However, fertility treatment coverage can be hard to find in many corners of health insurance, even if it is growing rapidly with large employers who see it as a necessary perk to keep workers.

According to the researchers, it’s a divide that is leading to the haves and have-nots for treatments, which may involve a range of prescription drugs and procedures such as artificial insemination or in vitro fertilization, in which an embryo is created by mixing eggs and sperm in a laboratory dish.

It’s still mostly for people who can afford to pay a lot out of their own pockets, said Usha Ranji, associate director of women’s health policy at KFF, a nonprofit that studies health care issues.

Clouding this picture are insurers’ concerns about costs and questions about how much fertility coverage should be emphasized or mandated versus helping people find other ways to start families, such as adoption.

If you’re going to offer one, there should be a corollary and perhaps even more significant benefits to the adoption, said medical ethicist Dr. Philip Rosoff.

A total of 54 percent of the largest U.S. employers, those with 20,000 or more workers, covered IVF in 2022, according to benefits consultant Mercer. That’s up from 36% in 2015. Walmart started offering hedging last fall, and banking giant JPMorgan started this year.

Many companies that offer coverage extend it beyond those with an infertility diagnosis, making it accessible to LGBTQ+ couples and single women, according to Mercer.

The benefits adviser also said there is big growth among employers with 500 or more workers, as 43% offered IVF coverage last year. But coverage becomes unpredictable with smaller employers.

Lauderhill (Florida) Fire Rescue Lt. Ame Mason estimates that she and her husband have spent nearly $100,000 of their own money on fertility treatments in recent years, including several failed IVF attempts. Mason and her husband both work for the same department.

Her brother-in-law also has a fertility problem. He works for a larger fire department in nearby Palm Beach County and has gotten the cover. Mason said the couple have one son.

It’s pretty wild. You could work a county away and have coverage, Mason said. There is nothing that regulates both government jobs.

Twenty-one states have laws requiring coverage of fertility treatments or fertility preservation, which some patients need before cancer treatments, according to the nonprofit patient advocacy organization Resolve. Of these states, 14 require IVF coverage.

But most of these requirements don’t apply to individual insurance plans or coverage sold through small employers.

People tell us their biggest barrier to family building is a lack of insurance coverage, said Barbara Collura, CEO of Resolve, adding that some insurers don’t consider care medically necessary.

The state and federally funded Medicaid program for low-income people limits coverage of fertility problems largely to diagnosis in several states, according to KFF, which says Black and Hispanic women are disproportionately affected. States can also exclude fertility drugs from prescription coverage.

By not covering this for the poor, we were saying we don’t want you to reproduce, said medical ethicist Lisa Campo-Engelstein of the University of Texas Medical Branch in Galveston, Texas. She noted that Medicaid programs cover birth control and sterilization procedures such as vasectomy.

In Orange, Tincopa says she’s been talking to state and federal lawmakers about creating some sort of option for people to purchase individual insurance with coverage.

The state Senate is considering a bill that would require coverage of fertility treatments, including IVF, for large employers. But the California Association of Health Plans opposes it, just as it has opposed similar bills in recent years, because of how much it could cost.

Spokeswoman Mary Ellen Grant noted that an independent analysis showed bills like this could raise premiums by up to $1 billion in the state. She also said she would create a coverage gap because it would not apply to Medicaid enrollees in the state.

It’s not about the treatment itself, he said. It is strictly based on increasing costs for our members. It would impact everyone whether or not they received the benefit.

But big estimates of the cost of fertility often overstate the number of people who will use the benefit, said Sean Tipton, of the American Society for Reproductive Medicine. He also said that most people with fertility problems don’t need IVF.

Tipton, who has advocated for benefits mandates in several states, said she expects fertility treatment coverage to grow, particularly with small employers who may need to offer it to attract and keep workers.

Any state that decides to apply for fertility treatment coverage should also apply for adoption support, said Rosoff, a retired Duke University Medical School professor. He said equity and justice dictate doing so, adding that adoption promotes the social good of finding homes for children.

Many companies that have expanded fertility benefits also support adoption.

Ame Mason’s employer helps with neither.

Mason said she’s been thinking about adopting, but for now, she’ll stick with IVF, saving wherever she can and working overtime as much as possible to pay for it. They found a doctor in Florida after traveling to Barbados for slightly less expensive treatment.

Additionally, she and her husband are seeing improvements in their most recent IVF attempts. This makes her reluctant to stop trying.

We keep getting that glimmer of hope, she said.

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The Associated Press’s health and science department receives support from the Howard Hughes Medical Institutes Science and Educational Media Group. The AP is solely responsible for all content.

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