The Affordable Care Act – What It Means For Infertility Health Care

Recently, the United States Supreme Court ruled that the Affordable Care Act is constitutional. While reactions to this news varied, many people celebrated the decision with a smile on their face. But what does this mean for infertility health care? Should you be celebrating too? The answer is, maybe.

The biggest impact the affordable health care act has on infertility coverage is that patients with reproductive health conditions should not be denied health coverage due to pre-existing conditions. In addition, lifetime caps are now eliminated. This is especially good for patients who may need specific pre-natal or neo-natal care, which can often reach or exceed the lifetime caps insurance companies impose.

However, the Affordable Care Act does not include any specific provisions for infertility care. States are still not required to include infertility treatments as part of their “benchmark plan”, the minimum coverage state’s are now required to offer. Each state will select an insurance plan, containing 10 essential health benefit categories, to be their state’s benchmark plan by September 2012, and the plans will go into effect beginning in 2014.

Just because there is no specific fertility provision does not mean there is no possibility for your state to provide infertility coverage. 15 states currently have mandates for infertility treatment, insurers are still able to offer more than what is covered in the benchmark plan, and your state may even choose to include infertility treatment as part of the benchmark plan. You can contact your State’s Division/Department of Insurance to ask them to select a benchmark plan that offers infertility health coverage.

If you would like to remain updated on this process, want more information or resources, or even want to get involved in some way, we suggest checking out RESOLVE: The National Infertility Association, which has been following the creation of the Essential Health Benefits Plan since the passage of the Affordable Care Act in 2010 and continues to work to ensure that people diagnosed with infertility have access to the medical treatments they need.

{ 2 comments… add one }

  • Davina Fankhauser August 21, 2012, 12:09 pm

    I am excited to see Circle + Bloom address this topic. I am thankful that professional organziations such as yourself, Resolve, and Fertility Within Reach are all on the same page. A consistent message adds strength to our voices.

    Many thanks!

  • Rob October 30, 2013, 3:35 pm

    which states offer mandates? that would have been useful information, or at least a link….

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