Jessica Tincopa and her husband, Rob Tran, stand for a portrait in Orange, Calif., Friday, May 5, 2023. Tincopa may leave 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 in vitro fertilization, which can cost well over $20,000, but the pandemic wiped out their savings and the state's health insurance marketplace doesn't cover things like IVF.
Clouding this picture are insurer concerns about cost as well as questions about how much fertility coverage should be emphasized or mandated versus helping people find other ways to build families, such as adoption. The benefits consultant also said there's big growth among employers with 500 or more workers, as 43% offered IVF coverage last year. But coverage gets spotty with smaller employers.
Twenty-one states have laws mandating coverage of fertility treatments or fertility preservation, which some patients need before cancer treatments, according to the nonprofit patient advocacy organization Resolve. Of those states, 14 require IVF coverage. “By not covering this for poor folks, we’re 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 Medicaid programs do cover birth control and sterilization procedures like vasectomies.
“This is not about the treatment itself,” she said. “It’s strictly based on the increased costs for our members. It would impact everybody regardless of whether they received the benefit.”