California insurers must cover IVF procedures under the new law

from Kristen HuangCalMatters

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When 36-year-old Megan Meo and her husband decided to start a family, they knew they wanted two children. Little did they know that they would have to endure multiple rounds of infertility treatment, causing much heartache and draining thousands of dollars.

“It’s weird when my body doesn’t work for something it’s designed to do,” Meo said. “It hurts my heart.”

Meo is among an estimated 9 million Californians who will benefit from a new law requiring some insurers to pay for infertility diagnosis and treatment. On Jan. 1, large group health insurers in California — from employers with at least 100 workers — will be should begin covering fertility preservation and IVF services.

The law also redefined infertility in state statute, eliminating an exception that prevented same-sex couples or single people from receiving fertility benefits.

The law does not apply to people who get their insurance through religious employers, federally regulated plans or Medi-Cal. Last month, a settlement in a class-action lawsuit brought by a Santa Clara couple requires Aetna to expand fertility benefits to LGBTQ couples nationwide.

Advocates expect small group insurers will soon be required to offer the same coverage through a separate regulatory process pending federal approval. Once federal officials approve that process, most Californians with employer-sponsored health insurance should receive the benefit, said Sen. Caroline Menjivar, the law’s author and a Van Nuys Democrat.

“I’m so proud of that bill. I want that bill on my tombstone,” Menjivar said. “It affects so many people from singles to heterosexual couples.”

Menjivar, who is lesbian, said the new law strikes a personal chord. In order to have children, she would have to rely on infertility treatments — and insurance companies have often excluded LGBTQ people from coverage for these services. One of her friends spent more than $20,000 on infertility treatments to have three children, she said.

“It draws a lot of people,” Menjivar said, breaking down in tears. “I get emotional because I know these people. I know what this looks like for my friends.”

The high cost prevents people from using IVF

In vitro fertilization, or IVF, usually helps people who are struggling to conceive. For 9% of men and 11% of women of reproductive age struggle with infertility in the US During an IVF cycle, doctors retrieve eggs from the ovaries and fertilize them with sperm in a laboratory. The resulting embryos can then be transferred into the uterus.

The process, although simple, can take months or even years before a successful pregnancy. It is also expensive. A A 2010 survey of infertility treatment costs among 400 Northern California women found that the average payment for one cycle of IVF was $24,000. The average cost for a successful pregnancy, which can take several cycles, was $61,000. Since then, health care costs have soared.

Before insurance coverage took effect, Meo’s fertility clinic told her that one round of IVF would cost between $30,000 and $39,000.

“The idea of ​​spending $40,000 on something that might not work was really scary,” she said. She and her husband have been trying to start a family for two years. Her infertility is partly related to a uterine scar left by a previous miscarriage. Insurance coverage lessens the emotional and financial burden on them, Meo said.

Alize Powell, director of government affairs at RESOLVE: The National Fertility Association, said cost is the No. 1 barrier preventing people from accessing care. Congress repeatedly halted legislative efforts to require health insurers to cover fertility servicesmost recently in 2024, California is the 15th state to require coverage for state-regulated plans.

“Infertility is an illness and should be covered by insurance, just like any other illness or disease that people have,” Powell said.

Jamie Falls, 44, has been trying to get pregnant for 11 years. She and her husband, who had a failed vasectomy reversal, took out a loan to afford the $13,000 it cost for one round of IVF in 2020. The procedure didn’t work. They have been saving ever since to try another round.

Insurance coverage offers some relief, Falls said, but after trying for so long, it almost seems too good to be true.

“I wouldn’t wish this journey on anyone. It’s the hardest thing I’ve ever been through (but) I can’t imagine not being a mom,” Falls said.

Health-insured individuals who opposed the law before it took effect said it would raise overall insurance costs by making it harder for small businesses and people who buy individual policies.

Infertility is often unexplained

Many people who struggle to conceive don’t know why they can’t. Studies show that about 30% are diagnosed with unexplained infertility.

It’s a frustrating diagnosis, said Sarah Jolie, 39, who has been trying to conceive with her husband for five years. Tests to check her ovarian reserve, hormone levels and ensure there were no blockages came back normal. The couple even sought out a urologist, a male infertility specialist, to run tests on Jolie’s husband just so everything would come back clean.

The couple tried intrauterine insemination — a process in which sperm is inserted directly into the uterus while the woman is ovulating — three times without pregnancy.

Jolie said she and her husband are keeping IVF on the table as a last resort, but she doesn’t want to go through with the procedure without knowing what it’s treating.

Recently, after seeking another specialist, Jolie learned she has endometriosis, a chronic disease that can cause adhesions, scarring and inflammation around the reproductive organs. Multiple doctors previously told Jolie that endometriosis had nothing to do with her infertility, she said, but a specialist told her it was a common and treatable cause.

Studies suggest between 30% to 50% of women with endometriosis are infertileaccording to the American Society for Reproductive Medicine.

Jolie said she felt unheard and undervalued throughout the process, constantly having to advocate for more tests and more answers. The insurance also refused to pay for any of her fertility tests or appointments, but did cover her husband’s visit to a urologist.

“I got a lot of comments in the community, even from a lot of men, like, ‘You should have children. It’s the greatest privilege.’ But our society also doesn’t support women and getting the health care they need to be able to do that,” Jolie said. “It feels like a slap in the face that I didn’t expect. I really thought it would be a much more supportive process from a medical perspective.”

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a cost they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.